Medicaid stats for the state of California

Below are some important Medicaid stats for the state of California.

Enrollment

  • In December 2013, the monthly enrollment for the elderly and people with disabilities was 1,931,400.

Conditions

  • In the 2011 fiscal year, the distribution of California Medicaid enrollees was: the aged (9%), the disabled (9%), adults (42%) and children (40%).

Costs Covered

  • In 2012, acute care expenditures accounted for 69.2% of Medicaid spending in California.
  • Long-term care made up 26.6% of Medicaid expenditures.
  • In the same year, disproportionate share hospital (DSH) payments made up 4.2% of Medicaid spending.

Medicaid Expansion

  • California is one of 27 states that elected the Medicaid expansion in 2014.
  • Before the Affordable Care Act’s Medicaid expansion, the monthly enrollment average in California was 9,157,000.
  • After the establishment of the ACA, the monthly enrollment average became 11,500,000, which marks an increase of 25.6%.

1) What is Medicaid?

Covering nearly 60 million people in the United States, including pregnant women, the elderly, the disabled, and families with children, Medicaid is one of the most important programs in all of the country. It even accepts applicants who are not American citizens as long as the immigrant in question meets all of the eligibility requirements.

The two main factors that determine whether or not someone will receive the benefits of CA Medicaid are household size and income. The way eligibility works is that the greater your household size is, the more money the government allows you to earn and still receive medical assistance from the program. Some of the services that you will receive after you apply for Medicaid are:

  • Doctor visits.
  • Hospital visits.
  • Dental care (for children under 21).
  • Vision care (for children under 21).
  • Screenings.
  • Treatment.
  • Immunizations.
  • Preventive care.

One of the most important benefits of having Medicaid CA involves the Affordable Care Act. Once it was established as law, Obamacare implemented a piece of legislation known as the individual mandate, which required all Americans to have health insurance or face a fine. Medicaid benefits fit the description of the health coverage required by the individual mandate, so those who have the medical assistance do not need to purchase additional coverage from the Marketplace.

2) How do I apply for Medicaid in California?

For those interested in submitting a California Medicaid application, it is important that you know there are a number of different ways how to apply for Medicaid. First of all, California features its own state Medicaid program, which is commonly known as Medi-Cal. This program features the same mandatory benefits as every other state’s program, from visits to the hospital to screenings for children and surgery.

The fastest way you can find out if you are eligible for this program is by applying online through Covered California. Covered California is the state’s own health insurance marketplace, which was created after the establishment of the Affordable Care Act. By following the prompts, you will be able to see if you are eligible and apply for medical assistance. Another way that you can apply for Medicaid CA is by sending in your application by mail. Simply fill out a single, streamlined application that is available in English and other languages (from Spanish to Farsi), then sign and mail it to:

Covered California
P.O. Box 989725
West Sacramento, CA 95798-9725.

Your final option is to visit a local county services office and hand in your Medicaid application in person. For a quick and convenient application process, apply online here.

3) What does CA Medicaid cover?

California’s Medicaid program covers a wide variety of services. These services and treatments that they provide can be divided into three main categories: primary care, ongoing care/recovery and other medical-related costs. The full breakdown of all that is covered is as follows:

  • Primary Care:
    • Visits to the doctor
    • Hospital stays
    • Screenings for children
    • Surgeries
    • Prescriptions
    • Diagnostic tests
    • Emergency services
    • Dental care
  • Ongoing Care/Recovery:
    • Physical therapy
    • Occupational therapy
    • Outpatient drug abuse services
    • Nursing home stays
    • Personal care
    • Adult day care
  • Medical-related costs:
    • Supplies
    • Durable medical equipment (DME)
    • Transportation for disabled children
    • Transportation for visits to the doctor

Based on how you qualified for medical assistance, the California Medicaid program may not cover all of the above services and treatments. Some individuals will be eligible for full Medi-Cal, while others will only receive partial Medi-Cal. In addition, even if all of these services are covered, you should note that there are rules and limitations to the coverage before you apply for Medicaid in CA. When it comes to prescriptions, for instance, only those drugs listed on the accepted drugs list will be paid for by the program. Nevertheless, if there is ever something that Medi-Cal does not cover, you can appeal the decision, and program officials will consider overturning it.

