FAQs

Medi-Cal is a complex public health insurance program made up of many separate smaller programs designed to assist families and individuals obtain affordable medical services.  The information you provide on your Medi-Cal application and any required verifications you submit are used to determine the Medi-Cal program(s) for which you might qualify and which program may be most appropriate for you and your family.

People in many different situations qualify for Medi-Cal. Some are listed below:

• 65 years of age or older
• Blind
• Disabled
• Under 21 years of age
• Pregnant
• Diagnosed with breast or cervical cancer
• In a skilled nursing or intermediate care facility
• Refugee status during a limited period of eligibility. (Adult refugees may not be eligible depending upon how long they have been in the U.S.)
• Parent or caretaker relative of a child under 21, and
  • The child’s parent is deceased or doesn’t live with the child, or
  • The child’s parent is incapacitated, or
  • The child’s parent, who is the primary wage earner, is unemployed or underemployed.

When the County receives your application, it will be assigned to an Eligibility Technician (ET). The worker will review your application and determine if additional information is needed. Once the Eligibility Technician (ET) has all of the necessary information, he or she will determine if you are eligible for Medi-Cal. You will get a letter in the mail telling you if your Medi-Cal application is approved or denied. If you do not understand this letter or do not agree with the information in this letter you should contact your Eligibility Technician (ET). If you want to meet with your worker to discuss your application, call your worker to set up an appointment. However, anyone can help you with the application process --- a family member, friend, or anyone else of your choice.

Forty-five (45) days are allowed to process a Medi-Cal application not involving a disability. If you are applying for Medi-Cal based on a disability, your application process may take up to 60 days or longer. To avoid delays in the processing of your case, submit all information requested of you as soon as possible. Ask your Eligibility Technician (ET) for help if you are having trouble obtaining information.

It depends.

• If your income is less than Medi-Cal limits for your family size, you will receive Medi-Cal services at no cost to you.
• If your income is more than Medi-Cal limits for your family size, you will have to pay a certain amount only in the month you have medical expenses. The amount that you pay is called your share of cost (SOC). When you pay or promise to pay that amount, we say that you have met your SOC. Once you have met your SOC, Medi-Cal will pay the rest of your covered medical bills for that month.

Cal-Optima is the managed care program that administers Medi-Cal benefits in Orange County. Once your Medi-Cal application is approved, you will receive enrollment information from Cal-Optima and at that time you will be able to choose a health care provider.

Any bill received 3 months prior to your application for Medi-Cal may be covered by requesting Retroactive Medi-Cal Coverage. In addition, certain unpaid, old medical bills can be used to reduce your Medi-Cal share of cost (SOC).

If you receive SSI/SSP payments, your Social Security Administration (SSA) Office automatically sets up Medi-Cal for you. No separate application for Medi-Cal is needed. People not receiving SSI/SSP must apply for Medi-Cal with the county Social Services Agency (SSA). The Social Security Administration is in no way affiliated with the county Social Services Agency.

Medicare is a federal health insurance program available to most people 65 years of age or older, certain disabled or blind persons, regardless of income. Medicare is administered though the Social Security Administration. The county Social Services Agency does not process applications for Medicare benefits.

The name, worker number, and telephone number of your Eligibility Technician (ET) may be found at the top right-hand corner of all Notices of Action sent to you.

• Social Services Agency Office Locations

You may request a duplicate renewal/reinvestigation packet by contacting your worker or your local Medi-Cal office.

• Social Services Agency Office Locations

To change your address, contact your worker or your local Medi-Cal office.

• Social Services Agency Office Locations

If you are an adult between the ages of 19 to 64 with annual income between 138% and 200% of the Federal Poverty Level, do not have dependent children in the home, and you are not blind or disabled, you may still qualify for help through the Medical Safety Net (MSN) Program. For information about that program, please call 714-834-6248.

There are various programs available that provide Cash Assistance.