 | | | Medically Needy Medi-Cal: Frequently Asked Questions | | | | | | | | |
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1) What is Medically Needy Medi-Cal? |
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Medically Needy Medi-Cal provides full scope Medi-Cal services to aged, blind, or disabled people with income above the eligibility levels of no-cost Medi-Cal programs. The program usually requires that you incur a monthly share of cost, similar in principle to a monthly co-payment. |
2) What does "incurring medical expenses" mean? |
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"Incurring medical expenses" means that you have to pay for part of your medical expenses out of your own pocket. You are responsible for the first medical expenses of each month, up to your share of cost amount.
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3) How do I figure out my share of cost? |
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Next, subtract any health, vision, and dental insurance premium payments.
Finally, subtract a maintenance needs level (MNL) for your family size: If you are the only person in your family, deduct $600; if there are two in the family, deduct $750; if there are 2 adults or 1 adult and 2 children= $934, 4 people= $1,100; 5= $1,259; 6= $1,417; 7= $1,550; 8 = $1,692.
The figure you get after this calculation is the amount you must pay at the beginning of each month before Medi-Cal begins paying for services. The $600 figure is Medi-Cal’s maintenance need level.
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4) What services does Medically Needy Medi-Cal provide? |
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Medically Needy Medi-Cal provides full-scope Medi-Cal. You may also have access to other Medi-Cal programs, including: |
5) What prescription drug coverage comes with Medically Needy Medi-Cal? |
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You will be covered for drugs that are on Medi-Cal's approved list of prescription drugs. You can access prescription services after meeting any share of cost requirements. If you have both Medi-Cal and Medicare, the list of drugs that are covered depends on which plan you are enrolled in under Medicare Part D. You can use Medicare Part D co-payments and deductibles to meet your share of cost.
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6) How do I apply for Medically Needy Medi-Cal? |
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Medi-Cal provides applications in eleven languages. You can download an application online, but you must still submit it in person or by U.S. mail.
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7) How soon after applying will I be eligible for benefits from Medically Needy Medi-Cal? |
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On average, processing of an application takes between 30 to 90 days. The eligibility worker may enroll you in the program without conducting a medical determination of disability. For example, Social Security Disability Insurance (SSDI) beneficiaries have already met the disability rules for this program and do not need a medical determination.
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8) Can I qualify for Medically Needy Medi-Cal while I am eligible for private health coverage? |
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Yes. Your enrollment in private health coverage will not jeopardize your participation in Medically Needy Medi-Cal. Obtaining private health coverage may enable you to access providers or services you may not have had available to you on Medi-Cal alone. You may also qualify for the Medi-Cal/HIPP program, which can cover your insurance premiums if:
- You have qualifying private health coverage; and
- You are eligible for Medi-Cal and have a share of cost of $200 or less.
When using private health coverage and Medi-Cal simultaneously, the private health coverage is billed first. After the private health carrier pays or denies a claim, Medi-Cal is then billed and will pay for services it covers.
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9) How do I stay enrolled/eligible in Medically Needy Medi-Cal? How often do I need to reapply? |
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As long as you continue to meet disability and financial requirements, you will continue to be eligible for Medically Needy Medi-Cal. This program verifies assets, income and earnings annually. If you get a job or your circumstances change, you may want to consider accessing Medi-Cal through another eligibility category (see FAQ 15).
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10) Are there rules for immigrants to qualify for Medically Needy Medi-Cal? |
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11) Can I receive Medically Needy Medi-Cal if I am married? |
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Yes. If you are married and both you and your spouse are eligible for Medically Needy Medi-Cal, then the maintenance need level for two persons is used. If your spouse is not eligible for Medically Needy Medi-Cal, then Medi-Cal uses deeming rules to determine if you are eligible for the program. Contact your local county Medi-Cal office for more information about how deeming rules work and how they can affect your eligibility for this program. |
12) Can I work and receive Medically Needy Medi-Cal? |
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Yes. You can work and continue to be eligible for Medically Needy Medi-Cal. As your income changes, your monthly Medically Needy share of cost will be adjusted accordingly. If you are working, you may also consider Medi-Cal’s 250% California Working Disabled (250% CWD) Program as an additional approach to access Medi-Cal that may be more cost effective.
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13) Does what I have in the bank or what I own, such as my home or car, affect my eligibility for the Medically Needy category of Medi-Cal? |
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Yes. You are allowed to have assets up to $2,000 in value ($3,000 for a couple). Some of your assets, like your home and car, are not counted for this program. Click here for a list of additional exemptions. Assets may include:
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checking and savings accounts;
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the value of stocks, bonds, and trust deeds;
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additional cars or recreational vehicles; and
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promissory notes and loans that are payable to you.
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14) Is Medically Needy Medi-Cal referred to in other ways? |
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Yes. This Medi-Cal eligibility category is often called “ share of cost” Medi-Cal. |
15) Is this the only way to qualify for Medi-Cal? |
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No. There are different ways you can qualify for Medi-Cal. Each Medi-Cal eligibility category has unique requirements. Db101 has detailed information on the following Medi-Cal categories:
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