It can be difficult to find accurate and complete information about Medi-Cal programs. Keep in mind that if your circumstances change, it may be more cost effective to consider another eligibility category of Medi-Cal. Some social workers and advocates may have limited knowledge of Medi-Cal programs and private health coverage options. They also may be unaware of how income and employment changes may impact your Medi-Cal eligibility. It is important to verify that the information you receive is accurate and complete.

Most of us usually rely on the experience of others to understand how to deal with similar situations. The real problem with this is that benefits are person-centered. Benefit programs fit each individual differently, based on a variety of facts and conditions, such as:

You may be eligible for Medi-Cal in California through one of the following Medi-Cal programs: Supplemental Security Income-Linked (SSI), Aged & Disabled Federal Poverty Level (ADFPL), Medically Needy (MN), 250% California Working Disabled Program (250% CWD), or one of the many other Medi-Cal programs. Some individuals are eligible for one or more of these eligibility categories. Understanding which program you are enrolled in can be confusing because of the different benefit programs and acronyms used. Some programs are based on disability while others are not. The rules governing each program are different. Misidentifying these programs is a common problem. Make sure to know exactly which program you are enrolled in or are considering.

Many people do not clearly discuss their plans to apply for benefits with their medical provider(s). Ideally, you and your medical provider should share complete information to assess the duration of your disabling condition(s). If this step is not included, you may end up with a Medi-Cal (or other benefit program) application that does not support your claim. This could be because the information you provided does not clearly reflect how long the disabling condition may last or how it affects your day to day activities.

The more specifically you document your medical condition, the easier it will be to support a claim and to make a case for continuing benefits. Detailing in a daily journal even the most seemingly insignificant symptoms can be of great value. If you or the individual are too ill, or can't maintain the journal on a daily basis, a friend or relative can log the entries. This journal can also provide you with a way to inform providers about your medical condition.

It is your responsibility to maintain accurate and detailed records. The earnings you report to Medi-Cal will be verified. Clearly document all communication with Medi-Cal. Make copies of letters and keep records of phone conversations, including the date and time phone calls take place and the name of the individual who was assisting you. These steps can help you avoid pitfalls during the application process and while maintaining eligibility for benefits. Many people keep a journal of Medi-Cal contacts in a spiral notebook.

If you underreport earnings, you may lose eligibility for a Medi-Cal program. Make sure to report all of your gross income. Gross income is the amount paid before taxes are deducted from your paycheck. If you are self-employed, you can report earnings based on your IRS tax return. Earned income, in some cases, may allow you to access a more cost effective eligibility category of Medi-Cal such as the 250% California Working Disabled Program.

When determining eligibility in the program, Medi-Cal does not consider the entire amount of your earnings. See the program description of the particular programs to see how income is counted and what further deductions you may be able to make from your gross income.

Many individuals eligible for Medi-Cal are hesitant to consider work for fear of losing health coverage. If you are working, you may consider Medi-Cal’s 250% California Working Disabled Program (250% CWD) as a more cost effective approach to Medi-Cal.