Full-scope Medi-Cal is California’s complete Medicaid coverage: doctor visits, hospital stays, prescriptions, dental, vision, mental health care, maternity care, and long-term services, with no premiums or copays for most members. It is the opposite of restricted-scope Medi-Cal, which pays only for emergencies and a few limited services. Since January 2024, any California resident who meets the income rules qualifies regardless of immigration status, and the state no longer looks at bank accounts, cars, or other assets when deciding eligibility.
What Full-Scope Medi-Cal Covers
The program covers the full range of medical care a person is likely to need. That includes outpatient doctor visits and specialist appointments, emergency room care at any hospital, inpatient hospitalization and surgery, prenatal care, labor and delivery, and postnatal care for parent and baby. Prescriptions are handled through the Medi-Cal Rx pharmacy program.1Medi-Cal Rx. Medi-Cal Rx Homepage Preventive care, routine screenings, immunizations, lab work, and chronic disease management for conditions like diabetes and asthma are all included.
Mental health and substance use treatment run from outpatient counseling and therapy through inpatient psychiatric care, detox, residential rehab, and outpatient recovery. Rehabilitative services cover physical and occupational therapy along with devices that help you recover from or manage a condition.
California adds benefits that go beyond the federal Affordable Care Act minimums. Adult dental care through Denti-Cal covers cleanings, fillings, extractions, root canals, and dentures. Vision benefits include routine eye exams and medically necessary glasses. The state also covers long-term care in skilled nursing facilities, home-based supportive services, and non-emergency medical transportation to and from scheduled appointments for members who cannot otherwise get there. Children receive broader dental and vision benefits than adults under the pediatric essential health benefit.
Who Qualifies
Eligibility is based almost entirely on household income measured against the Federal Poverty Level. Adults ages 19 through 64 generally qualify at or below 138 percent of the FPL.2California Department of Health Care Services. 2025 Federal Poverty Levels Children qualify at up to 266 percent of the FPL, and pregnant individuals qualify at up to 213 percent.3Covered California. Program Eligibility by Federal Poverty Level for 2025
For 2026, the federal poverty guideline for a single person is $15,960 per year. That puts the 138 percent adult cutoff at roughly $22,025 a year, or about $1,835 a month. For a family of four, the FPL is $33,000, and the 138 percent threshold is approximately $45,540.4U.S. Department of Health and Human Services. 2026 Poverty Guidelines – 48 Contiguous States
Two policy changes recently reshaped who can enroll. Assembly Bill 133 phased out the Medi-Cal asset test, raising the limits in 2022 and eliminating them entirely on January 1, 2024.5California Department of Health Care Services. Reinstatement of the Medi-Cal Asset Limit Fact Sheet A second car or a savings balance no longer disqualifies you. And starting January 2024, California extended full-scope coverage to all income-eligible residents regardless of immigration or citizenship status.6Department of Health Care Services. Medi-Cal Help Center – Coverage for All People previously on restricted or emergency-only Medi-Cal were moved into full-scope coverage automatically.
You also have to live in California and intend to stay. There is no minimum residency period. You qualify from the day you move here.
What You Pay
For most full-scope members, the answer is nothing. No premiums, no copays, no deductibles. The program covers the full cost of your care.
The exception is the Share of Cost program. Some members whose income exceeds the standard thresholds but who qualify under certain other categories must pay a set dollar amount toward medical expenses each month before Medi-Cal begins paying. The county calculates that amount based on income above your “maintenance need” level. Once your medical bills for the month reach the Share of Cost figure, Medi-Cal covers the rest. Months with no medical expenses cost you nothing. Pregnant individuals are exempt from Share of Cost for pregnancy-related services.
How to Apply
You can apply online through BenefitsCal or CoveredCA, by mail to your county social services office, by phone, or in person at a county office. Every route uses the same Single Streamlined Application.
Have these ready before you start:
- Proof of identity, such as a California driver’s license, state ID, or passport.
