Medi-Cal benefits and eligibility come down to two questions: does your income fit under the program’s limits, and what does the coverage actually include? Medi-Cal is California’s Medicaid program, run by the Department of Health Care Services, and it provides free or low-cost health coverage to residents with limited income. A single adult earning up to about $22,025 per year qualifies, and children and pregnant individuals can qualify at higher income levels. Coverage includes doctor visits, hospital stays, prescriptions, dental, vision, mental health care, and long-term services.
Who Qualifies by Income
Medi-Cal eligibility is tied to household income as a percentage of the federal poverty level. For 2026, the FPL is $15,960 per year for a single person and $33,000 for a family of four.1HHS ASPE. 2026 Poverty Guidelines The cutoff depends on which category you fall into:
- Adults ages 19 to 64 qualify with income up to 138 percent of the FPL, which works out to roughly $22,025 per year for a single adult.
- Children under 19 qualify with family income up to 266 percent of the FPL.
- Pregnant individuals qualify up to 213 percent of the FPL, with coverage continuing for 12 months after delivery.
These thresholds already include a 5-percentage-point income disregard built into the calculation.2Covered California. Program Eligibility by Federal Poverty Level for 2026 Income is measured using Modified Adjusted Gross Income (MAGI) for most applicants, which is essentially your federal tax income with a few adjustments. Seniors and people with disabilities who qualify through Supplemental Security Income or other non-MAGI pathways use a different income calculation.
If you have a disability and earn more than the standard limit, the 250% Working Disabled Program offers another path. You can qualify with countable income up to 250 percent of the FPL and receive full-scope Medi-Cal benefits. The income calculation excludes disability-related income and treats family earnings differently than regular MAGI, which lets you hold a job without losing coverage.
Immigration Status Is No Longer a Barrier
California has fully expanded Medi-Cal to all income-eligible residents regardless of immigration status. The expansion rolled out in phases: children and young adults first, adults 50 and older in May 2022 under AB 133, and adults ages 26 through 49 on January 1, 2024.3Department of Health Care Services. DHCS TBL Policy Changes to Individuals With UIS Fact Sheet4Medi-Cal. Ages 26 Through 49 Adult Full Scope Medi-Cal Expansion Standard income rules still apply; immigration status simply is no longer a reason to be turned away.
Asset Rules for Seniors and People With Disabilities
Non-MAGI applicants used to have to prove they owned less than a few thousand dollars in countable assets. That changed under Welfare and Institutions Code § 14005.62, which directs the state to stop using resources and assets to determine eligibility for non-MAGI programs. The statute phases this in by disregarding $130,000 in nonexempt property for a single-member household and $65,000 for each additional household member, moving toward a complete elimination of resource tests.5California Legislative Information. California Welfare and Institutions Code 14005.62
MAGI-based applicants, which includes most working-age adults and children, were never subject to asset limits, so this change does not affect them.
If Your Income Is Too High: Share of Cost
If you earn too much for free Medi-Cal but have substantial medical needs, the Share of Cost (SOC) program may still cover you. It works like a monthly deductible. Your county calculates an SOC amount based on how much your income exceeds the “maintenance need” level for basic living expenses. Each month, you pay that amount toward your own medical bills before Medi-Cal picks up the rest.6Medi-Cal. Share of Cost
Doctor visits, prescriptions, medical supplies, and even old unpaid medical bills you still owe count toward meeting the SOC. Once your qualifying expenses hit the SOC amount for the month, Medi-Cal covers your remaining costs.
What Medi-Cal Covers
The schedule of benefits under Welfare and Institutions Code § 14132 is broad. Medi-Cal pays for outpatient care including physician visits, specialists, and clinic appointments, along with inpatient hospital stays and everything that comes with them: nursing, medications, imaging, and surgery.7California Legislative Information. California Welfare and Institutions Code WIC 14132 Emergency services are fully covered with no out-of-pocket cost for emergency room visits.
Pregnancy-related care covers prenatal visits through labor, delivery, and postpartum follow-up. Newborns are automatically enrolled and receive all necessary screenings and medical attention from birth.8Covered California. Medi-Cal for Pregnant Women Pediatric care includes childhood immunizations, developmental screenings, and regular check-ups.
Other covered services include:
- Prescription drugs through the Medi-Cal formulary at participating pharmacies.
- Laboratory and diagnostic testing, including blood work, X-rays, and other imaging.
- Rehabilitative services such as physical, occupational, and speech therapy.
- Family planning services, including contraception and reproductive health care.
- Durable medical equipment like wheelchairs, hearing aids, prosthetics, and medical supplies.
- Nursing facility care, including skilled nursing and intermediate care for people who need extended institutional support.
Most members receive care through a managed care health plan that coordinates services through a network of county providers. A smaller number receive fee-for-service Medi-Cal, where the state pays providers directly for each visit.
