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The Medi-Cal expansion is scheduled to begin May 16, 2016.
The expansion applies to undocumented children younger than 19 whose families have incomes at or below 266 percent of the federal poverty level (FPL). Income eligibility depends on family size. For example, a child in a family of four qualifies if the family’s yearly income is at or below $64,638.
While the coverage expansion begins on May 16, 2016, families can get money back for certain care received starting May 1, 2016. Providers can submit claims for full-scope services provided in May. If a family paid out of pocket for services provided in May, the family can submit a claim to Medi-Cal to get money back.
Your child’s current local health program WILL NOT automatically transfer your child to Medi-Cal. YOU MUST APPLY. In order for your child to get comprehensive Medi-Cal coverage, you will need to enroll your child in restricted-scope “emergency” Medi-Cal or apply after May 16, 2016, so your child can be automatically transferred into full-scope Medi-Cal when the expansion launches. You should contact your child’s local insurance program or Kaiser Child Health Plan program for information about how long your child’s current coverage will continue after enrollment in Medi-Cal.
No, you do not have to wait. You can enroll your child TODAY!
Even though enrollment in full-scope Medi-Cal for undocumented children will start May 16, 2016, families can take action now by enrolling their children in restricted-scope Medi-Cal. Children enrolled in restricted-scope Medi-Cal will be automatically switched into full-scope Medi-Cal when the expanded program begins.
You can apply in person at your local county human services office, over the phone, online, with a mail-in application, or at your local clinic. You can get help finding a clinic at www.localclinic.net (www.clinicalocal.net for Spanish) or by calling (855) 899-7587.
Health care coverage for undocumented children will expand from restricted-scope Medi-Cal (sometimes called “emergency” Medi-Cal) to full-scope (or “comprehensive”) Medi-Cal. Restricted-scope Medi-Cal only covers emergency and pregnancy-related services, and it may also cover care and services related to an emergency medical condition (including dialysis services). It does not cover medications, regular doctors’ visits, or dental care. The newly available coverage for undocumented children, full-scope Medi-Cal, covers all medically necessary services, including medical, vision, dental, and mental health services.
No, health care for Medi-Cal-eligible services is free or low cost. You will not need to pay back the cost of services at a later time.
Children with full-scope Medi-Cal also have dental coverage and are able to get regular dental care and services, including: exams, x-rays, cleanings, fillings, and more. To learn more, visit www.childrenspartnership.org/dentalcoverage.
Yes, California Children’s Services (CCS) services are unchanged. You can continue to see those specialists and get treatment for CCS-qualifying conditions.
Unless the individual has an eligible immigration status for full-scope Medi-Cal, their benefits will be reduced to restricted-scope Medi-Cal.
Deferred Action for Childhood Arrivals (DACA) recipients may be eligible for free or low-cost full-scope Medi-Cal and can enroll at a county human services office or at a local clinic. To find a clinic, visit www.localclinic.net (www.clinicalocal.net for Spanish) or call 855-899-PLUS. To determine if you are eligible for DACA, visit Own the Dream at www.weownthedream.org or call their toll-free hotline (855) DREAM-31.
There are a few different ways to verify income. All records and income information are kept confidential and will not be used for any other purpose other than verifying income eligibility for Medi-Cal. Typically, counties are required to get information from the employer if it’s available. If an employer does not provide this information, the county will work with the applicant to determine the nature of the employment and provide them with the available options to verify income. If the individual is:
- A day laborer who has different jobs on a daily basis, the county will provide them with some sort of affidavit or calendar that they can fill out to show their earnings;
- Self-employed, the county may ask them to fill out profit and loss statements to show their earnings;
- Consistently employed and paid via personal check, a copy of the check can be provided; or
- Consistently employed but paid in cash, the county will ask the individual to provide some sort of affidavit or statement regarding their income.
Personal information you give to Medi-Cal will not be shared with immigration enforcement, even if you or other members of your family are undocumented. Medi-Cal can only use personal information to check if you or your family members are eligible for health coverage. Enrolling in Medi-Cal will not hurt your or your child’s ability to become a lawful permanent resident “green card holder” or a US citizen. This is because enrolling in and utilizing Medi-Cal services will not affect your immigration status and is not considered when determining whether you might be a public charge. The only exception is if a person receives long-term care paid for by Medi-Cal, it could be considered in determining whether a person is a public charge. Determining whether a person is a public charge involves a study of all the facts and circumstances that relate to their ability to support themselves, including their education, work history, and resources. This means that even if you get long-term care it does not automatically make you a public charge.
- California Welfare & Institutions Code Section 14100.2 states that information provided on Medi-Cal applications is confidential and can only be used in the administration of the Medi-Cal program.
- Long-standing federal guidance says that states cannot ask for the immigration status of other family members applying for Medicaid (Medi-Cal) for eligible family members.
In June 2015, California Governor Jerry Brown signed the state budget trailer bill (SB 75), which includes an investment to expand full-scope, comprehensive Medi-Cal to all low-income undocumented children under the age of 19. On October 9, 2015, California Governor Jerry Brown signed SB 4 (Lara), which strengthens this expansion by ensuring that undocumented children already enrolled in restricted-scope “emergency” Medi-Cal (which undocumented children are currently eligible for) would be automatically transitioned to full-scope, comprehensive Medi-Cal seamlessly without having to fill out an additional application.
No. The Supreme Court decision does not impact California’s recent Medi-Cal expansion to undocumented children. It also does not impact individuals with DACA status who may be eligible for Medi-Cal.
Yes. All former foster youth under the age of 26 can enroll in Medi-Cal, regardless of income or immigration status. If the youth’s immigration or citizenship status is not yet verified, they will be asked to complete a form (MC 13) to clarify their citizenship or immigration status.
From a DHCS All County Welfare Director’s Letter:
“The Former Foster Care Youth should be immediately enrolled into the FFY program which provides full scope Medi-Cal coverage regardless of immigration status; coverage shall not be delayed while completion of the MC 13 is pending. This paragraph supersedes ACWDL 00-41.” p. 4