What is Medi-Cal?
Medi-Cal – California’s Medicaid program – provides free or reduced-cost health coverage for low-income individuals and families. Medi-Cal increases patients’ access to important healthcare services, such as doctor visits, immunizations, hospital care, and the 10 essential health benefits.
Medi-Cal Eligibility Requirements
Medi-Cal primarily serves individuals and families who are generally below 138% of the Federal Poverty Level for adults and 266% for children. Others who are eligible for Medi-Cal include (but are not limited to): newborns, foster care youth, pregnant women, persons with disabilities, and seniors. You can find out more information about Medi-Cal eligibility here.
How many children are in Medi-Cal?
Medi-Cal is the largest state Medicaid program in the nation, covering nearly half the children in California. It is estimated that a total of 5.2 million youth are currently enrolled in Medi-Cal. Children's hospitals provide over 1.9 million outpatient visits each year across the state, regardless of income or payer source. Among our 8 member hospitals, Medi-Cal funds over 60% of inpatient and outpatient visits.
Financial Challenges
Unfortunately, Medi-Cal reimbursement does not usually cover the basic costs of care for children's hospitals. This is a major concern, because children's hospitals typically provide lifesaving care for children with serious conditions -- care that can be complex and costly. Although Medi-Cal does not sufficiently cover costs, it is still an important payer for children’s hospitals.
Medi-Cal Expansion
The Affordable Care Act (ACA) has expanded coverage to populations that were previously uninsured. Since the ACA was passed into law in 2010, nearly 1 million more youth have been enrolled in Medi-Cal.