Medi-Cal Member Outreach and Redetermination Community Toolkit
The Medi-Cal Member Outreach and Redetermination Toolkit offers information and resources to help partners support members through upcoming Medi-Cal changes. Updates will be made as new information becomes available. Partners may reach out to the Community Engagement Department with questions or additional resources. This resource is intended for partner use and is not for broad public distribution.
- Alliance Provider Toolkit: Details about Medi-Cal changes and Alliance collateral (videos, social media posts and flyers). https://thealliance.health/for-providers/resources/medi-cal-redetermination-tool-kit/
- Medi-Cal Member Benefits Matrix: Overview of covered benefits. https://thealliance.health/health-plan/medi-cal/medi-cal-covered-benefits-matrix/
- Member Handbook: Information for members about covered benefits, member rights and responsibilities. https://thealliance.health/medi-cal-health-care/medi-cal-member-handbook/
- Provider Directory: Listing of Alliance providers, including location, specialty and language. https://provider.portal.ccah-alliance.org/providerdirectory/
- Online Self-Service: Forms and resources for updating contact details, requesting a PCP change, ordering new ID cards and filing a grievance. https://thealliance.health/medi-cal-health-care/online-self-service/
- Member Portal Instructions: Step-by-step guidance on creating and using a Member Portal account. https://thealliance.health/medi-cal-health-care/online-self-service/using-the-member-portal/
- State website: https://benefitscal.com/
- Information on how to apply, create personal user accounts, access CBO account information and find resources.
- BenefitsCal Help Center: https://benefitscal.com/Help/help-center/HCHCH?lang=en
- FAQs, forms, learning tools and support options for applying for benefits and using BenefitsCal.
- Tutorial Videos: https://benefitscal.com/Help/how-to-videos/HCVID
- What CBOs can do on BenefitsCal: https://youtu.be/ulmjjl_rpjI?si=fbDGQrD4dGzNQeMg
- How to submit a Medi-Cal Renewal: https://youtu.be/RfFhCZsSAQc?si=a_HxP_f7oyE12JAy
- BenefitsCal YouTube Page: https://www.youtube.com/@benefitscal9356
- Monterey County:
- MC CHOICE Outreach Number: 866-361-0477
- DSS Upload Link: DSSUpload.com
- Medi-Cal Enrollment Assistance Materials: https://www.countyofmonterey.gov/government/departments-a-h/administrative-office/intergovernmental-and-legislative-affairs/downloadable-resources
- Santa Cruz County: https://santacruzhumanservices.org/Home/CommunityPartners/BenefitsCollaborativeToolkitCollaterals
Frequently Asked Questions
What are the income limits to qualify for Medi-Cal?
Income limits depend on family size. DHCS has a calculator that estimates a member’s potential eligibility. You can find the calculator at www.dhcs.ca.gov/Medi-Cal/Pages/qualify.aspx. You can also view eligibility estimates below or at www.dhcs.ca.gov/Medi-Cal/Pages/eligibility-chart.aspx. Please note that eligibility is based on several factors, not just income. Even if a member’s income appears to be above the limits shown, applying is still the best option. Community partners should encourage members to contact or visit their county’s eligibility office to apply.
Eligibility by Federal Poverty Level (annual income)
|
Family Size |
Income Limit (138% FPL) |
|
1 |
$21,597 |
|
2 |
$29,187 |
|
3 |
$36,777 |
|
4 |
$44,367 |
|
5 |
$51,957 |
|
6 |
$59,547 |
Is there an asset limit?
Some Medi-Cal programs have an asset limit of $130,000 for one person. An asset limit is the maximum amount of countable assets a person can own and still qualify for Medi-Cal. Assets can include money, property or other things a person owns. Members can learn more at https://www.dhcs.ca.gov/medi-cal/help/#keep
If a member owns a home, are they still eligible for Medi-Cal?
Some assets, such as the home they live in, may not count toward the $130,000 asset limit. For more information, visit the Help pages under Asset Limits: www.dhcs.ca.gov/Medi-Cal/Pages/help.aspx
What assets are not counted toward the $130,000 asset limit?
Some assets are not counted toward the asset limit. These may include a member’s primary residence, one vehicle, household items and certain retirement accounts. Members can learn more at https://www.dhcs.ca.gov/medi-cal/help/#keep
How long is the application approval process?
It may take up to 45 days to process a Medi-Cal application. However, the process may vary depending on the county office capacity and caseload.
Where can members apply for Medi-Cal?
