Health Coverage (Medi-Cal)
Medi-Cal is California's version of the federal Medicaid health coverage program. This is a public health care program for California residents with low income and resources.
Medi-Cal is a large program that provides a range of free or low-cost health services aimed to assist Californians with medical needs.
Are You Eligible?
Medi-Cal eligibility is based mainly on your income.
Medi-Cal has no sign-up period, you can apply at any time.
You can use the BenefitsCal Ask Robin online virtual assistant before completing an actual application to estimate your eligibility.
Once you apply a County Eligibility Worker will decide if you qualify.
Application Process
- Complete & Submit Application
- Paper Documents may be needed if income, citizenship or other information cannot be verified electronically or is questionable. For a list of paper documents that could be needed view Commonly Used Verification Documents.
- Within 45 Days of the day you apply, you will get a Notice of Action (NOA) in the mail. This will let you know if your Medi-Cal application was approved or denied.
- If approved:
• You will get a Benefits Identification Card (BIC) in the mail. For the first 45 days you will be covered under Fee-For-Service Medi-Cal (also called, Regular Medi-Cal).
• Within 45 days of getting your BIC, you will be mailed information about your Health Plan options.
• Once you receive your Health Plan options, you have 30 days to select a plan. If you do not select a plan, a plan will be assigned to you.
• For a full list of medical plans, go to the Medi-Cal Managed Care Medical Plan Directory.
• For a full list of dental plans, go to the Medi-Cal Managed Care Dental Plan Directory.
Using Your Coverage
Provide your plastic Medi-Cal Benefits Identification Card (BIC) to your medical provider to verify your coverage, allowing your providers to bill for your medical and/or dental care.
DO NOT throw away your Medi-Cal Benefit Identification Card (BIC). If you received Medi-Cal in the past, you may already have a plastic BIC card that can be used again. If you lose your card, contact your County Worker and ask for a new card.
Protect yourself against scams, always keep your BIC number safe and secret. If you receive a text, email or phone call from anyone other than a medical provider asking for your BIC number, DO NOT provide your information, this is a SCAM!
Medi-Cal offers a core set of health benefits; these services include the following:
- Outpatient (Ambulatory) Services
- Emergency Services
- Hospitalization
- Maternity and Newborn Care
- Mental Health and Substance Use Disorder Services, including Behavioral Health Treatment
- Prescription Drugs
- Programs such as Physical and Occupational Therapy (known as Rehabilitative & Habilitative Services) and Devices
- Laboratory Services
- Preventative and Wellness Services & Chronic Disease Management
- Children's (Pediatric) Services, including Oral and Vision Care
- Transportation Services
- Other:
- Dental – Visit Medi-Cal Dental for more information
- Vision
- Non-Emergency Medical Transportation Services
- Long Term Services and Supports
Look at the Medi-Cal Health Benefits to learn more about these services. For the meaning of the terms used visit Healthcare.gov Glossary.
Keeping Your Coverage
To keep your health care benefits you must renew your coverage each year.
- Your coverage may be renewed automatically if all your information can be verified electronically. If this occurs, you will receive a Notice of Action (NOA) to confirm the renewal.
- If the County cannot electronically verify all your information, you will receive a Renewal form in the mail. Please review, complete and return along with requested documents.
- When the completed Renewal Form is received, the County will send you an NOA. This will tell you if you are still eligible for the Medi-Cal program. If you do not return the Renewal Form on time, you will lose your coverage.
- You will have 90 days to contact the county if your medical coverage has been lost due to not returning the requested information. You will have to provide further information in order to restore your coverage.
DO NOT throw away your Medi-Cal Benefit Identification Card (BIC). If you received Medi-Cal in the past, you may already have a plastic BIC card that can be used again. If you lose your card, contact your County Eligibility Worker and ask for a new card.
Protect yourself against scams, always keep your BIC number safe and secret. If you receive a text, email or phone call from anyone other than a medical provider asking for your BIC number, DO NOT provide your information, this is a SCAM!
Account Maintenance
Please keep your phone number and email addresses updated. You can update your contact information through BenefitsCal or call your County Eligibility Worker.
Things to Know
For many individuals who enroll in Medi-Cal, there is no premium, no co-payment, and no out of pocket cost. Some households will see affordable costs, such as a low monthly premium. For some Medi-Cal children, the monthly premiums are $13 per child up to a family maximum of $39 per month. In general, individuals in Medi-Cal will get the same health benefits available through Covered California at a lower cost.
Santa Clara County has two managed care plans, Santa Clara Family Health Plan and Anthem Blue Cross.
All plan enrollment and disenrollment are handled by Medi-Cal Managed Care Health Care Options.
Online - https://www.healthcareoptions.dhcs.ca.gov/
Phone - 1-800-430-4263
In Person Monday – Friday 8am-12pm & 1pm-5pm
Benefit Assistance Center
1867 Senter Rd. San Jose, 95112
South County Social Services
1879 Tomkins Ct. Gilroy, 95020
North County Social Services
1330 W. Middlefield Rd. Mt. View, 94043
The application is a single application for multiple health coverage programs. It is common that members of the same family or tax household are eligible for different programs.
For example, both parents could be eligible for tax credits through Covered California, while the children are eligible for Medi-Cal. This is because the eligibility rules for Medi-Cal kids are different than for adults, which ensures that no child lacks affordable coverage.
If you have questions about your coverage under Medi-Cal managed care, you can call your health plan’s customer service representatives directly, just as you would under any other health coverage plan.
If you have questions about your coverage under Medi-Cal managed care, you can call your health plan’s customer service representatives directly, just as you would under any other health coverage plan.
Yes, losing health coverage such as Medi-Cal is considered a qualifying event that would trigger a special enrollment period.
You will receive a notice informing you how to enroll in a Covered California plan. You may also contact your local county office to request assistance in enrolling in a Covered California plan.
Medi-Cal only tries to recover its costs for medical assistance after your death when a recipient is age 55 or over, or when a member of any age is cared for at an institution, such as a nursing home. Medi-Cal does not seek payment during your lifetime or the lifetimes of your surviving spouse, disabled son or daughter, or while your child is under 21 years of age.
If you are under 55, you can sign up for Medi-Cal knowing that nothing will happen to your assets unless you are institutionalized.
For those over age 55 or in an institution, the Department of Health Care Services may present a claim for the cost of your care. It would be paid from your estate at the time of your death.
For more information, please visit California Department of Health Care Services Third Party Liability & Recover Division.
Yes. Make sure to answer yes to the application question “Are you pregnant?” or tell the person helping you to fill out your application. You can apply for health insurance that can cover pre-natal care, labor and delivery, and postpartum care. Health insurance plans can no longer deny health insurance if you are pregnant.
- Contact the County Worker that is handling your case. You will find their contact information of the top right corner of the last County Notice of Action (NOA).
- If you are not satisfied with the response from your County Worker, ask to speak to a Supervisor.
- If you are not satisfied with the response from a Supervisor;
You may request a free confidential case review from our County Ombudsman Office by emailing [email protected].
OR
You have a right to ask for Hearing. To request a Hearing, follow the instructions on the back side of the County NOA you received.
Fill out the back of the NOA and send or take page to;
Appeals Unit
County of Santa Clara Social Services
333 W Julian St.
San Jose, CA 95110-2335OR
Call 1-800-952-5253
TDD for hearing or speech impaired 1-800-952-8349
