Medi-Cal is California’s Medicaid program, providing free or low-cost health coverage to roughly 14 million residents who meet income and, for some groups, asset requirements. It covers doctor visits, hospital care, prescription drugs, dental, vision, and mental health treatment, and most enrollees pay nothing out of pocket. The program is run by the California Department of Health Care Services (DHCS) and funded jointly by the state and the federal government, with California covering a wider range of services than most other state Medicaid programs.
How Coverage Is Delivered
About 95 percent of enrollees receive care through a managed care plan rather than traditional fee-for-service.1California Department of Health Care Services. Medi-Cal Monthly Eligible Fast Facts Under managed care, you’re assigned to a health plan with its own network of doctors, hospitals, and specialists. You pick a primary care provider who handles your general care and refers you out when you need a specialist. Fee-for-service, which lets you see any provider who accepts Medi-Cal, is now limited mainly to people with complex medical situations or those in areas without good managed care options.
Prescriptions work differently from the rest of your care. Pharmacy benefits run through Medi-Cal Rx, a statewide fee-for-service program administered by DHCS, so you fill prescriptions at any participating pharmacy regardless of which managed care plan you’re in.2Medi-Cal Rx. Medi-Cal Rx Home
Several specialized programs sit alongside standard Medi-Cal. California Children’s Services covers treatment for children under 21 with serious physical conditions like congenital heart disease, cancer, cerebral palsy, and sickle cell anemia.3California Department of Health Care Services. Information About California Children’s Services The Medi-Cal Access Program provides maternity coverage with no copays or deductibles for pregnant individuals whose income is too high for regular Medi-Cal but still within 322 percent of the federal poverty level.4California Department of Health Care Services. Medi-Cal Access Program Home and Community-Based Services waivers help seniors and people with disabilities get long-term care at home instead of in a nursing facility.
Who Qualifies
Most people qualify based on Modified Adjusted Gross Income (MAGI) measured against the federal poverty level (FPL). For 2026, the FPL is $15,960 per year for a single person and $33,000 for a family of four.5HHS ASPE. 2026 Poverty Guidelines The income ceiling depends on your category:
- Adults without dependents: up to 138% of FPL (about $22,025 per year for one person)
- Parents and caretaker relatives: up to 109% of FPL
- Children under 19: up to 266% of FPL (roughly $42,450 for one child)
- Pregnant individuals: up to 213% of FPL
These thresholds have held steady across recent years.6Covered California. Household Eligibility by Federal Poverty Level You also have to be a California resident, provable with a utility bill, rental agreement, or government-issued ID. Immigration status no longer disqualifies anyone: since January 1, 2024, California has offered full-scope Medi-Cal to all income-eligible adults regardless of immigration status, completing a phased expansion that previously covered only those under 26 and those 50 and older.7Medi-Cal. Ages 26 Through 49 Adult Full Scope Medi-Cal Expansion
Some groups get Medi-Cal automatically. Supplemental Security Income (SSI) recipients are enrolled without a separate application.8Social Security Administration. Supplemental Security Income in California Former foster youth qualify until age 26 regardless of income.9California Department of Health Care Services. Former Foster Youth Program CalWORKs cash-assistance recipients are automatically enrolled too. The Medically Needy program covers people whose income exceeds normal limits but who have high medical expenses, with a monthly share of cost that works like a deductible.
Asset Rules for Older Adults and People with Disabilities
If you’re applying based on income alone, assets don’t come into the picture. But starting January 1, 2026, California reinstated asset limits for non-MAGI programs: the Aged, Blind, and Disabled program, Share of Cost Medi-Cal, the Working Disabled Program, long-term care, and Medicare Savings Programs.10California Department of Health Care Services. Asset Limits FAQs The limit is $130,000 for an individual, plus $65,000 for each additional household member.
Countable assets include cash, bank account balances, second vehicles, and real property you don’t live in. Several big-ticket items are exempt: your primary home if you live in it, one vehicle, personal household goods, and retirement account balances as long as you’re taking regular distributions. The distributions themselves count as income, but the account balance doesn’t count toward the asset limit.
Current enrollees won’t be asked about assets until their 2026 annual renewal. New applicants have to report them on the application, and exceeding the limit means denial. SSI recipients and people in the expansion categories (younger adults and children) aren’t affected by the new rule, and SSI follows its own much lower $2,000 limit. Transferring assets after January 1, 2026, to get under the cap can trigger a penalty period that delays coverage.10California Department of Health Care Services. Asset Limits FAQs
What Medi-Cal Covers
Nearly all covered care comes at no cost to the enrollee. Some beneficiaries have small copayments, but total copayments can’t exceed 5 percent of household income in a year.11California Department of Health Care Services. Medi-Cal Changes 2026-2028
Doctor visits, preventive screenings, vaccinations, chronic condition management, and treatment for illnesses are all included. Telehealth is available for non-emergency visits. Hospital care covers inpatient stays, outpatient procedures, surgeries, emergency room visits, maternity care, neonatal intensive care, and psychiatric hospitalization. Emergency care is covered even at out-of-network hospitals, a federal requirement for all Medicaid programs. Planned procedures may require prior authorization.
