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. With financial help through Covered California, plans could be as low as $0 per month. 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 report a change in income.
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 service from the state that helps Californians find quality health insurance. We also offer financial help to lower the cost — some people pay as little as $0 per month for a plan. 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.