Members can apply for Medi-Cal by visiting their county office or via BenefitsCal. Some Community-Based Organizations can assist with applications and renewals. Information on how to set up a BenefitsCal account can be found at https://www.dhcs.ca.gov/Medi-Cal/Pages/apply.aspx
How does someone sign up for a BenefitsCal Account?
To sign up for a BenefitsCal account, members will need an active email address and cell phone number ready to go beforehand. Visit the BenefitsCal website at: www.benefitscal.com/Public/login
For step-by-step visual directions on how to sign up, members can view the YouTube video at: www.youtube.com/watch?v=MyArMk7PvjQ. The video is in English with the option for subtitles in the member’s preferred language.
If a member is denied their application, can they still appeal their Medi-Cal case?
Individuals have the right to ask for an appeal if they disagree with the denial of a health care service or benefit. Individuals must file an appeal within 60 days of the date on the Notice of Action. An appeal does not guarantee a change in decision.
When do members have to renew?
Every member needs to renew their coverage each year. However, everyone's renewal date is different. Members who have a BenefitsCal account can check their renewal date online.
What should members do if they receive their renewal packet more than 90 days after their renewal deadline?
Members should contact their county office to report that their packet was received late. If they have a BenefitsCal account, they can check their renewal due date and complete the renewal online.
How can a member know when they should renew?
If the member has a BenefitsCal account, they can check their renewal date online. Some counties may send members a text message when their renewal packet is mailed. The Alliance will also call and text members up to 45 days before their renewal deadline.
What if a member misses their redetermination deadline?
If the member has missed their renewal deadline and it is within 90 days of their redetermination date, they should reach out to their county office as soon as possible. If it has been more than 90 days, the member may need to reapply either through their county office or online at the BenefitsCal website at: https://benefitscal.com/Public/login.
The Alliance understands that the information is subject to change and information posted here may not reflect the most current guidance. Please visit www.dhcs.ca.gov/Medi-Cal/Pages/immigration-status-categories.aspx and https://www.dhcs.ca.gov/keep-your-Medi-Cal/Pages/Medi-Cal-Immigrant-Eligibility-FAQs.aspx to stay up to date on Medi-Cal eligibility and immigration status.
What is UIS?
UIS stands for Unsatisfactory Immigration Status. This is a term used by the Department of Health Care Services (DHCS) to identify individuals who do not meet the criteria for full-scope Medi-Cal coverage. DHCS has more information on their website about what immigration status categories may fall under UIS: www.dhcs.ca.gov/Medi-Cal/Pages/immigration-status-categories.aspx
What is public charge?
Public charge is a term used in immigration law. It refers to whether the federal government believes a person may depend on government support in the future when deciding certain immigration matters, such as entering the United States or applying for lawful permanent resident status (a green card). Visit the California Immigrant Guide for more details: https://www.immigrantguide.ca.gov/
Are Medi-Cal benefits considered a Public Charge or will they be in the future?
DHCS and county social services agencies cannot provide legal services or advice about a member’s privacy, immigration status or public charge laws. If members have questions about their immigration status and/or Medi-Cal benefits, they should talk to a qualified immigration lawyer. The California Department of Social Services’ Immigration Services Bureau keeps a list of qualified nonprofit organizations to provide immigration-related services to Californians.
More information is available at https://www.dhcs.ca.gov/keep-your-Medi-Cal/Pages/Medi-Cal-Immigrant-Eligibility-FAQs.aspx
What conditions are considered emergencies for Emergency Medi-Cal?
According to DHCS, everyone who qualifies based on income, regardless of immigration status, can get Emergency Medi-Cal, such as treatment required to address serious medical emergencies that require immediate care.
More information is available at https://www.dhcs.ca.gov/Medi-Cal/Pages/benefits.aspx
If a member has UIS, can they still appeal their Medi-Cal case?
Members have the right to ask for an appeal if they disagree with the denial of health care service or benefit. They must file an appeal within 60 days of the date on the Notice of Action. An appeal does not guarantee a change in decision.
How can members report a change of address or county?
Address and county changes may be reported through their county office.
Members may contact their caseworker at their respective county Human Services Agency office in the county they moved from to request an Inter-County Transfer (ICT) within 10 days of the change. This is a request to transfer benefits from the previous county to their current county.
Will members have to complete community hours?
Starting January 1, 2027, some adults may need to work, volunteer, or go to school to keep Medi-Cal. The member’s county office will let them know if they must comply with work requirements. More information about upcoming changes can be found at https://www.dhcs.ca.gov/Medi-Cal/Pages/changes.aspx
Medi-Cal program changes (2026 – 2028)
This page is subject to change as the California Department of Health Care Services (DHCS) shares news about Medi-Cal changes. We strongly recommend that you check the DHCS Medi-Cal Changes page often for the most recent information.