Prescription coverage through Medi-Cal Rx includes most generics at no cost. Brand-name drugs may require prior authorization or step therapy (trying a standard treatment first). Prenatal vitamins, smoking cessation aids, and other over-the-counter items are covered when a provider prescribes them.
California is one of the few states that provides comprehensive dental benefits to adult Medicaid enrollees. Medi-Cal Dental (formerly Denti-Cal) covers cleanings, exams, fillings, root canals, extractions, dentures, and other restorative work.12California Department of Health Care Services. Medi-Cal Dental Finding a dentist who accepts Medi-Cal can be harder than finding a medical provider, especially for specialty work. Children get full dental benefits including orthodontics when medically necessary.
Vision benefits for adults include a routine eye exam and one pair of eyeglasses every 24 months, plus treatment for eye disease and medically necessary contact lenses.13California Department of Health Care Services. Medi-Cal Vision Benefits Children are covered more frequently.
Mental health care includes outpatient therapy, psychiatry, and medication management through your managed care plan. More serious conditions are handled by your county’s specialty mental health plan, which provides crisis intervention, day treatment, and residential care. Substance use treatment, including detox, residential programs, outpatient counseling, and medication-assisted treatment, runs through the county’s Drug Medi-Cal system.
One important limit to understand: Medi-Cal covers emergency and urgent care anywhere in the United States, but routine and preventive care are not covered outside California.14Legal Information Institute. California Code of Regulations Title 22 Section 51006 – Out-of-State Coverage International coverage is limited to emergency hospitalization in Canada or Mexico. If you travel or go out of state for school, don’t expect Medi-Cal to cover anything beyond true emergencies.
How to Apply
You can apply online through Covered California, by phone or in person at your county social services office, or by mail. The online route is the fastest; it gives you an initial eligibility determination and sends your application to the county for processing. County offices are better if your situation is complicated, like a disability claim, share of cost, or long-term care application, because an eligibility worker can walk you through the paperwork.
Have ready proof of income (pay stubs or tax returns), residency (utility bill, lease, or government mail), and household composition. Non-citizens need immigration documents. The county cross-checks what you report against tax and employment databases, so discrepancies can delay things. Standard processing takes up to 45 days, or up to 90 days when a disability determination is involved.
If you need care immediately, Hospital Presumptive Eligibility can give you temporary Medi-Cal for up to 60 days while your full application is processed.15California Department of Health Care Services. Hospital Presumptive Eligibility Program A qualifying hospital decides on the spot whether you likely meet income requirements and enrolls you in fee-for-service coverage that same day. You still need to submit a full application to keep coverage past the presumptive period.
Keeping Your Coverage
Medi-Cal renews once a year. In many cases the county can verify your continued eligibility automatically from tax records and wage data, and you’ll get a notice that coverage continues without needing to do anything. When automatic verification doesn’t work, you’ll get a renewal packet asking for updated information.
Miss the deadline on that packet and your coverage will be terminated, though there’s a 90-day reconsideration window during which you can submit the missing documents and have benefits reinstated without a gap. Starting in 2026, renewal is also when the county will first check assets for people in non-MAGI programs, so anyone in Aged, Blind, and Disabled or the other affected categories should expect to report financial information they haven’t had to disclose before.16California Department of Health Care Services. County Welfare Directors Letter 26-02
If Medi-Cal denies, cuts, or ends your coverage, you can appeal. For managed care enrollees, start with a plan appeal within 60 calendar days of the notice, then escalate to a state hearing through the California Department of Social Services within 120 days of the plan’s decision if needed.17California Department of Social Services. Hearing Requests Requesting a hearing quickly after a reduction or termination notice can keep your current benefits in place during the appeal.
Estate Recovery
One feature of Medi-Cal that catches many families off guard: after a beneficiary who was 55 or older passes away, the state can seek reimbursement from the estate for certain services paid during their lifetime, mainly nursing home care, hospital and prescription costs, and other covered services received at age 55 or older.18California Department of Health Care Services. Estate Recovery Program
Several protections block recovery entirely. DHCS cannot recover from the estate of anyone survived by a spouse or registered domestic partner. Recovery is also blocked when a surviving child is under 21 or is blind or disabled at any age. A sibling who holds equity in the beneficiary’s home and lived there for at least a year before the beneficiary entered a nursing facility is protected too.
When none of those exemptions apply, heirs can request a hardship waiver from DHCS within 60 days of the claim letter. The waiver can reduce or eliminate the claim if enforcement would cause substantial hardship to dependents, heirs, or survivors, and a denial can be appealed through an estate hearing. For anyone considering long-term care through Medi-Cal, this is worth understanding well before a health crisis forces the decision.