Medi-Cal is California’s medical care insurer for low-income residents and persons with disabilities. Medi-Cal is short for the California Medical Assistance Program. Because of the state’s dire fiscal situation in the year 2011, eligibility rules could change if funds for the program are cut, so stay abreast of changes by checking in periodically at the state’s Department of Health Care Services website.
Check with eligibility verification system for rules for eligibility and enrollment. The Medi-Cal website has several pages dedicated to Medi-Cal along with its broad mandate. You could be enrolled in the event you already collect Social Security benefits, food stamps, adoption assistance, foster care or perhaps in-home support services offered by their state.
Look further to determine if you qualify, even when you are not already collecting government benefits. In case you are 65 or older, blind or else disabled, in a elderly care facility, you could qualify. Women who are undergoing remedy for breast or cervical cancer could also qualify if their income is lower than 200 percent of the federal poverty level.
Call your neighborhood County Welfare Office. Medi-Cal lists the state’s 58 county welfare offices on its website. The office can answer any questions you might have and can give you some idea whether you are going to qualify, even before you complete the application form.
Apply for assistance. The straightforward application comes in 11 different languages and is available online. The application asks you to your identifying information, marital status, the people in your household as well as their ages, and whether you have a property either in California or in another state. You happen to be also necessary to list all your causes of income as well as expenses relating to medical health insurance, alimony and other factors that matter in your overall household budget.
Be completely honest on the application. The penalties for fraud and abuse are severe, and can include losing your benefits and potential prosecution for recipients and providers. The state’s Health Department reports on its website that since 1999 it has poured a tremendous quantity of resources into combating Medi-Cal fraud.
At the time of January 2018, 2.5 million everyone was signed up for Medi-Cal fee-for-service, representing about 19% of all enrollees. In the fee-for-service arrangement, health care providers submit claims to the Medi-Cal program for services rendered. Medi-Cal managed care. Most beneficiaries receive Medi-Cal advantages of contracted Medicaid managed care organizations. Since January 2018, 10.8 million everyone was enrolled in a Medi-Cal managed care plan, representing about 81% of all the enrollees.
California has several models of managed care which are designated in the county level: County Organized Health System (COHS) model, with one health plan per county, “two plan model” with one community health plan and one commercial health plan within the county, a geographic managed care model with multiple plans per county, a regional managed care model with 1-2 commercial health plans in lots of counties, and different one-county models in San Benito and Imperial counties.
In Denti-Cal, the majority of beneficiaries are covered through fee-for-service arrangements, where state pays dentists directly for services, instead of the managed care model. However, more than 879,000 Denti-Cal enrollees do receive dental hygiene through managed care plans started as experimental alternatives in the 1990s: in L . A . County where managed care plans are optional for beneficiaries, as well as in Sacramento County where these are mandatory.
Eleven counties had no Denti-Cal providers or no providers ready to accept new child patients protected by Denti-Cal: Del Norte, Tehama, Yuba, Sierra, Nevada, Amador, Calaveras, Alpine, Mariposa, Mono ifepbh Inyo counties. Delta Dental, operating inside the same building as DHCS’ Denti-Cal division, enrolls dentists into DentiCal, processes claims by dentists, pays dentists and authorizes treatments, and also handles customer care operations and outreach.
Medi-Cal is jointly administered through the Centers for Medicare and Medicaid Services (CMS) and the California Department of Medical Care Services (DHCS), whilst the county welfare department in each of the 58 counties is responsible for local administration from the Medi-Cal program.