Aged, Blind and Disabled Medically Needy Medi-Cal

What happens after you apply

1. The county records the day your application arrives. Once approved, coverage starts on the first day of that month.

   The county

2. The county checks your income, benefits, citizenship and California address in records it can reach. It also checks bank records for savings. Over the limit? You can spend the extra by the end of the month, such as on medical bills.

   The county

3. If you get Medicare, Social Security disability or SSI, you do not need papers to prove citizenship. Others get full coverage while they find proof. The county can order a birth certificate for you.

   Only if records cannot confirm your citizenship or identity

   The countyA helper can help with this You get 90 days to show proof, and more time if you are still trying.

4. If something is missing, the county mails you a letter listing the papers it needs. Send them, or call the county if you need help getting them.

   Only if the county cannot check something itself

   The countyA helper can do this for you You get 10 days. If they do not arrive, the county asks again and gives 10 more days.

5. Medi-Cal has no interview. The county talks with you only if you ask, or if something does not match. Missing a meeting cannot get you turned down.

   Only if you ask, or if something on the application does not match

   The countyA helper can help with this

6. You can ask Medi-Cal to pay medical bills from the 3 months before you applied. Ask within 12 months of the month you got care. You fill out form MC 210A. A worker may fill it out with you by phone, and you sign by phone. If a disability must be decided, those months wait for that decision.

   Only if you asked for help with past medical bills

   The countyA helper can help with this If the form comes by mail, send it back within 10 days.

7. If Social Security has not found you disabled, a state office decides. You fill out form MC 223 about your health. You sign form MC 220 for each doctor. If Social Security turned you down recently, you may be sent back to Social Security.

   Only if you are applying because of a disability

   The stateA helper can help with thisThe county sends your case to the state within 10 days. If there is no decision by day 90, you get a letter.

8. The state may ask you to see a doctor for an exam. The state sets it up.

   Only if the state needs more health information

   Your doctor or clinicianOnly you can do this

9. If you can get free Medicare Part A, the county asks you to sign up with Social Security. With a share of cost, you do not have to sign up for Part B. The exception is if you qualify for help with Medicare costs.

   If you are 65 or older, will be soon, or are disabled

   Social SecurityA helper can help with this

10. You get a letter that shows your monthly share of cost. The county first checks if you qualify for Medi-Cal with no share of cost. With a share of cost, you usually do not join a health plan. You can see any provider who takes Medi-Cal.

    The countyWithin 45 days. If the state must decide about a disability, within 90 days.

11. If you are new to Medi-Cal, a plastic Medi-Cal card comes by mail. Sign the back. If you had Medi-Cal before, keep your old card. Without Medicare, you also show it at the pharmacy. Need care before the card comes? Ask the county about a temporary paper card.

    The stateOnly you can do thisIt is mailed about 2 business days after approval.

12. Each month, you pay or owe medical bills up to your share of cost. Each provider records what you paid or owe. After that, Medi-Cal pays for the rest of that month. If a provider will not record it, ask the county.

    Every month you need care

    YouA helper can help with this

13. Ongoing costs like prescriptions, supplies or equipment can count toward your share of cost. Bring proof of what you paid each month.

    Only if you pay for ongoing medical costs

    The countyA helper can do this for you

14. Old unpaid medical bills can also lower your share of cost. The county gives you 10 days to send the details.

    Only if you have old unpaid medical bills

    The countyA helper can do this for you You get 10 days to send the details.

15. If you have Medicare, a Medicare drug plan covers your prescriptions, not Medi-Cal. You may also get Extra Help with drug costs automatically. If you have no drug plan, Medicare picks one for you. Changing it is your own choice. HICAP gives free, unbiased help.

    Only if you have Medicare

    Medicare

16. If you qualify for help with Medicare costs, Medi-Cal pays your Part B premium every month. If not, it pays only in months you meet your share of cost.

    Only if you have Medicare Part B

    The stateAbout 2 months after approval.

Can’t be combined with

• Aged, Blind and Disabled Federal Poverty Level Medi-Cal. If you qualify for Medi-Cal with no share of cost, the county uses that instead.
• 250% Working Disabled Medi-Cal (CWD). If you have a job and a disability, you may qualify for both. The county explains both, and you choose one.
• Qualifying Individual (QI). You can get QI help with Medicare costs only in months you have not met your share of cost.
• Qualified Disabled and Working Individual (QDWI). You can get QDWI help with Part A costs only in months you have not met your share of cost.

Coming changes

• Starting January 1, 2027: For applications from January 1, 2027, Medi-Cal can pay bills from only 2 months back, not 3.
• Starting July 1, 2027: Starting July 1, 2027, the Medi-Cal savings limit drops to $21,000 for one person and $31,000 for a couple. Today it is $130,000 and $195,000. Renewals from then on use the new limit.
• Starting July 1, 2027: Starting July 1, 2027, many adult refugees, asylees and some other immigrants are set to move to limited Medi-Cal. It covers mostly emergencies.