Medi-Cal Access Program Frequently Asked Questions

To qualify for MCAP, you must be:

1. Pregnant: You must be pregnant. The application date is the date the complete and eligible application is received by MCAP from Covered California.
2. A California resident: A person living in California who plans to stay; and
3. Not enrolled in other programs: You cannot be receiving no-cost Medi-Cal or Medicare Part A and Part B benefits as of the application date; and
4. Not covered by any other health insurance plan: You cannot have other health insurance, unless your other health insurance plan doesn't cover maternity services or has a maternity-only deductible or copayment greater than $500 as of your date of application. MCAP will be the primary insurance and when using MCAP services you will need to choose a Managed Health Care Plan. MCAP does not pay the other insurance co pay or deductible. and
5. Within the MCAP income guidelines: You must have a Federal Modified Adjusted Gross Income within the MCAP income guidelines.

Who can be an applicant?

An applicant can be a pregnant individual age 18 or older applying for themselves, or an applicant can be the legal partner of a pregnant individual. An applicant can also be a legal guardian or natural parent, foster parent, or stepparent with whom a pregnant child lives. An emancipated-minor, who is not living in the home of a natural parent or adoptive parent, a legal guardian, foster parent, or stepparent, may also be an applicant.

How do you apply?

To apply for Medi-Cal Access Program go to www.Coveredca.com.

Services available for your baby through the DHCS Medi-Cal Managed Care Delivery System

Medi-Cal currently provides a core set of health benefits, including doctor visits, hospital care, immunization, pregnancy-related services and nursing home care, if medically necessary. For a majority of enrollees, Medi-Cal provides covered services through the managed care delivery system in all 58 counties, although services may be accessed on a fee-for-service basis.

The Affordable Care Act (ACA) ensures all Medi-Cal health plans offer a comprehensive package of services, known as Essential Health Benefits (EHB). The ten EHBs include the following categories of services: Ambulatory Patient Services; Emergency Services; Hospitalization; Maternity and Newborn Care; Mental Health and Substance Use Disorder Services including Behavioral Health Treatment, Prescription Drugs; Rehabilitative and Habilitative Services and Devices; Laboratory Services; Preventive and Wellness Services & Chronic Disease Management and Pediatric Services (including oral and vision care). Medi-Cal currently meets the requirements to cover all of the ten EHBs.

Beginning in 2014, all enrolled individuals, those already on Medi-Cal as well as newly eligible adults, may receive an expanded array of mental health and substance use disorder services. The following mental health benefits will be available through Medi-Cal managed care plans or the fee-for-service delivery system: Individual and group mental health evaluation and treatment (psychotherapy); Psychological testing when clinically indicated to evaluate a mental health condition; Outpatient services for the purposes of monitoring drug therapy; Outpatient laboratory, drugs, supplies and supplements; Psychiatric consultation; Specialty mental health services currently provided by County Mental Health Plans will continue to be available.

The following substance use disorder services will also be made available to eligible Medi-Cal beneficiaries: Voluntary Inpatient Detoxification; Intensive Outpatient Treatment Services; Residential Treatment Services; Outpatient Drug Free Services and Narcotic Treatment Services. Dental care and vision services are available with some limitation. Dental services are available to all adults.