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Learn About Requirements for Medicaid in California

“What are the requirements for Medicaid in California?” is a common question that petitioners interested in Medicaid ask, because they want to make sure they are qualified to receive assistance before submitting an application. Determining who is eligible for Medicaid is the first step in the application process for medical assistance, so applicants can decide whether or not they should apply for benefits. Applicants should understand how to qualify for Medicaid in order to complete a successful application and potentially be accepted into California’s health care assistance program. Requirements for Medicaid in CA, also known as the Medi-Cal system, are based upon the federal government’s application guidelines and the state’s own protocol for who is to receive Medicaid assistance. To gain more information on the eligibility requirements for Medicaid under the Medi-Cal program, continue reading the sections below.

Who qualifies for Medicaid in California?

Medicaid benefits eligibility in California begins with the income requirements established by the federal government. Generally, anybody who is eligible for Medicaid will be considered low-income or very low-income. California also offers Medicaid coverage to individuals and families who fall within a variety of special circumstances and also meet other eligibility guidelines. For example, senior citizens 65 years of age or older can qualify for Medi-Cal, as can individuals with a disability or those living in a nursing home or immediate care home. Medicaid eligibility requirements in California extend medical assistance to individuals who are on refugee status and who have been in the United States for a certain amount of time. Furthermore, CA Medicaid benefits eligibility extends to anybody who has been screened for breast cancer or cervical cancer.

Pregnant women are eligible for Medicaid benefits in California as well as caretakers and parents of uninsured children younger than 21 years of age. However, parents and guardians of those younger than 21 only qualify for Medicaid coverage if one of the child’s parents is deceased or not living in the household, the child’s parent is physically unable to care for the child or the parent is not employed full-time or is unemployed. Additionally, individuals and families can qualify for Medicaid benefits in CA if they are enrolled in one of the following programs:

  • CalFresh
  • CalWorks
  • Refugee Assistance
  • Foster Care or Adoption Assistance Program

There are a certain set of California Medicaid eligibility requirements all potential beneficiaries must meet in order to receive health care assistance apart from the circumstances listed above. The conditions all Medicaid applicants must meet in order to be eligible for benefits are as follows:

  • Applicants must be a citizen or legal resident of the United States (including refugees).
  • Applicants must be a resident of California.
  • Applicants must meet the income requirements for Medicaid.

To learn more about qualifying for Medicaid, you can download our free guide today.

What are the income requirements for Medicaid in California?

Medicaid income requirements in California changed recently due to the Affordable Care Act’s Medicaid expansion. The income requirements for Medicaid in CA adhere to the federal income limits for medical assistance through Medicaid. This Medicaid eligibility requirement statute states that any individual or household that falls below 138 percent of the federal poverty level can be eligible to receive health care assistance through the state. However, the Medicaid income requirement may be higher for applicants who meet one of the qualifying conditions listed in the previous section. The yearly household income requirement in California increases as the number of household members increases. For example, a household with a single member can make a smaller salary than a household with four members and still qualify for Medicaid.

What are the Medicaid application guidelines in California?

The Medicaid application guidelines in California require applicants to demonstrate that they meet the Medicaid eligibility requirements. This means an applicant must provide proof of Medicaid qualifications through supplemental documents and supporting information such as a Social Security Number, alien registration number, birth certificate or proof of residency. In addition to supportive documents, Medicaid eligibility petitioners will be asked to provide detailed information regarding their household. There are many steps involved in filling out a Medicaid application. To gain a better understanding of what the process entails, download our free guide today.

What are common Medicaid disqualifications in California?

An applicant may not meet California Medicaid eligibility requirements for a variety of reasons. However, the most common reason an applicant is disqualified from receiving benefits is because he or she does not fall below the income limit. Additionally, an applicant who is ineligible for Medicaid in CA may be disqualified because he or she cannot provide the supplemental documents and information needed to verify his or her identity and financial situation. For instance, if an applicant cannot provide proof of income or unemployment through pay stubs or unemployment benefits, then he or she may be considered unqualified for medical assistance. After completing the Medicaid application process, petitioners will receive a notice of denial or acceptance.