An application for Medi-Cal can be obtained by calling your local office of the Department of Public Social Services  (DPSS) (DPSS Office Locations) to request one be mailed, or by visiting the office and picking up the application.

Instructions for completing the application are provided.  It is important to answer every question.  If help filling out the application is needed, contact the local DPSS office.

After completing the application, either return it to the local DPSS office by mail or in person.  For faster service, please include the following with the application:

• Proof of the identity of the head of household
• Proof of U.S. Citizenship or U.S. Nationalization and identification for all applicants. Go to http://www.dhcs.ca.gov/services/medi-cal/pages/dra.aspx.
• Social Security  number for each person for whom application is made
• Proof of income
• Proof of the value of real and personal property

An eligibility technician (ET) will be assigned to process the application.  If additional documents or proof of circumstances are needed, the ET will request them. 

When eligibility to Medi-Cal is determined, a letter, called a Notice of Action, is sent to advise the applicant of the approval for or denial of benefits.

If an applicant disagrees with any action taken by the county, there is an appeals process known as a State Hearing.  Instructions for requesting a State Hearing are on the back of any Notice of Action sent by the county.

If urgent medical help is needed, do not wait to apply for Medi-Cal.  The Riverside County Regional Medical Center in Moreno Valley can provide emergency service.  http://www.rcrmc.org/

Healthy Families Program

• Low-cost health coverage for children ages 0 – 19.
• Obtain a mail-in application by calling 1-888-747-1222 or by answering “yes” on question 59 of the regular Medi-Cal application.

Access for Infants and Mothers (AIM)

• Provides health care to pregnant women, at least 30 weeks into the pregnancy, whose income is too high to qualify for no-cost Medi-Cal.
• To obtain an application call 1-800-433-2611.

BabyCal

• Provides pregnant women with early and ongoing prenatal care.
• To obtain information about BabyCal call 1-800-BABY-999 or 1-800-222-9999.

Child Health Disability Prevention (CHDP)

• Provides preventative health screening examinations to children whose family income is at or below 200% of the Federal Poverty Level (FPL)  For more information about the FPL click here.
• To obtain more information about CHDP call 951-358-5481.

Women, Infants and Children (WIC) Supplemental Nutrition Program

• Provides assistance for nutritional supplements for low-income pregnant and breast-feeding women, infants, and children up to age 5 who have a medical or nutritional risk.
• To obtain more information about WIC call 951-358-5311.

Family Planning Services

• Provides information and options for family planning and birth control.
• Services are provided at low or no cost.
• To obtain more information about family planning call 1-800-942-1054.
• The Family Planning Access Care and Treatment (Family PACT) provides free breast and cervical cancer screening services.  To obtain more information call 1-800-511-2300.

250 Percent Working Disabled Program allows persons that meet the federal definition of disability but are still working to buy into the Medi-Cal program by paying monthly premiums on a sliding scale based on their income.

Long-Term Care (LTC) provides care for the aged and persons with disabilities who may reside in a skilled nursing or intermediate care facility.  Long-term care is associated with several individual Medi-Cal programs. http://aspe.hhs.gov/poverty/04poverty.shtml

Medicare Recipient Programs

• Qualified Medicare Beneficiary (QMB) pays for the Medicare Part A and B premiums, co-insurance and deductibles.  Qualified families must have income at or below 100% of the Federal Poverty Level.  http://aspe.hhs.gov/poverty/04poverty.shtml

• Specified Low-Income Medicare Beneficiary (SLMB) pays for Medicare Part B premiums if the family income is at or below 120% of the Federal Poverty Level.   http://aspe.hhs.gov/poverty/04poverty.shtml

• Qualifying Individual 1 (QI-1) pays for Medicare Part B premiums for families whose income is between 120% and 135% of the Federal Poverty Level.  http://aspe.hhs.gov/poverty/04poverty.shtml

• Qualified Disabled Working Individual (QDWI) pays the Medicare Part A premium for people who have lost entitlement to free Part A benefits due to substantial employment.  Family income must be at or below 200% of the Federal Poverty Level and the family must be eligible to Medi-Cal under another program. http://aspe.hhs.gov/poverty/04poverty.shtml

Presumptive Eligibility Program

• Provides immediate, temporary medical coverage to encourage early prenatal care for low-income pregnant women.  Family income must be at or below 200% of the Federal Poverty Level.  http://aspe.hhs.gov/poverty/04poverty.shtml

• Enrollment must be done through a Qualified Presumptive Eligibility provider.  Once the Presumptive Eligibility period of eligibility is over, the individual must apply for regular Medi-Cal or CalWORKs to continue to receive coverage.  Click here for more information.  

Income Disregard and Asset Waiver Program (200% Program)

• A pregnant woman’s property is not considered in the eligibility determination when the family’s income is at or below 200% of the Federal Poverty Level. http://aspe.hhs.gov/poverty/04poverty.shtml

Postpartum Program

• A woman who received Medi-Cal benefits on her last day of pregnancy may continue to be eligible to receive pregnancy-related and postpartum services for an additional 60 days beginning on the last day of her pregnancy

Income Disregard Program (200% Program)

• A Medi-Cal program for infants to age one, whose family income is at or below 200% of the federal Poverty Level.  The family’s property is not considered in the eligibility determination. http://aspe.hhs.gov/poverty/04poverty.shtml

133% Program

• A Medi-Cal program for children from age one through six whose family income is at or below 133% of the Federal Poverty Level.  The family’s property is not considered in the eligibility determination. http://aspe.hhs.gov/poverty/04poverty.shtml

100% Program

• A Medi-Cal program for children from age six through nineteen whose family income is at or below 100% of the Federal Poverty Level.  The family’s property is not considered in the eligibility determination. http://aspe.hhs.gov/poverty/04poverty.shtml

• Persons who need kidney dialysis or total parenteral nutrition (TPN) and related services may be eligible for limited Medi-Cal Special Treatment Programs coverage if all the conditions are met and the individual is not receiving Medi-Cal through another program.

Tuberculosis (TB) Services

• Persons who are infected with Tuberculosis (TB) and meet Medi-Cal eligibility requirements may get limited outpatient TB medical services.  Medical clinics or medical providers who serve TB infected persons may assist the individual in applying for Medi-Cal.

Breast and Cervical Cancer Treatment Program (BCCTP)

• Persons in need of breast and/or cervical cancer treatment whose family income is at or below 200% of the Federal Poverty Level may be eligible for treatment services.  http://aspe.hhs.gov/poverty/04poverty.shtml

• The California Cancer Detection Program provides free screening for breast and cervical cancer for uninsured women whose family income is at or below 200% of the Federal Poverty Level.  http://aspe.hhs.gov/poverty/04poverty.shtml

• The BCCTP is a state program.  To obtain more information on this program or for the location of a screening provider near you, call 1-800-824-0088.

• The Family Planning, Access Care and Treatment (Family PACT) program also provides free breast and cervical cancer screening services.  Call 1-800-511-2300.