Medi-Cal Overview
Medi-Cal Enrollment
Parents can enroll their children 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
The Access Support Network, Community Health Centers of the Central Coast, and CAPSLO are certified enrollment counselors and can help with Covered CA applications, free of charge. Find these and other non-profit enrollment assisters at: https://apply.coveredca.com/hix/entity/locateassister/searchentities The Public Health Nurse Navigator Program also helps parents and caregivers with Medi-Cal applications, free of charge. Call 805-781-4838 or visit, www.slocounty.ca.gov/Departments/Health-Agency/Public-Health/All-Public-Health-Services/Health-Care-Access-Health-Care-Navigation.aspx. Many Family Resource Centers provide enrollment assistance, as well (see sidebar for link). To learn more about enrollment assistance visit this page: www.slohealthaccess.org/enrollment-assistance.html |
Medi-Cal Outreach NavigationFamilies now have access to a new support program for applying for Medi-Cal benefits in San Luis Obispo County. Promotores Medi-Cal Outreach Navigators are available to all community members to provide education, outreach and enrollment navigation services for Medi-Cal benefits in English and Spanish.
For assistance in English and Spanish families can contact (805) 788-8247 or Medi-calsupport@cfsslo.org For support in Mixteco call (805) 903- 3153. Need Help?
Download the Family Resource Center Directory and contact the appropriate Family Resource Center for help from an advocate or other staff member.
Family Resource Centers can help with non-medical needs too, such as food, clothing, and shelter. |
Medi-Cal Information
Who Qualifies?
For Children: Families with incomes up to 160% of the current year's Federal Poverty Level (FPL) receive Medi-Cal coverage for their children at no cost. Families with incomes between 160% and 266% FPL pay a monthly Medi-Cal premium of $13 per child ages 1-19, up to a cap of $39 per month. If a child is ages 0-1, they are eligible for Medi-Cal with no premium. Check eligibility at www.mybenefitscalwin.org or apply.coveredca.com/lw-shopandcompare.
For Adults: 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. There is no longer an asset test -- as of 2014, only modified adjusted gross income is considered. Adults with incomes above this level qualify for subsidies through Covered California. Check eligibility at www.mybenefitscalwin.org or apply.coveredca.com/lw-shopandcompare. For information on special circumstances, contact SLO County DSS or your nearest Family Resource Center (see sidebar).
Pregnant Women: There are several public and subsidized insurance options for pregnant women, regardless of immigration status. Read more here: www.coveredca.com/individuals-and-families/getting-covered/pregnant-women.
For Adults: 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. There is no longer an asset test -- as of 2014, only modified adjusted gross income is considered. Adults with incomes above this level qualify for subsidies through Covered California. Check eligibility at www.mybenefitscalwin.org or apply.coveredca.com/lw-shopandcompare. For information on special circumstances, contact SLO County DSS or your nearest Family Resource Center (see sidebar).
Pregnant Women: There are several public and subsidized insurance options for pregnant women, regardless of immigration status. Read more here: www.coveredca.com/individuals-and-families/getting-covered/pregnant-women.
Who Provides Coverage and Care?
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 Denti-Cal, 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 CenCal Health, the managed care plan, for mild to moderate mental health issues. CenCal Health subcontracts managed care for mental health to the Holman Group.
Care (providers): For a list of health care and dental providers, contact CenCal Health, visit the CenCal Health provider directory, or click here for more options. For more severe mental health issues, call the County Mental Health intake number at (800) 838-1381. For mild mental health issues, referrals to providers can be made by primary care physicians or directly through the Holman Group, CenCal's mental health managed care provider, at (800) 321-2843.
Care (providers): For a list of health care and dental providers, contact CenCal Health, visit the CenCal Health provider directory, or click here for more options. For more severe mental health issues, call the County Mental Health intake number at (800) 838-1381. For mild mental health issues, referrals to providers can be made by primary care physicians or directly through the Holman Group, CenCal's mental health managed care provider, at (800) 321-2843.
Medi-Cal Tips
Don't be Shy!
Think you may qualify? Give it a try -- go in person to SLO County DSS, apply online at coveredca.com, or call the Covered California number, 1-800-300-1506 and Covered California will transfer you to SLO County DSS if you qualify for Medi-Cal. CAPSLO staff are helping anyone to enroll and Community Health Centers is also enrolling their clients at CHC sites.
Income level near the Medi-Cal limit?
For children's coverage, the Medi-Cal limit is higher than adults, at 250% FPL. If a family's income level appears to be over the limit to qualify for Medi-Cal, it is always best to apply anyway.
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
Think you may qualify? Give it a try -- go in person to SLO County DSS, apply online at coveredca.com, or call the Covered California number, 1-800-300-1506 and Covered California will transfer you to SLO County DSS if you qualify for Medi-Cal. CAPSLO staff are helping anyone to enroll and Community Health Centers is also enrolling their clients at CHC sites.
Income level near the Medi-Cal limit?
For children's coverage, the Medi-Cal limit is higher than adults, at 250% FPL. If a family's income level appears to be over the limit to qualify for Medi-Cal, it is always best to apply anyway.
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 families in accessing hospital benefits. 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.
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.
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. Those who likely qualify are income eligible, uninsured California residents who are:
For more information about the Hospital Presumptive Eligibility Program: www.dhcs.ca.gov/services/medi-cal/eligibility/Pages/HospitalPE.aspx.
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.
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. Those who likely qualify are income eligible, uninsured California residents who are:
- Parents/caretaker relatives
- Pregnant women
- Former foster care children 18 to 26 years of age who received foster care on their 18th birthday
- Adults 19 to 64 years of age who are not pregnant, not enrolled in Medicare and not eligible for any group described above
For more information about the Hospital Presumptive Eligibility Program: www.dhcs.ca.gov/services/medi-cal/eligibility/Pages/HospitalPE.aspx.