4) Who is eligible for California Medicaid?

There are a few factors that can make you eligible to receive Medicaid in California. The two most common things that will determine whether or not you qualify are household size and income. But you must also meet a number of other criteria before filling out a CA Medicaid application, such as:

  • You need to be a United States citizen or a legal resident of the U.S.
  • You have to live in California.

Certain individuals, such as the elderly and the disabled, must also meet medical requirements and age requirements in order to qualify.

The various groups of people who are eligible to apply for Medicaid and enjoy its benefits include:

  • Those who are at least 65 years old.
  • Children under the age of 21.
  • Those who are in a nursing or intermediate care facility.
  • Those who are considered refugees for a certain period of time, based on how long you have lived in the U.S.
  • The blind.
  • The disabled.
  • Pregnant women.
  • Women who have been screened for breast or cervical cancer.
  • Parents or caretaker relatives with a child under the age of 21 (when the parent is deceased, doesn’t live with the child, is incapacitated, is unemployed or underemployed).

Review the 2015 California Medicaid income requirements below:

  • 1 person = $11,770
  • 2 family members = $15,930
  • 3 family members = $20,090
  • 4 family members = $24,250
  • 5 family members = $28,410
  • 6 family members = $32,570
  • 7 family members = $36,730
  • 8 family members = $40,890
  • Add $4,160 for each additional person for families with more than eight family members.

You may also qualify for Medicaid if you are a member of any of the following programs:

  • CalFresh
  • CalWorks (AFDC)
  • Foster Care or Adoption Assistance Program
  • Refugee Assistance
  • SSI/SSP

5) What is the Medicaid expansion, and did California accept the Medicaid expansion in 2014?

In addition to the District of Columbia, California is one of the 27 states that accepted the Obama administration’s offer to expand Medicaid in 2014. This was done after the establishment of the Affordable Care Act, which offered federal funds to any state in the country that wanted to augment their Medicaid program.

In choosing the Medicaid expansion, the state of California can now distribute medical assistance to individuals who have an income up to 133 percent of the federal poverty level and are below the age of 65. Similarly, children who are 18 years or younger receive the same benefits if their families have an income up to 133 percent of the poverty level or higher. Furthermore, disabilities and having a family, which were both factors in whether or not one would receive medical assistance, no longer determine if someone should get Medicaid.

The most important result of the Medicaid expansion is that low-cost and free care is now available to more individuals and families in California than ever before. Applicants simply need to meet the requirements, which can be income, age and medically based. In terms of income, an applicant cannot make more than $16,105 per year to qualify for California Medicaid benefits. On the other hand, if you are applying for Medicaid because of a pregnancy, it must be medically verified.

6) How do I contact California Medicaid?

For those individuals and families who would like to learn more about Medi-Cal in California, there are two options available for them to employ. The first thing that they can do, especially if they have questions regarding eligibility or on how the application process works, is visit a local Medicaid office. A representative at one of the county offices will be able to help them find the answers they seek. If you would rather not take the drive to a nearby CA Medicaid office, you also have the option of emailing your question on the Medi-Cal website or mailing your inquiry to the following address:

Medi-Cal Eligibility Division
P.O. Box 997417, MS 4607
Sacramento, CA  95899-7417

The final option that residents have to get in touch with someone in a Medicaid office is to call their specific Medicaid phone number at 1-800-541-5555. An automated system is even available if that is what you prefer: 1-800-786-4346.

The most common reasons why one would need to contact a Medicaid representative are if they are having trouble with their application and if they do not know if they are eligible. If you believe that you are ready to begin your Medicaid application and have finished contacting the Medicaid representative in your area, apply here.

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