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 11.3 million citizens were enrolled in Medi-Cal as of October 30, 2014, or about 30% 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 became 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]

Medi-Cal health benefits include ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder treatment, dental, vision, and long term care and supports. [5]

Many of these benefits for most beneficiaries are contracted out to Medi-Cal Managed Care organizations. Dental benefits and mental health benefits for the seriously and persistently mentally ill are universally excluded from Medi-Cal Managed Care contracts. California has several models of Medi-Cal Managed Care which are designated at the county level: County Organized Health System model with one health plan per county, "Two Plan Model" with one community health plan and one commercial health plan in the county, Geographic Managed Care model with multiple plans per county, Regional Managed Care model, with 1-2 commercial health plans in many counties, and two unique one-county models in San Benito and Imperial counties. [6] [7]

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.[8][9] C4Yourself and CalWIN are statewide online application systems that allows you to apply for benefits.[10][11]

Law[edit]

Federal law mostly consists of the Social Security Amendments of 1965 which added Title XIX to the Social Security Act,[13] and state law mostly consists of Chapter 7, Part 3, Division 9 of the California Welfare and Institutions Code (WIC).[14] Federal regulations are mostly found in Subchapter C, Chapter IV, Title 42 of the Code of Federal Regulations (CFR),[15] and state regulations are contained in Division 3, Title 22 of the California Code of Regulations (CCR).[16] C4Yourself is a program of the California Statewide Automated Welfare System (SAWS) Consortium IV Joint Powers Authority.[17]

Costs[edit]

Medi-Cal costs are estimated at $73.9 billion ($16.9 billion in state funds) in 2014-15. For comparison, the entire California state budget in 2014-2015 is $156 billion, of which about $108 billion was general funds (not allocated for special expenditures, such as bonds).[18] 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.[19]

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.[20]

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.[21] County indigent medical programs can be categorized as California Medical Service Program (CMSP) and Medically Indigent Service Program (MISP) counties.[22] 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 transitions to Medi-Cal when the Patient Protection and Affordable Care Act took effect in 2014.[23]


See also[edit]

References[edit]

  1. ^ http://www.californiahealthline.org/capitol-desk/2014/11/medical-jumps-to-11-3-million
  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. ^ http://www.dhcs.ca.gov/services/medi-cal/Documents/Benefits%20Chart.pdf, California DHCS summary of Medi-Cal Benefits.
  6. ^ "Medi-Cal Managed Care Models". Retrieved 6 December 2014. 
  7. ^ "Medi-Cal Managed Care Division". Retrieved 6 December 2014. 
  8. ^ WIC § 10800 et seq.
  9. ^ 22 CCR § 50004
  10. ^ "County Offices to Apply for Medi-Cal". California Department of Health Care Services. Retrieved 18 January 2013. 
  11. ^ "Consolidating California’s Statewide Automated Welfare Systems". California Legislative Analyst's Office. 13 February 2012. Retrieved 18 January 2013. 
  12. ^ "Medi-Cal Managed Care Health Plan Directory". 
  13. ^ 42 U.S.C. § 1396 et seq.
  14. ^ WIC § 14000 et seq.
  15. ^ 42 C.F.R. 430 et seq.
  16. ^ 22 CCR § 50005
  17. ^ WIC § 10823 et seq.
  18. ^ Governor's Office Enacted 2014-2015 California State Budget summary., June 2014
  19. ^ Gorn, David. "Legislature Backs Bill Pushing State To Accept $6 Million Medi-Cal Grant". Retrieved 17 September 2014. 
  20. ^ The California Partnership
  21. ^ "Understanding County Health Services in California: A Brief Overview". Institute for Local Government. Retrieved 2012-10-08. 
  22. ^ "County Programs for the Medically Indigent in California" (PDF). California HealthCare Foundation. 1 October 2009. Retrieved 20 November 2012. 
  23. ^ DHCS Research and Analytic Studies Division. "MEDI-CAL MONTHLY ELIGIBLES TREND REPORT FOR JANUARY 2014". 

External links[edit]