2026
- Some adults will no longer be able to sign up for full-scope Medi-Cal coverage based on their immigration status.
- Individuals subject to the enrollment freeze can keep full-scope coverage if they complete timely renewals and continue to meet Medi-Cal eligibility rules.
- A three-month grace period is available to reenroll into full scope Medi-Cal for those who missed their renewal deadline.
- Exceptions (enrollment freeze does not apply): Children ages 0 to 18, pregnant or postpartum people (up to 1 year after pregnancy), former foster youth under 26.
2027
- Starting January 1, 2027, some members will get their Medi-Cal care through Fee-for-Service (FFS) Medi-Cal instead of a health plan. This change is based on immigration status and affects how Medi-Cal members get care.
- Affected people will no longer be in a health plan. They can choose any doctor that accepts FFS Medi-Cal.
- “Fee-for-Service” does not mean the member pays. Medi-Cal still pays for care.
- This applies to:
- Undocumented people.
- Some people with green cards who are in the five-year waiting period before they can get full-scope federal Medicaid.
- People considered Permanently Residing in the U.S. Under Color of Law (PRUCOL), meaning they are allowed to stay in the U.S. even without formal immigration status.
- For details, view the DHCS Immigration Categories page.
- Some adult Medi-Cal members between ages 19 to 64 will need to work, volunteer, go to school or participate in training to keep Medi-Cal.
- These new work or volunteer rules do not apply to:
- Children (0–18).
- Older adults (65 and older).
- Pregnant people (through pregnancy and up to one year after).
- Parents of children ages 0-13.
- People with disabilities.
- People with serious health or mental health conditions or substance use problems.
- People who were released from jail or prison within the last 90 days.
- People on Medicare Part A or Part B.
- American Indians or Alaska Natives.
- People under age 26 who were in foster care on their 18th birthday.
- Starting March 1, 2027, Medi-Cal redeterminations will occur every six months for adults who are enrolled in Medi-Cal.
- These members will continue with once-a-year renewals:
- Members in a Medi-Cal program that is not under the Affordable Care Act new adult group.
- Pregnant or postpartum individuals.
- Alaska Native or American Indian members.
- Former foster youth under age 26 who were in foster care on their 18th birthday.
- In 2026, the federal government is changing how it classifies some immigration statuses (a person’s legal standing in the U.S. based on how and why they came here).
- Members may be affected if they get Medi-Cal and are:
- A refugee or asylee.
- A humanitarian parolee.
- A survivor of domestic violence or human trafficking.
- These people will keep getting state-funded full-scope Medi-Cal through June 30, 2027. After that, people in this group will only be eligible for pregnancy-related services and emergency services.
- Members may be affected if they get Medi-Cal and are:
- Find more information on the DHCS Immigration Categories page.
- Some members will need to pay monthly premiums to keep their full-scope Medi-Cal based on their immigration status.
- If affected members do not pay the premium, they will only get restricted scope Medi-Cal. This means they will only be able to get emergency care, pregnancy-related care or nursing home care.
- Members will not have to pay a premium if they are:
- A child (0-18 years old).
- A former foster youth under age 26 and were in foster care on their 18th birthday.
- Pregnant or within one year after their pregnancy ends.
- Some adult Medi-Cal members will stop getting full-scope dental services based on their immigration status.
- Services for emergency dental needs will still be available to all Medi-Cal recipients regardless of immigration status.
- This change does not affect:
- Members who qualify for federal full-scope Medi-Cal.
- Children under age 19.
- People who are pregnant and for one year after pregnancy.
- Foster youth under age 26 who were in foster care on their 18th birthday. They will keep dental benefits.
- An asset is something you own that has value. An asset limit is the most you can own in countable assets and still qualify for Medi-Cal. Starting July 1, 2027, the asset limit is being decreased to:
- $21,000 for one person.
- $31,000 for two people.
- Add $1,550 for every extra person in the house (up to 10 people).
- This change affects people who:
- Are 65 or older.
- Have a disability (physical, mental, or developmental).
- Live in a nursing home.
- Are in a family that makes too much money to qualify under federal tax rules.
- Learn more about this change on the DHCS website.
Alliance Contacts
Community Engagement Department
- Mariposa & Merced Counties
Adourin Malco
[email protected] - Monterey County
Gabriela López Chávez
[email protected] - San Benito & Santa Cruz Counties
Ulises Cisneros-Abrego
[email protected]
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