Medi-Cal is California’s version of Medicaid, the public health insurance program that provides free or low-cost coverage to residents with limited income. It covers roughly one-third of all Californians, making it the largest Medicaid program in the country. If you live in California and earn below a certain income threshold, Medi-Cal may be your primary path to health coverage.
Who Qualifies for Medi-Cal
Eligibility is based primarily on income. If your household income falls below 138% of the federal poverty level, you likely qualify. For 2026, that translates to roughly $22,000 per year for an individual or $45,540 for a family of four. You can apply at any time of year, not just during open enrollment.
Medi-Cal covers a wide range of groups: families with children, pregnant women, seniors, people with disabilities, foster youth, and adults with certain conditions like tuberculosis, breast cancer, or HIV/AIDS. Children under 19, pregnant individuals (through one year after pregnancy ends), and current or former foster youth under 26 are eligible regardless of immigration status. If you already have Medi-Cal, you can stay covered as long as you remain eligible, regardless of immigration status.
Starting January 1, 2024, California fully eliminated asset limits for Medi-Cal eligibility. That means savings accounts, vehicles, and other property no longer count against you when applying. However, the state has proposed reinstating asset limits beginning January 1, 2026, for certain applicants whose eligibility isn’t based on standard income calculations. This primarily affects some seniors and people with disabilities who qualify through non-income pathways.
What Medi-Cal Covers
Medi-Cal provides comprehensive coverage that matches or exceeds what many private insurance plans offer. The program covers all ten essential health benefit categories required under the Affordable Care Act:
- Doctor visits and outpatient care
- Emergency services
- Hospital stays
- Maternity and newborn care
- Mental health and substance use treatment
- Prescription medications
- Rehabilitation services and devices
- Lab work and diagnostic tests
- Preventive care and chronic disease management
- Pediatric services, including dental and vision for children
Dental Coverage
Dental care, known as Denti-Cal, is included for those with full-scope Medi-Cal benefits. This covers preventive services like cleanings and exams, basic procedures like fillings, and some major work. Adult dental benefits were fully restored in 2022 after being scaled back during earlier budget cuts.
Vision Coverage
Full-scope Medi-Cal members get a routine eye exam and a pair of eyeglasses once every 24 months. If you have a medical reason for more frequent exams, such as eye pain or blurred vision, additional visits are covered. Replacement glasses within the 24-month window are covered if your prescription changes or your glasses are lost, stolen, or broken through no fault of your own (you’ll need to provide a written explanation). Contact lenses are only covered when eyeglasses aren’t an option due to a medical condition.
What Medi-Cal Costs
Most Medi-Cal members pay nothing. There are no monthly premiums and no co-pays for the majority of enrollees. This is one of the biggest practical differences between Medi-Cal and private insurance or marketplace plans.
Some members do have what’s called a “Share of Cost,” which works like a monthly deductible. If your income is above the standard eligibility threshold but you still qualify through a specific category (often seniors or people with disabilities), the county calculates a monthly amount you must spend on medical expenses before Medi-Cal kicks in for the rest of that month. The amount is based on how much your income exceeds a “maintenance need” level set by the state. Not everyone has a Share of Cost, and if yours is $0, your coverage is completely free.
Managed Care vs. Fee-for-Service
Medi-Cal delivers care through two systems, and which one you’re in affects how you access doctors and services.
When you first qualify, you start in Fee-for-Service (sometimes called “Regular” Medi-Cal). Under this model, you can see any provider who accepts Medi-Cal, but nobody coordinates your care for you. Depending on where you live, you may need to choose a managed care health plan within 30 days. If you don’t pick one, the state assigns you to a plan automatically.
Managed care plans give you a network of providers and assign you a primary care doctor who coordinates your care. These plans also offer “Community Supports,” extra services not available in Fee-for-Service, which can include things like housing support or medically tailored meals depending on your plan and county. Most Medi-Cal members end up in managed care. In some counties, enrollment is automatic with no selection required.
If you’re enrolled in both Medicare and Medi-Cal (known as “dual eligible”), and your Medicare Advantage plan has a matching Medi-Cal health plan in your county, you’ll be placed into that matching plan.
How to Apply
You can apply for Medi-Cal at any time of year. There’s no enrollment window to wait for. Applications are accepted online, by mail, by phone, by fax, by email, or in person at your county human services office. The most common route is applying online through Covered California or your county’s benefits portal.
Standard applications take up to 45 days to process. If you’re applying based on a disability, expect up to 90 days. During the waiting period, if you have a medical emergency, you may be eligible for retroactive coverage that applies to the three months before your application date, as long as you would have been eligible during that time.
How Medi-Cal Differs From Medicare
These two programs are easy to confuse because of their similar names, but they serve different populations and work differently. Medicare is a federal program primarily for people 65 and older, regardless of income. Medi-Cal is a state program for California residents with limited income, regardless of age. Medicare is funded entirely by the federal government through payroll taxes and premiums. Medi-Cal is funded jointly by the state and federal governments.
Medicare doesn’t cover 100% of costs. Most enrollees pay premiums, deductibles, and co-pays, and many purchase supplemental insurance to fill the gaps. Medi-Cal, by contrast, covers most services at no cost to the member. Some people qualify for both programs simultaneously. If you’re 65 or older with low income, you may have Medicare as your primary insurance and Medi-Cal as a secondary that picks up costs Medicare doesn’t cover, including long-term care and dental.