Medi-Cal

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The California Medical Assistance Program (Medi-Cal or MediCal) is the name of the California Medicaid welfare program serving low-income families, seniors, persons with disabilities, children in foster care, pregnant women, and certain low-income adults. It is jointly administered by the California Department of Health Care Services (DHCS) and the federal Centers for Medicare and Medicaid Services (CMS), with many services implemented at the local level by the counties of California. Approximately 8.8 million citizens were enrolled in Medi-Cal for at least 1 month in 2009-10, or about 23% of California's population.[1]

Eligibility[edit]

Medi-Cal provides health coverage for people with low income and limited ability to pay for health coverage, including the aged, blind, disabled, young adults and children, pregnant women, persons in a skilled nursing or intermediate care home, and persons in the Breast and Cervical Cancer Treatment Program (BCCTP).[2][3][4] People receiving federally funded cash assistance programs, such as CalWORKs (a state implementation of the federal Temporary Assistance for Needy Families (TANF) program), the State Supplementation Program (SSP) (a state supplement to the federal Supplemental Security Income (SSI) program), foster care, adoption assistance, certain refugee assistance programs, or In-Home Supportive Services (IHSS) are also eligible.[2][4]

Beginning in 2014 under the Patient Protection and Affordable Care Act (PPACA), those with family incomes up to 138% of the federal poverty level will become eligible for Medi-Cal (pursuant to 42 U.S.C. § 1396a(a)(10)(A)(i)(VIII)), and individuals with higher incomes and some small businesses may choose a plan in Covered California, California's health insurance marketplace, with potential federal subsidies.

Benefits[edit]

Effective July 2009, Medi-Cal no longer offers Dental Insurance for people over 21 years of age. Medi-Cal has not paid for male neonatal non-therapeutic circumcision since 1982.[5]

Administration[edit]

Medi-Cal is jointly administered by the Centers for Medicare and Medicaid Services (CMS) and the California Department of Health Care Services (DHCS), while the county welfare department in each of the 58 counties is responsible for local administration of the Medi-Cal program.[6][7] C4Yourself and CalWIN are statewide online application systems that allows you to apply for benefits.[8][9]

Law[edit]

Federal law mostly consists of the Social Security Amendments of 1965 which added Title XIX to the Social Security Act,[10] and state law mostly consists of Chapter 7, Part 3, Division 9 of the California Welfare and Institutions Code (WIC).[11] Federal regulations are mostly found in Subchapter C, Chapter IV, Title 42 of the Code of Federal Regulations (CFR),[12] and state regulations are contained in Division 3, Title 22 of the California Code of Regulations (CCR).[13] C4Yourself is a program of the California Statewide Automated Welfare System (SAWS) Consortium IV Joint Powers Authority.[14]

Costs[edit]

Medi-Cal costs were estimated at $34.1 billion ($12.9 billion in state funds) in 2005-06.[15][16] For comparison, the entire California state budget in 2005-06 was $113 billion, of which about $90 billion was general funds (not allocated for special expenditures, such as bonds).[17] In September 2014, California government enacted Bill SB 18 that will require the state to accept $6 million grant from the California Endowment, matched with federal grant, to assist the enrollment program.[18]

Related programs[edit]

Medi-Cal with the assistance from the Robert Wood Johnson Foundation created The California Partnership for Long-Term Care. The goal is to protect Californians from being forced to spend everything they have worked for on long-term care, and to prevent or delay dependence on Medi-Cal.[19]

Covered California[edit]

Main article: Covered California

Covered California is the health insurance marketplace in California, the state's implementation of the American Health Benefit Exchange provisions of the Patient Protection and Affordable Care Act.

Indigent health programs[edit]

Since 1933, California law has required counties to provide relief to the poor, including health care services and general assistance.[20] County indigent medical programs can be categorized as California Medical Service Program (CMSP) and Medically Indigent Service Program (MISP) counties.[21] There are 34 CMSP counties and 24 MISP counties. The CMSP county programs are largely managed by the state, whereas MISP counties manage their own programs with their own rules and regulations. Many patients from both the CMSP and MISP county programs are expected to transition to county LIHP / MCE / HCCI programs and eventually to Medi-Cal / Medicaid when the ObamaCare provisions take effect in 2014.

See also[edit]

References[edit]

  1. ^ http://www.dhcs.ca.gov/dataandstats/statistics/Documents/2_1_Reporting_Year_FY2009-10.pdf
  2. ^ a b O'Shaughnessey 2001, footnote 1, pg. 25.
  3. ^ O'Shaughnessey 2001, p. 6.
  4. ^ a b http://www.dhcs.ca.gov/services/medi-cal/Pages/Medi-CalEligibility.aspx
  5. ^ Adler, Peter W. (December 2011). "Is it lawful to use Medicaid to pay for circumcision?". Journal of Law and Medicine 19 (2): 335–353. OCLC 30122918. PMID 22320007. 
  6. ^ WIC § 10800 et seq.
  7. ^ 22 CCR § 50004
  8. ^ "County Offices to Apply for Medi-Cal". California Department of Health Care Services. Retrieved 18 January 2013. 
  9. ^ "Consolidating California’s Statewide Automated Welfare Systems". California Legislative Analyst's Office. 13 February 2012. Retrieved 18 January 2013. 
  10. ^ 42 U.S.C. § 1396 et seq.
  11. ^ WIC § 14000 et seq.
  12. ^ 42 C.F.R. 430 et seq.
  13. ^ 22 CCR § 50005
  14. ^ WIC § 10823 et seq.
  15. ^ Solis, Beatriz Maria (2007), Medi-Cal Managed Care Enrollees: Diverse Experiences and Perceptions About the Health Care System, p. 5 
  16. ^ Kaiser Commission on Medicaid, 2007
  17. ^ Major Features of the 2005 California Budget, California Legislative Analyst's Office, July 2005
  18. ^ Gorn, David. "Legislature Backs Bill Pushing State To Accept $6 Million Medi-Cal Grant". Retrieved 17 September 2014. 
  19. ^ The California Partnership
  20. ^ "Understanding County Health Services in California: A Brief Overview". Institute for Local Government. Retrieved 2012-10-08. 
  21. ^ "County Programs for the Medically Indigent in California" (PDF). California HealthCare Foundation. 1 October 2009. Retrieved 20 November 2012. 

External links[edit]