If you travel outside California and have a medical emergency, Medi-Cal still covers you. Federal rules require every state Medicaid program to pay for out-of-state emergency services, and coverage also applies when another state’s medical resources are closer or more readily available. Non-emergency care generally has to come from participating providers inside California.
Dental, Vision, and Mental Health
The program formerly known as Denti-Cal is now Medi-Cal Dental. It covers examinations, cleanings, X-rays, fillings, extractions, root canals, crowns, dentures, and orthodontics for children who qualify.9Department of Health Care Services. Medi-Cal Dental Dental coverage is available to all Medi-Cal members, and you can find a participating dentist through the DHCS provider directory.
Vision benefits include comprehensive eye examinations, low vision evaluations, and corrective lenses at no cost through the Fee-for-Service Vision Services program. Optical laboratories fabricate the prescription lenses.10Department of Health Care Services. Medi-Cal Fee-for-Service Vision Services
Mental health care includes therapy, counseling, psychiatric evaluations, and medication management. Severe mental illness is handled through county mental health plans, and mild to moderate conditions are typically treated through your managed care plan. Substance use disorder treatment is available through county programs.
In-Home Care and Rides to Appointments
The In-Home Supportive Services (IHSS) program provides in-home assistance to eligible seniors and people who are blind or disabled, as an alternative to institutional care. A county social worker assesses your needs and authorizes a specific number of monthly hours for a caregiver, who in many cases can be a family member. Covered tasks include bathing, grooming, meal preparation, and housekeeping.11California Department of Social Services. In-Home Supportive Services Program
Medi-Cal also covers transportation to and from medical, dental, mental health, and other covered appointments if you have no other way to get there. Federal regulations require Medicaid programs to pay for rides by taxi, public transit, specialized medical transport, and even meals and lodging when long-distance travel is necessary.12eCFR. 42 CFR 440.170 – Any Other Medical Care or Remedial Care Recognized Under State Law Many managed care plans arrange rides through transportation brokers. Contact your health plan before the appointment to schedule the ride.
How to Apply
There are four ways to apply, all free:13Department of Health Care Services. Apply for Medi-Cal
- Online through BenefitsCal, the state benefits portal, where you can also manage your case and complete renewals.
- Online through Covered California, the state health insurance marketplace, which also helps you shop for subsidized private plans if you don’t qualify for Medi-Cal.
- By mail, using the Single Streamlined Application from the DHCS website sent to your county social services office.
- In person at your local county social services office with help from staff.
You will need identification, proof of California residency such as a utility bill or lease, and income documentation like recent pay stubs or tax returns. The application asks about every household member, including dates of birth, employment details, and tax filing status. The county must process your application within 45 days, or 90 days if eligibility depends on establishing a disability.
Once approved, you receive a packet listing the managed care health plans available in your county and have 30 days to pick one. If you don’t choose, Medi-Cal assigns a plan for you.14Covered California. Using Your Medi-Cal Coverage Before deciding, check that your current doctors and any specialists you see are in each plan’s network.
Keeping Your Coverage
Medi-Cal coverage currently renews every 12 months. Your county tries to verify your eligibility automatically using available data (called ex parte renewal). If it can confirm you still qualify without contacting you, coverage continues seamlessly. If it can’t, you receive a renewal form in the mail that you need to complete and return within at least 30 days.
Missing the renewal deadline is one of the most common reasons people lose coverage. Keep your mailing address current with your county office and respond quickly to any correspondence. If a renewal form doesn’t arrive when you expect it, contact your county or log in to BenefitsCal.
Starting January 1, 2027, adults in the Medicaid expansion group (those who qualify under the 138% FPL standard) will face eligibility checks every six months instead of every twelve. Children, pregnant individuals, seniors, and people with disabilities stay on the 12-month cycle.15Medicaid.gov. Implementation of Eligibility Redeterminations – Section 71107 of the Working Families Tax Cut Legislation The state must still attempt ex parte renewal first and give you at least 30 days to return any requested information before terminating coverage.
Estate Recovery After Death
One rule catches families off guard. Federal law requires every state to seek recovery from the estates of deceased Medi-Cal beneficiaries who were 55 or older when they received certain services: nursing facility care, home and community-based services, and related hospital and prescription costs.16Office of the Law Revision Counsel. 42 USC 1396p – Liens, Adjustments and Recoveries, and Transfers of Assets Recovery also applies to beneficiaries of any age who were permanently institutionalized in a nursing facility.
California limits recovery to assets that pass through probate, so property held in living trusts, joint tenancies, and similar probate-avoiding arrangements is generally out of reach. Recovery is completely barred if the beneficiary is survived by a spouse, registered domestic partner, a child under 21, or a blind or disabled child of any age. The state cannot recover more than the total Medi-Cal benefits paid or the value of the estate, whichever is less.
Your home is typically exempt while you are alive and on Medi-Cal, but it becomes the main target for recovery after death if it passes through probate and no exempt survivor exists. Anyone receiving or anticipating long-term care services should talk with an attorney about how property is titled and whether a trust makes sense before any claim arises.