Do You Qualify Tho?
This program provides free or low-cost health coverage to eligible Californians.
Medi-Cal
What identity documents can be submitted when applying for Medi-Cal?
Full scope Medi-cal covers what dental services for clients?
Checkups, cleanings, x-rays, fillings, root canals, dentures, Orthodontics, Complete and partial dentures, and emergency care.
Cleaning can happen every 6 months.
Members can access dental services through Medi-Cal Dental enrolled providers
Your client is seeking support in accessing mental health services for their child. Everyone in the family has Medi-Cal. What do you do?
Connect with client.
Either call managed care with client or provide number for managed care.
Let client know that they will need MC ID card on hand for person seeking services during the assessment.
Assessment happens over the phone where client will learn if they are eligible or not.
Children under this age can qualify for full-scope Medi-Cal regardless of immigration status.
What is 19
When submitting a new application how long do families have to submit their documents to Medi-Cal?
Typically within 10 days of application submittal.
If more documents are required client will receive a letter in the mail and have until the letter deadline to submit all documents.
If documents are not submitted in time client may have to reapply.
Full scope Medi-Cal can cover what vision services for clients?
Routine eye exams
Eyeglasses-Once every 24 months
Contact lenses
Prosthetic eye services
Children under 21 can receive early screenings, diagnostics, and treatment benefits.
Your client would like to get access to a primary care doctor. All family members have Medi-Cal. How would you support them in getting access to this service?
To find a Primary Care Provider (PCP) with Medi-Cal, use the online Medi-Cal Managed Care Health Care Options portal to search for doctors in your county.
Call your health plan provider directly (number is on your insurance card) to ask for a list of available PCPs in your area.
You must choose a PCP within 30 days of enrolling in a plan, ensuring the provider is accepting new Medi-Cal patients.
When can a client apply for Medi-Cal?
Anytime throughout the year
If someone’s income changes, they must report it within this number of days.
10 Days.
Client can report this online through their BenefitsCal portal or call their local DSS and connect with an ERS worker to report income changes.
They can also report family dynamic changes and anything that might come up in the household.
Families can receive transportation to and from medical appointments through this service covered by Medi-Cal
Ventura Transit
Your client is pregnant and is due in two weeks. They disclose they do not have health insurance. How do you navigate this?
Clients can immediately access care through Presumptive Eligibility (PE) for Pregnant Women, which provides temporary, no-cost coverage for prenatal care. They can apply immediately at community clinics, county health offices, or online to secure coverage for prenatal, delivery, and postpartum care.
What form of Medi-Cal provides immediate, no-cost coverage for sudden, serious medical conditions, regardless of immigration status or social security number
Emergency Medi-Cal.
This is available for low-income residents, including adults who may not qualify for full-scope coverage due to immigration status.
The hospital can help you apply for emergency Medi-Cal benefits.
This program only covers services deemed a "medical emergency" by a review team. Including Pregnancy-related services.
What documents are required for self-employed clients when it comes to applying for Medi-Cal?
Typically clients will have to submit one of the following documents:
What Are the Requirements to Qualify for Free Pediatric Incontinence Supplies?
Enrolled in Medi-Cal
Medical note from a doctor
Ages 5 and up
Through this benefit families can receive free pull-ups, diapers, and supplemental supplies (Gloves, wipes, and bedsheets)
Your client is currently facing homelessness and is looking for support in paying for their housing deposit they have active Medi-Cal. How do you navigate this?
Sometimes client may be able to qualify through our local ECM providers that serve the homeless population.
Through this program they have limited funding to help pay eviction notices and rental deposits.
Your client has private insurance but has been struggling to pay for co-pays for their children. What type of Medi-Cal can the family apply for?
Medi-Cal as a secondary.
Medi-Cal acts as secondary insurance to private plans covers out-of-pocket costs like deductibles, copays, and services not covered by the primary plan. Known as "crossover claims," Medi-Cal serves as the payer of last resort, meaning primary insurance must be billed first.
Your client was just denied for Medi-Cal and they believe they qualify. What do you do?
The client can file a fair hearing trial within 90 days of receiving a denial letter.
Clients can either apply online or call to request a hearing.
Your client is looking to apply for IHSS to be a caregiver for their child that has a disability. What are the requirements for clients that would like to apply?
Your client comes to you has no health insurance and is no longer eligible for Medi-Cal due to recent increase of income. How do you navigate this?
Let client know about available health resources and programs that are available to them with no health insurance. Examples of these are listed below.
Remind families about Covered California and when open enrollment starts. This will be insurance for families who do not qualify for Medi-Cal.