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Medi-Cal

According to the California Department of Health Care Services (DHHS) Medi-Cal qualification website, a family of two can qualify for Medi-Cal if their annual income is below 138% of the federal poverty level which is $22,108 (California Department of Health Care Services, 2016). An individual can also qualify for Medi-Cal if they are: 65 or older; blind; disabled; under 21; pregnant; in a skilled nursing or intermediate care home; on refugee status for a limited time, depending on how long they have been in the United States; breast cancer cervical cancer patients who qualify under the Breast and Cervical Cancer Treatment Program (California Department of Health Care Services, 2016); and/or a parent or caretaker relative of a child under 21 if the child's parent is deceased or doesn't live with the child, or the child's parent is incapacitated, or the child's parent is under employed or unemployed. Medi-Cal is also available to individuals who are enrolled in CalFresh, SSI/SSP, CalWorks (AFDC), Refugee Assistance, and/or the Foster Care or Adoption Assistance Program.

Applications for Medi-Cal can be made on the Covered California website (Covered California, 2016). Applications may also be filed in person at local county human services agencies (California Department of Health Care Services, 2016). Covered California gives a description of who’s eligible for Medi-Cal on their website that concisely summarizes the verbiage on the DHHS site: “Medi-Cal covers low-income adults, families with children, seniors, persons with disabilities, children in foster care as well as former foster youth up to age 26, and pregnant women” (Covered California, 2016).

According to California Health Advocates, the male spouse in the case would be considered for Medi-Cal under the Medi-Cal for individuals with Medicare program known as “dual eligibles” or “Medi-Medis” because he is 72 years of age (California Health Advocates, 2016). For a couple, the asset limitation is $3000 excluding the primary home, one vehicle, household goods and personal belongings, a life-insurance policy with a face value of $1,500 per person, a prepaid burial plan (unlimited if irrevocable or up to $1,500 if revocable) and burial plot. Various Medi-Cal programs are available to Medicare eligible individuals as shown in the table below from California Health Advocates (California Health Advocates, 2016).

Medi-Cal Programs – Qualification at a Glance

(Asset limits are the same for all programs: Single: $2,000; Couple: $3,000)

Program / Requirements

Your Monthly Income

Supplemental Security Income (SSI)

· 65 or older, blind or disabled

Single: up to $889.40/mo. Couple: up to $1,496.20/mo.

Note: Higher income levels apply for individuals who are blind.

Aged & Disabled Federal Poverty Level (A&D FPL) Program

· 65 or older, blind or disabled

Single: up to $1,220/mo. Couple: up to $1,645/mo.

Medi-Cal with a Share of Cost (SOC)

· 65 or older, blind or disabled

Single: over $1,220/mo. Couple: over $1,645/mo.

250% California Working Disabled (CWD)

· Have work

· Meet Social Security’s definition of disability

· Pay small monthly premium

Single: up to $2,475/mo. Couple: up to $3,338/mo. Note: Income excludes disability benefits

Medi-Cal benefits include coverage for healthcare that is deemed "medically necessary". Coverage includes lab tests, imaging examinations, provider visits, home nursing care, hospitalization, home healthcare, prescription drugs under Medicare part D (in this case), hearing aids, ambulance services, hospice care, medical equipment, and prosthetics. In addition to these benefits the California Department of Health Care Services specifically lists outpatient (ambulatory) services, emergency services, maternity and newborn care, mental health and substance use disorder services including behavioral health treatment, physical and occupational therapy, preventive and wellness services, and chronic disease management (California Department of Health Care Services, 2016). Medi-Cal covers costs only if the enrollee uses facilities and providers that accept Medi-Cal (California Health Advocates, 2016).

In this case, the couple is looking for “home care services, an adult day health program, or the possibility of nursing home care.” According to California Health Advocates and DHHS, as per the list above, all of these services are covered by Medi-Cal.

In my search for information, I relied on the California Department of Health Care Services, Covered California, and California Health Advocates website pages as listed in the bibliography. As a departmental chairman at our academic medical center and as vice president of the medical group I have a significant amount of healthcare literacy. Even so, I found it fairly difficult to navigate the sites, and it took quite a bit of time to ferret out the specific information that I was looking for. Based on this experience I think the sites would be fairly difficult to use for someone with a low level of healthcare literacy. I think the sites would also prove difficult to use for individuals with a visual impairment. Because my eyesight is much worse on the left than on the right, I was able to check this myself. I tried navigating the sites using my left eye only, and this proved to be impossible. Regarding individuals with arthritis or other disabilities that limit hand functionality, the number of clicks required to find information on the sites would prove difficult. Short-term memory loss would also be challenging as I found in navigating the sites that it was useful to be able to recall where I had seen a particular piece of information. If I did not have these memories at my disposal, I would have to start from scratch with each query.

Bibliography

California Department of Health Care Services. (2016). Breast and Cervical Cancer Treatment Program. Retrieved June 15, 2016, from California Department of Health Care Services: http://www.dhcs.ca.gov/services/medi-cal/Pages/BCCTP.aspx

California Department of Health Care Services. (2016). County Offices to Apply for Health Coverage, Medi-Cal, and Other Benefits. Retrieved June 15, 2016, from California Department of Health Care Services: http://www.dhcs.ca.gov/services/medi-cal/Pages/CountyOffices.aspx

California Department of Health Care Services. (2016). Medi-Cal Eligibility. Retrieved June 15, 2016, from California Department of Health Care Services: http://www.dhcs.ca.gov/services/medi-cal/Pages/DoYouQualifyForMedi-Cal.aspx

California Department of Health Care Services. (2016). What are the Medi-Cal Benefits? Retrieved June 15, 2016, from California Department of Health Care Services: http://www.dhcs.ca.gov/services/medi-cal/Pages/Medi-Cal_EHB_Benefits.aspx

California Health Advocates. (2016). Medi-Cal (for People with Medicare). Retrieved June 15, 2016, from California Health Advocates: http://www.cahealthadvocates.org/low-income/medi-cal.html#qualify

Covered California. (2016). How to Apply. Retrieved June 15, 2016, from Covered California: http://www.coveredca.com/apply/

Covered California. (2016). Medi-Cal. Retrieved June 15, 2016, from Covered California: http://www.coveredca.com/medi-cal/