Medi-Cal Highlights

Medi-Cal is California's Medicaid program. It is a public health insurance program which provides health care services for low-income residents. Key facts when working with families include:
  1. All income-eligible children up to age 26, including undocumented children, can enroll in full scope Medi-Cal. This includes dental care, mental health, and other benefits. Children are income eligible if their family earns below 266% of the federal poverty level (FPL). Families will pay a small monthly premium if they have household incomes nearer to the limit, except for children ages 0-1, who do not have premiums at any qualifying income level. Check eligibility at www.mybenefitscalwin.org or apply.coveredca.com/lw-shopandcompare.
  2. Parents and single adults under age 65 with incomes up to 138% of the Federal Poverty Level are eligible for Medi-Cal coverage at no cost. Adults with incomes above this level qualify for subsidies through Covered California. For information on special circumstances, contact SLO County DSS or your nearest Family Resource Center (see sidebar).
  3. As of January 2024, all undocumented adults with qualifying incomes will be eligible for Medi-Cal. Prior to January 2024, undocumented adults up to age 26 and adults ages 50 and over are eligible. More information at dhcs.ca.gov/services/medi-cal/eligibility/Pages/Adult-Expansion.aspx
  4. Pregnancy coverage: There are several public and subsidized insurance options for pregnant women, regardless of immigration status. See article below and learn more here: www.coveredca.com/individuals-and-families/getting-covered/pregnant-women.
  5. In San Luis Obispo County, children with Medi-Cal coverage become members of CenCal Health, the county's Medi-Cal managed care provider. CenCal Health sends parents information about selecting a primary care provider and other member benefits.
  6. If a child already has a family member enrolled in Medi-Cal, no new application is needed; families can contact the Department of Social Services to have other children in the family added.
  7. All information is confidential and will not be shared with immigration or other agencies. For information to share with immigrant families about how to safely apply for health insurance and seek health care: protectingimmigrantfamilies.org/know-your-rights.

Medi-Cal Enrollment

Parents can enroll their families online at 
​www.mybenefitscalwin.org, or by visiting a SLO County Department of Social Services office: www.slocounty.ca.gov/Departments/Social-Services/Our-Locations.aspx

For enrollment assistance resources, click here.

Need Help?

Contact an advocate or staff member at a Family Resource Center for support with non-medical needs such as food, clothing, shelter, parent education and navigating social services. A full listing of Family Resource Centers in San Luis Obispo County can be found here: https://sloparents.org/slo-frc-directory/​

Pregnancy/Postpartum Medi-Cal for One Year After Last Day of Pregnancy

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Do you have clients who are pregnant or new moms and need health insurance? Medi-Cal and the Medi-Cal Access Program (MCAP) offer Medi-Cal health coverage for pregnant and postpartum women who do not have full insurance coverage. MCAP is for middle-income families who do not have health insurance and whose income is too high for no-cost Medi-Cal.
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A new federal law has extended postpartum coverage to an entire year following the last day of pregnancy. Postpartum women can receive Medi-Cal services regardless of income changes after birth, citizenship, or immigration status. This includes postpartum depression services.
 
During the pandemic, the state extended postpartum Medi-Cal for one year only for women with diagnosed mental conditions. This benefit has been expanded to all postpartum women. Please remind your clients of this important mental and physical health resource! Families can contact their local Department of Social Services office to learn more:  https://www.slocounty.ca.gov/Departments/Social-Services/Our-Locations.aspx

Medi-Cal Tips

Give it a try!
Not sure whether a client qualifies? It's always best to give it a try -- apply online at coveredca.com, go in person to SLO County DSS, or call Covered California at 1-800-300-1506 and Covered California will transfer the client to SLO County DSS if they qualify for Medi-Cal. Remember that for children's coverage, the income limit is higher than adults. For enrollment assistance resources, click here.

No Open Enrollment Period, Retroactive Coverage
There is no open enrollment period for Medi-Cal. Enrollment is ongoing, based on income. When a person applies for Medi-Cal, a question on the form asks whether anyone received medical treatment over the past three months. If the applicant marks "Yes," medical expenses from the prior three months may be covered retroactively. If "No" is marked, then coverage begins with the month in which the application was submitted.

New Enrollees
When a person first enrolls in Medi-Cal, their medical coverage is "Fee-For-Service" through the State of California for the first month and until they receive their CenCal Health card. Once they have their CenCal Health card, they are on the CenCal Health managed care plan. Community Health Centers of the Central Coast (CHC) will accept both types of coverage, but some private doctors on the CenCal Health managed care plan may not accept Fee-For-Service Medi-Cal.

More Information
At SLO County DSS: www.slocounty.ca.gov/dss/Medi-Cal.htm

In Case of Emergency: Hospital Presumptive Eligibility (HPE) Program

This program assists low-income, uninsured residents in accessing hospital services in an emergency. Hospital Presumptive Eligibility (HPE) provides an individual who has no insurance with immediate temporary access to full-scope Medi-Cal at no cost for up to two months. Eligibility is based on household size, income and state residency and is taken based on the applicant’s own self-attestation. U.S. citizenship is not required.

To apply for HPE benefits, an individual must visit a hospital that is a qualified HPE Provider. All hospitals in San Luis Obispo County are qualified. The HPE provider submits the individual’s information via the HPE Medi-Cal Application online portal and eligibility is determined in real-time.

For more information about the Hospital Presumptive Eligibility Program: www.dhcs.ca.gov/services/medi-cal/eligibility/Pages/HospitalPE.aspx.

Medi-Cal Coverage and Care Providers Explained

Coverage (insurance): Medi-Cal members in San Luis Obispo County are enrolled in a managed care plan through CenCal Health. This means that they can see any doctor with whom CenCal Health contracts. Dental coverage is provided through the Medi-Cal Dental Program, a state network. Mental health coverage is provided by the San Luis Obispo County Department of Mental Health Services for more severe mental illness and by community providers contracted with CenCal Health for mild to moderate mental health issues.

Care (providers): For a list of Medi-Cal health care providers, contact CenCal Health or visit the CenCal Health provider directory. CenCal Health also provides care for mild to moderate mental health issues - learn more here. For more severe mental health issues, call the County Mental Health intake number at (800) 838-1381. The SLO County Oral Health program provides a list of local Denti-Cal providers - visit this link to view the list. Or find Medi-Cal Dental Program providers by searching the state directory: ​dental.dhcs.ca.gov/find-a-dentist/home.