Medi-Cal

The California Department of Health Care Services (DHCS) determines who is eligible for Medi-Cal. You can apply for Medi-Cal benefits regardless of sex, race, religion, color, national origin, sexual orientation, marital status, age, disability or veteran status. If you are eligible, you can get Medi-Cal as long as you continue to meet the eligibility requirements.

You can apply for Medi-Cal at any time of the year.

You may apply online at BenefitsCal or contact your local county office to apply by mail, phone, fax, email or in person:

• Mariposa County Health and Human Services Agency
  Phone: 209-966-200
  800-549-6741
• Merced County Department of Human Services
  Phone: 209-385-3000
• Monterey County Department of Social Services
  Phone: 877-410-8823
• San Benito County Health and Human Services Agency, Public Assistance
  Phone: 831-636-4180
• County of Santa Cruz Human Services Department
  Phone: 888-421-8080

As an Alliance member, you have access to the health care and support services described in the Get Care section of this website.

You will pick one doctor to see for all your health care needs. We call that doctor your Primary Care Provider or PCP. Use the Provider Directory to find a PCP.

Your PCP will provide all your regular health care. If you need to see any other doctor, your PCP will send a request to the Alliance. This is called a PCP referral. A PCP referral is not needed for emergency care and family planning services. There are some services and medical equipment that must be approved by the Alliance before you can get them. This is called prior authorization. Your PCP or other doctor will send referral and prior authorization requests to the Alliance for approval.

The Alliance covers most health care services provided by your PCP, doctors, hospitals and licensed health care providers in our network. There are some services that are covered by Medi-Cal but not through the Alliance.

For a high-level summary of plan benefits, read the Benefits Matrix.

For full details, read the Member Handbook.

As of July 1, 2022, the Alliance covers community health worker (CHW) services for individuals when recommended by a physician or other licensed practitioner to prevent disease, disability, and other health conditions or their progression; prolong life; and promote physical and mental health and efficiency. CHW services have no service location limits and members can receive services in settings such as the emergency department. Services may include:

• Health education and training, including control and prevention of chronic or infectious diseases; behavioral, perinatal and oral health conditions; and violence or injury prevention.
• Health promotion and coaching, including goal setting and creating action plans to address disease prevention and management.
• Health navigation including providing information, training and support with getting health care and community resources.
• Screening and assessment services that help connect a member to services that improve their health.

CHW violence prevention services are available to members who meet any of the following circumstances as determined by a licensed practitioner:

• The member has been violently injured as a result of community violence.
• The member is at significant risk of experiencing violent injury as a result of community violence.
• The member has experienced chronic exposure to community violence.

CHW violence prevention services are specific to community violence (e.g., gang violence). CHW services can be provided to members for interpersonal/domestic violence through a qualified CHW. To qualify, CHWs must have lived experience that aligns with and provides a connection between the CHW and the person experiencing interpersonal/domestic violence.

If you think you may benefit from this service, contact your PCP or call Member Services at 1-800-700-3874 (TTY 1-800-735-2929).

As of January 1, 2024, California extends eligibility for full scope Medi-Cal to people who meet all Medi-Cal eligibility criteria, regardless of immigration status.

Immigration status does not matter. This expansion of full scope Medi-Cal brings California closer to a Healthy California for All.

You can apply for Medi-Cal online by visiting BenefitsCal.com.

More people can get coverage.

As of January 2024, assets no longer count toward your Medi-Cal eligibility. If your coverage was denied, delayed, reduced or stopped because of your assets, you can ask your local Medi-Cal office to review your case. Learn more on the DHCS website. You can also contact your local county Medi-Cal office if you have questions.

Important: Are you enrolled in Medi-Cal? Has your contact information changed? Give your county office your updated contact information so you can stay enrolled.

In December 2022, the U.S. government made some changes to the public charge final rule. There are more protections for immigrants and their families to use public benefits without fearing it will affect their immigration status. There are also less barriers for low-income immigrants to get a green card.

Now, many public benefits no longer count for public charge, like health care and food. Medi-Cal/Medicaid does not count under the new public charge rule unless someone is:

• In long-term institutionalized care.
• In a skilled nursing home.

Every family is different. It is important to:

• Know your rights.
• Get the facts. Understand if the rule affects you.

For more information on public charge, visit our website at www.thealliance.health/health-plan/medi-cal/public-charge.