[title-subtitle-heading subtitle=”Healthcare Coverage For Your Family”]Medi-Cal[/title-subtitle-heading]

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Medi-cal is California’s state Medicaid program. 8 million people in California are already signed up for free or discounted healthcare.

At Open Door we believe everyone has the right to quality health care! Our Member Services Department can help you sign up for Medi-Cal, and other programs, to assist you and your family in supporting your overall health and wellness.

Call the Humboldt County phone line at (707) 269-7057 or the Del Norte line at (707) 465-1988, for assistance.

You do not have to be a patient of Open Door to work with our Member Services staff to find coverage, and assistance is free.
We can help you navigate MediCal, CoveredCA.com the Insurance Marketplace, CalFresh and More!
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Covered California

Medi-Cal Basics

Expanded Coverage

Medi-Cal, as a health insurance program, has been covering Californians who couldn’t afford health care since 1966. As of 2013, there were 8.5 million people enrolled. Under the Patient Protection and Affordable Care Act, Medi-Cal coverage will expand in 2014, making 1 million to 2 million new people eligible. In recent surveys, most current individuals enrolled in Medi-Cal reported having a positive experience with the program and agreed that Medi-Cal provides access to high-quality care.

Beginning Jan. 1, 2014, single adults without children, ages 19-64, will be eligible for Medi-Cal. Enrollment for Medi-Cal coverage for these individuals began on Oct. 1, 2013. Coverage for these new enrollees begins Jan. 1, 2014.

For all Medi-Cal applicants, there are new, simplified procedures for Medi-Cal eligibility that also begin Jan. 1, 2014. Eligibility is based upon income, as required by the Affordable Care Act. To verify income and other eligibility data, faster, more convenient electronic methods will be used whenever possible. Medi-Cal still accepts applications and enrolls individuals who qualify using the eligibility procedures that were in place before the Affordable Care Act expansion. Periodic redetermination of eligibility for those who are enrolled will also be much simpler and will be done electronically whenever possible.

What services will Medi-Cal provide for me?

Medi-Cal covers a core set of services, including doctor visits, hospital care and pregnancy-related services, as well as nursing home care for individuals age 21 or older. The Affordable Care Act ensures all Medi-Cal health plans offer a comprehensive package of items and services, known as essential health benefits. Essential health benefits must include:

  • Ambulatory patient services.
  • Emergency services.
  • Hospitalization.
  • Maternity and newborn care.
  • Mental health and substance use disorder services, including behavioral health treatment.
  • Prescription drugs.
  • Rehabilitative and habilitative services and devices.
  • Laboratory services.
  • Preventive and wellness services and chronic disease management.
  • Pediatric services (including oral and vision care).

Starting in 2014, the array of mental health and substance use disorder services will expand to better meet the needs of individuals eligible for Medi-Cal. All Medi-Cal beneficiaries who qualify will be able to receive the following mental health benefits through Medi-Cal managed care plans and Medi-Cal fee-for-service:

  • Individual and group mental health evaluation and treatment (psychotherapy).
  • Psychological testing when clinically indicated to evaluate a mental health condition.
  • Outpatient services for the purposes of monitoring drug therapy.
  • Outpatient laboratory, drugs, supplies and supplements.
  • Psychiatric consultation.
  • Specialty mental health services currently provided by county mental health plans will continue to be available.
  • Substance use disorder services benefits.
  • Voluntary inpatient detoxification.
  • Intensive outpatient treatment services.
  • Residential treatment services.
  • Outpatient drug-free services.
  • Narcotic treatment services.

Dental care, vision services and speech therapy are generally available only to children and youths under age 21, but certain adults and pregnant women are also eligible for these services. Dental services will be available to all adults starting in May 2014.

These are all services that Medi-Cal covers today and will continue to cover for current and new enrollees.

Do I qualify for Medi-Cal?

The Medi-Cal expansion starting on Jan. 1, 2014, will open the door for a few million more low-income Californians under age 65 who are currently ineligible for coverage. To be eligible, your annual income must be 138 percent of the federal poverty level or less (in 2013 that would mean an individual who earned $15,856 or less).

The Medi-Cal expansion also allows coverage for parents who would lose coverage under current rules if their income slightly exceeds the federal poverty level.