- Proof of California residency, such as a recent utility bill, lease, or mortgage statement.
- Income verification: recent pay stubs, a W-2, or your most recent federal tax return.
- Social Security number if you have one. Applicants without an SSN can still apply.
The application asks for household size and total gross monthly income for everyone in the household. Report income before taxes and deductions. Errors slow processing and trigger requests for more documents.
When Coverage Starts and Retroactive Bills
The state generally has up to 45 days to process a standard application, and up to 90 days for applications based on disability.7Department of Health Care Services. Medi-Cal Help Center You’ll get a Notice of Action by mail explaining the decision. If approved, you receive a Benefits Identification Card to present at appointments.
Medi-Cal can also cover bills from the three months before the month you applied, as long as you were eligible during those months and the services are covered.8California Department of Health Care Services. Reimbursement of Medi-Cal Beneficiaries If you already paid those bills, the state can reimburse you. This retroactive window is worth pursuing if you delayed applying while medical debt piled up.
Keeping Your Coverage
Eligibility is reviewed periodically. Right now, most members renew every 12 months. The state first tries to confirm eligibility automatically using tax records and other data it already has. If everything matches, coverage renews without any action on your part.
If the state cannot verify your information, it mails a renewal form in a yellow envelope. You must complete and return it by the due date, typically at least 30 days out. Missing that deadline is one of the most common ways people lose Medi-Cal, and it is entirely preventable. Update your address any time it changes so renewal notices reach you.
A federal change affects renewals scheduled on or after January 1, 2027: states must redetermine eligibility every six months for most adults in the Medicaid expansion group, rather than annually.9Medicaid.gov. State Medicaid Director Letter 26-001 That means paperwork twice as often. The six-month cycle does not apply to children, pregnant individuals, or people eligible through non-income categories like disability. Those groups stay on the 12-month cycle.
If You’re Denied or Cut Off
If Medi-Cal denies your application, cuts your benefits, or ends your coverage, the Notice of Action explains how to challenge the decision. You have 90 days from the date the notice was mailed to request a State Fair Hearing under Welfare and Institutions Code Section 10951. Between 90 and 180 days, a judge may still allow a late filing if you can show good cause.
Timing matters if you already have benefits and the state is trying to reduce or end them. Requesting a hearing before the change takes effect keeps your current benefits in place while the appeal is pending.10eCFR. 42 CFR Part 431 Subpart E – Fair Hearings for Applicants and Beneficiaries This is called “aid paid pending.” Wait until after the change takes effect and you lose that protection. The tradeoff: if the hearing goes against you, the state can seek to recover the cost of services paid during the appeal.
Estate Recovery After Age 55
One part of Medi-Cal catches families off guard. After a member dies, California can seek reimbursement from the estate for certain costs. The Department of Health Care Services can file a claim against the estate of any member who was 55 or older when they received services, but only for costs tied to nursing home care, home and community-based services, and related hospital and prescription expenses.11California Legislative Information. California Welfare and Institutions Code 14009.5 Routine doctor visits and standard managed care are not subject to recovery.
Several protections limit what the state can collect. Recovery cannot happen at all if the member is survived by a spouse, a registered domestic partner, a child under 21, or a child of any age who is blind or disabled.11California Legislative Information. California Welfare and Institutions Code 14009.5 The state must waive its claim if enforcement would cause substantial hardship to dependents or heirs. California only recovers from property that passes through probate, so assets held in living trusts, joint tenancies, and similar arrangements are generally out of reach. If the home qualifies as a “homestead of modest value,” defined as a home worth 50 percent or less of the average home price in that county, the state will waive recovery on that property.
For members who receive long-term nursing facility care, recovery can apply regardless of age if the person was permanently institutionalized and not expected to return home. If you or a family member are entering a nursing facility on Medi-Cal, talk to an elder law attorney about these rules before transferring any assets.