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 Denti-Cal, mental health, and other benefits. Children are income eligible if their family earns below 266% of the federal poverty level (FPL). Families will pay some monthly premiums if their household income is above 160% FPL, 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. Pregnant individuals: There are several public and subsidized insurance options for pregnant individuals, regardless of immigration status. Learn more here: www.coveredca.com/individuals-and-families/getting-covered/pregnant-women.
  4. In San Luis Obispo County, children become members of CenCal Health. CenCal sends parents information about selecting a primary care provider and other member benefits.  ​
  5. 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 and get other children in the family added to the case.
  6. 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.

Medi-Cal Outreach Navigation

Families 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?

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/​

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 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.

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.