Starting a job marks a new chapter — and if you have health insurance through Medi-Cal, you might be worried about losing your eligibility. Rest assured, you have options. For starters, eligibility for Medi-Cal isn’t based on employment status. It depends on factors like income, age, and disability status. In fact, nearly 60 percent of Medi-Cal enrollees age 18 to 65 work.
Those who don’t qualify for Medi-Cal can explore affordable health plans through Covered California. Similar to Medi-Cal, Covered California helps people get health coverage at a lower cost. Four out of 5 get financial help. Read on to learn more about how to stay covered when you start working.
What Is Medi-Cal
Medi-Cal is a public health insurance program that provides needed health care services for low-income individuals, families, seniors, persons with disabilities, children in foster care and former foster youth, pregnant women, and low-income people with specific diseases such as tuberculosis, breast cancer, or HIV/AIDS.
Today, more than 14 million Californians use Medi-Cal.
Medi-Cal Coverage and Employment
A number of factors go into qualifying for Medi-Cal — but having a job isn’t one of them. In fact, many people are employed and stay on Medi-Cal. Eligibility for the program is based on income and other variables. When navigating your health care options as your income increases, it can help to understand what determines Medi-Cal eligibility, and how to update your income information.
Understanding Medi-Cal Eligibility
Qualifying for Medi-Cal is primarily based on your household income and size, but age, disability status, medical conditions, and enrollment in other government programs can also play a role. Here’s what does and doesn’t make a difference when it comes to being eligible for Medi-Cal.
Medi-Cal Income Limits
Most adults need a household income of less than 138 percent of the federal poverty level (FPL) to qualify for Medi-Cal. Your household income is the amount your household makes each year, including wages and salaries, self-employment income, benefits (like Social Security, unemployment, and disability), and all other income (think pensions and investment income). Learn more about how to calculate household size and income for Medi-Cal.
The FPL guidelines are created by the Department of Health and Human Services, and they change each year in January to adjust for inflation and cost of living. Check this chart to see if you currently qualify for Medi-Cal based on income and household size.
What Affects Medi-Cal Eligibility
Aside from income, there are other factors that impact Medi-Cal eligibility. If you make more than 138 percent of the FPL with your new job, you may still qualify if you are:
- Over age 65 or under 19
- Disabled or blind
- Pregnant
- On refugee status
- Diagnosed with breast and/or cervical cancer
- A parent or caretaker relative to an eligible child
- In a skilled nursing or intermediate care home
- Currently enrolled in CalFresh, SSI/SSP, CalWORKs (AFDC), refugee assistance, a foster care program, or an adoption assistance program.
What Does Not Affect Medi-Cal Eligibility
Factors that do not affect Medi-Cal eligibility include:
- Employment status
- Property: Owning property like a car or a home does not affect Medi-Cal eligibility.
- Assets: Starting in January 2024, assets (like how much money you have in the bank) are no longer considered when you apply.
- Gender, race, and ethnicity
- Marital status
- Education level
- Previous health insurance coverage
- Criminal history
Medi-Cal conducts annual eligibility checks to determine if enrollees still qualify for the program. You’ll receive a notice to let you know if you can keep your insurance through Medi-Cal and what your options are if you can’t. If you have questions about your status, call the Medi-Cal Helpline at (800) 541-5555.
Reporting Your Income
When your income changes, you have 10 days to report that to Medi-Cal. The same goes for changes in household size or address. You can do so online (just follow these instructions), or by contacting your county Medi-Cal office in person or by phone.
If your update means you no longer qualify for Medi-Cal, you will be referred to Covered California to help you stay covered.
What is Covered California?
Covered California is a free state-run service that helps Californians find quality health insurance. We also offer financial help to lower the cost. Here are some of the benefits covered by all plans with Covered California: preventive care, regular screenings, emergency room visits, mental health services, and prescription drugs.
Medi-Cal vs. Covered California
Covered California and Medi-Cal are state-run programs that work hand in hand to help Californians get quality health coverage at an affordable price. If eligibility for Medi-Cal coverage ends, Covered California can help you get health insurance and financial help to pay for it.
Here's how Medi-Cal and Covered California compare.
What If I Don’t Qualify for Medi-Cal
If you no longer qualify for Medi-Cal, you can still stay covered to protect your health and your finances. You may be able to get health insurance through your new employer or through Covered California.
Health Insurance Through an Employer
If you start a new job, your employer may offer health benefits. You can learn more about the plans your new job offers by contacting your employer or the Human Resources department.
Getting Covered Through Covered California
If you no longer qualify for Medi-Cal and are not offered an affordable employer-sponsored plan, Covered California is here to help. Covered California works closely with Medi-Cal to help you transition to a new health plan that works for you and your budget.
Covered California makes health insurance affordable for millions of Californians by providing financial help to lower the cost. With this financial help, many who transition from Medi-Cal to Covered California can get a health insurance plan with no monthly premium. Financial help comes in two forms: premium tax credits that lower your monthly cost and cost-sharing reductions that reduce how much you pay when you get care.
If you lose Medi-Cal, Covered California will automatically enroll you in the lowest-cost Silver plan available to you. This way, you won’t have a gap in coverage and can maximize the amount of financial help you get. You’ll have a special enrollment period of 90 days to keep, change, or cancel your new plan. If you’re not auto-enrolled in a new plan, you’ll have 90 days from the last day of your Medi-Cal coverage to sign up for a new plan. Check out this guide to things to consider when shopping for a health plan.
Remember, if you lose your Medi-Cal, Covered California can help. You can start by quickly seeing how much financial help you would get with Covered California. When you need support, Covered California is there to help online, by phone, or in person.
