Medi-Cal Forms, Information, Income Eligibility Levels
Get help completing the Medi-Cal annual renewal paperwork from local county organizations.
2023 Medi-Cal Income Eligibility Levels by Household Size
Medi-Cal Income Limits Increase Over 6%, 138% and 266% FPL explained.
Asset Increase For Non-MAGI Medi-Cal
2022 Medi-Cal Income Federal Poverty Levels
Medi-Cal Announces 5% Increase to Income Amounts
2020 FPL Income Level Charts for Medi-Cal
Annual Income Charts
Monthly Income Charts
Learn more about MAGI Medi-Cal in this YouTube Video
Countable Sources for MAGI Medi-Cal Income
Countable_Sources_Income 2020 Covered California
2020 guide to countable sources of income from Covered California for the Modified Adjusted Gross Income based on revised federal income tax form 1040 for 2019.
Individuals and families enrolled in Medi-Cal can create online accounts to report changes and upload documents.
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HMO Medi-Cal Member Handbooks
The Member Handbooks are also known as the Evidence of Coverage and detail how the Medi-Cal plan operates. Some counties offer several health plans in which you can enroll into. The EOC documents are not updated every year. There may be a newer EOC handbook listed on the health plans website.
Common Medi-Cal Forms and Notices
Below are some common forms that apply to MAGI Medi-Cal or eligibility for Medi-Cal based solely on your Modified Adjusted Gross Income (MAGI) that you might receive or need to submit to your county social services department. These forms are periodically updated so check with your county office to make sure you have the most up to date MCxxx form number.
$35: = Maintenance Need for Resident in LTC Facility
100% FPL:
= Qualified Medicare Beneficiary (QMB) Program; and
= Children Ages 6 Up to 19 Percent Program (Pre ACA); and = FPL Program for Aged and Disabled; and
= Section 1931 for certain Recipient’s (Pre ACA)
108% FPL: = Floor ACA Title XXI CHIP Expansion Children Ages 6-19
109% FPL:
= ACA Parents and Caretaker Relatives 114% FPL:
= ACA Parents and Caretaker Relatives not eligible for the ACA New Adult Group due to non-financial eligibility criteria such as enrollment in Medicare Parts A or B (109% FPL, plus 5% MAGI disregard)
120% FPL: < Specified Low-Income Medicare Beneficiaries (SLMB)
128% FPL: = Disabled Individuals in New Adult Group *ACWDL will be released when implemented
133% FPL:
= Children Ages 1-6 (Pre ACA)
= ACA Children and Title XXI Expansion Children Ages 6-19
135% FPL: < Qualified Individual 1 Program (QI-1)
138% FPL: = ACA New Adults Ages 19-64
138% FPL and below: = Full Scope Coverage for ACA Pregnant Women Above
138% – 213% FPL: = Pregnancy Related Medi-Cal Above
213% – 322% FPL: = Medi-Cal Access Program (MCAP)
142% FPL: = ACA Children Ages 1-6
150% FPL: = Target Low Income Program (Pre ACA)
160% FPL: = ACA OTLIC Program
185% FPL: = Transitional Medi-Cal (TMC) (Pre ACA)
200% FPL:
= Qualified Working Disabled Individuals; and
= Pregnant Women and Infants Up to Age 1 (disregard is in the 200% FPL) (Pre ACA)
= Refugee Medical Assistance (RMA)
202% FPL: = Transitional Medi-Cal (TMC) (Post ACA) *ACWDL will be released when implemented
208% FPL: = ACA Infants Ages 0-1
213% FPL: > Floor for ACA MCAP Linked Infants (OTLIC)
= ACA Pregnant Women and Infants Up To Age 1 (with 5% earned income disregard included)
250% FPL: = Optional Targeted Low Income Children (Pre ACA), and for Working Disabled Program
266% FPL:
= ACA Optional Targeted Low Income Children (OTLIC)
Above 266%-322% FPL: = County Childrens Health Initiative Pro
322% FPL: = ACA MCAP Linked Infants
Notes:
“=” means: eligible if budget unit income is equal to or less than income limit
“<” means: eligible if budget unit income is less than income limit
“>” means: eligible if budget unit income is greater than income limit
For applicants and recipients of the Medicare Savings Programs (MSPincludes Qualified Medicare Beneficiary, Specified Low Income Beneficiary and Qualified Individual 1 Programs) not receiving RSDI Title II income, the FPL figures are effective January 1, 2017, beginning the month of publication for MSP applicants or recipients receiving RSDI Title II income, the new FPL figures are effective March 1, 2017.
Medi-Cal Essentials presentation
This is presentation given by the Department of Health Care Services to Certified Insurance Agents on how Medi-Cal works with Covered California. The full webinar may be view from a link on the Covered California CIA webpage http://hbex.coveredca.com/agents/webinars/
Links to consumer resource pages for Medi-Cal
Medi-Cal: Department of Health Care Services, main page
- http://www.dhcs.ca.gov/Pages/default.aspx
County Offices to Apply for Health Coverage, Medi-Cal, and Other Benefits
ACA and Medi-Cal FAQs
Medi-Cal covered benefits
Medi-Cal managed care health plans by county
