Who Qualifies for Medi-Cal in California? 2025

Receiving medical care can be expensive, especially for low-income individuals and families who are already pinching pennies. California offers Medi-Cal, which is known as Medicaid in other areas of the United States, for those who need coverage due to various life circumstances, including low income. Because Medi-Cal can be complicated, it may leave you wondering who qualifies for Medi-Cal in California.

Medi-Cal has strict provisions and laws that govern how it is used and who qualifies. A California Medi-Cal planning lawyer understands the ins and outs of the ever-changing qualifications and can help you understand how it applies to your particular situation.

Medi-Cal Coverage

Medi-Cal is California’s public health insurance program that benefits low-income individuals, children, those who are pregnant, and Social Security recipients, including Medicare recipients with limited resources who need help with premiums and out-of-pocket costs. Applicants must provide proof of residence, but it is available to everyone, regardless of immigration status.

Around 41% of Los Angeles residents are covered by Medi-Cal. Nearly half of the population can use Medi-Cal to help pay for medical care, such as:

• Doctor visits
• Maternity and newborn care
• Emergency room visits
• Mental health services
• Prescriptions
• Vaccines
• Eyeglasses
• Dental care
• Hearing aids
• Nursing home stays
• Skilled nursing facilities
• Home visits
• Transportation

According to the Department of Healthcare Services (DHCS), one-third of California residents are enrolled in Medi-Cal, with 88% on the Medi-Cal managed care plan and 12% on the fee-for-service delivery system. If you have questions about Medi-Cal eligibility or how to apply, a Medi-Cal planning lawyer can help.

Long-Term Care Eligibility on Medi-Cal

Medi-Cal covers multiple long-term care options for individuals who are over 65 years old. You can qualify for:

• Institutional or Nursing Home Medicaid, which doesn’t have an income or asset limit
• Medicaid Waivers or Home and Community Based Services, which has an income limit of $1,801 and no asset limit for a single individual
• Regular Medi-Cal with an income limit of $1,801 for a single individual

If you have questions about your eligibility or how to protect your assets, an experienced Medi-Cal planning lawyer could help.

Hire a Medi-Cal Planning Lawyer

Anyone can apply in person at a local DHCS building, like the one on Hamilton Avenue in Torrance, CA. While hiring a lawyer who often works on Medi-Cal planning cases isn’t required, their particular skill set can provide you with a number of benefits.

1. Medi-Cal planning laws are often changing, so making informed choices can be tricky. An experienced Medi-Cal planning lawyer follows these changes carefully and can guide you according to current regulations. This can help ensure you aren’t disqualified for an old understanding of the law.
2. A Medi-Cal planning lawyer can help remove the headache of applying for Medi-Cal by handling the paperwork and the legal matters for you.
3. Every situation is different. A lawyer has the experience necessary to help you in your specific, unique circumstances. They can explain your rights, how to apply for coverage, and how to protect your assets.
4. Because not everyone meets the eligibility requirements, a planning lawyer can help you figure out how to qualify. One way might be to create a trust.

One of the major benefits of hiring a Medi-Cal Planning lawyer is that they can help you protect your assets. One example of this is if you are over 65 and die without a plan in place. Medi-Cal can seek to recover payment through your house, unless it is in an irrevocable trust. Working with an estate planning lawyer who is also skilled with Medi-Cal planning can help keep your estate intact.

FAQs

Q: What Makes Someone Eligible for Medi-Cal?

A: A few things can make someone eligible for Medi-Cal. Losing healthcare coverage due to things like being laid off or other circumstances might make you eligible, along with turning 65 and being within the income limit. You might also qualify if you’re pregnant, blind, age 21 or younger, in a skilled home or nursing facility, or on refugee status. If you have questions, you could reach out to a Medi-Cal planning attorney for guidance.

Q: What Is the Income Limit for Medi-Cal?

A: The income limit for Medi-Cal varies depending on multiple factors, including how many people are in the family and what needs there are. In general, the income limit is 138% of the poverty level. For example, if you are a family of 4, then the income limit would be $44,367.

Q: How Much Does Medi-Cal Cost Per Month?

A: For most enrolled in Medi-Cal, there is no premium, deductible, or out-of-pocket cost. On July 1, 2022, the premiums were reduced to $0 for most people on Medi-Cal. The benefits are equivalent to those on the California Covered program.

Some working individuals with disabilities or pregnant individuals under the Medical Access Program might pay low monthly premiums. Those on the Medical Needy program might be required to meet the share-of-cost deductible.

Q: What Is Considered Low Income in California?

A: In California, what is considered low income depends on the area. For a one-person household to be covered by Medi-Cal, that person’s income must be at or below $21,597 in Los Angeles County. For a four-person family, that level is a maximum of $44,367. Low-income families, children, and pregnant women have always been included on Medi-Cal. In January of 2014, the eligibility was expanded to include low-income adults.

Contact Meinzer Law Firm, PC, Today

With over two decades of experience, the Meinzer Law Firm is dedicated to staying up-to-date with shifting Medi-Cal eligibility requirements and changing Medi-Cal rules that affect planning for your future.

Past clients have boasted about our extreme efficiency and ability to get our work done quickly. We pride ourselves on answering your questions with care and accuracy, and we value your experience. Medi-Cal planning doesn’t have to be complicated, and we would like to help make it easy and clear for you.

If you are looking for guidance or would like to speak to an experienced California Medi-Cal planning attorney, contact us by phone or through our contact page to schedule a consultation today.