The Basics of Medi-Cal

The United States is often considered slow compared to many of the major industrialized nations of the world when it comes to providing its citizens with publicly-funded health care. In 1965 President Lyndon B. Johnson signed the first major public health care program into law when he created Medicare. One of the major parts of this legislation allowed for the creation of a program known as Medicaid.

While Medicare was designed to provide senior citizens over the age of 65 with affordable health care alternatives, the Medicaid program was given a much different approach. The goal of Medicaid was to help anyone with low income or no means of providing themselves with reliable and affordable health care. The California Medical Assistance Program, or Medi-cal, is the Medicaid program for the state of California which provides millions of low income families, children, and seniors with health care coverage.

The oversight of Medi-cal, and all other state Medicaid programs, can be relatively complicated. Each state is responsible for directly administering their Medicaid program with all decisions made by local government officials. However, the Centers for Medicare and Medicaid Services (CMS) keep a vigilant eye on the state run programs to ensure the following:

  • Eligibility standards are being met
  • Quality service is delivered
  • Funding is appropriately allocated

Medi-cal and other state Medicaid programs should not be confused with Medicare. While Medicare is designed as a social insurance program for senior citizens and other eligible citizens; Medicaid is designed to provide health coverage on a needs based system. Low income and a lack of financial resources are the primary eligibility criterion for Medi-cal participants; whereas income plays no role in an individual’s Medicare eligibility. Another major difference between the two systems is funding. Medicare is funded entirely at the federal level through income taxes levied on all working individuals in the United States. Medi-cal on the other hand is funded almost equally by the federal and state government.

Within the state of California the management of Medi-cal is the responsibility of the Department of Health Care Services and the California Department of Public Health. The DHCS is responsible for administering the Medi-cal program on a day to day basis, while the DPH is responsible for managing the funding of the program. Eligibility requirements for Medicaid in California include the following low income individuals or groups:

  • Families with children
  • Senior citizens
  • Individuals in foster care
  • Pregnant women
  • Those with certain diseases including tuberculosis, breast cancer or HIV/AIDS

Individuals who feel they are eligible for Medi-cal benefits need to contact their local county office in the state for an application to determine their eligibility.

The Medi-cal program provides some of the following benefits to low income individuals in the state of California:

  • Medical Services
  • Clinic Services
  • Drug and Alcohol
  • Inpatient/Outpatient Services
  • Long Term Care
  • Pharmacy and Vision Services
  • Durable Medical Equipment
  • Wheelchairs
  • Wheelchair Repair
  • Hearing Aids

California’s economic woes during the current recession have greatly affected the Medi-cal program, creating budget problems and bringing future problems to the forefront. Medicaid programs in every state are expected to face budgetary issues between 2020 and 2040 as the Baby Boomer generation heads into retirement, requiring greater and more expensive medical attention in the process. California will face an even greater problem in funding Medi-cal in comparison to other state Medicaid programs. As of 2009 the state had an estimated population of 38.1 million people. On January 1, 2009 there were 6.8 million individuals enrolled in Medi-cal. Those 6.8 million represent 18% of the state’s population. The number of individuals enrolled in Medi-cal for at least one month during 2009 was 8.5 million, or 22.5% of the state population.

As of 2009 Medi-cal was meeting its stated goals of providing health coverage to those most in need. Data from the fiscal year 2008-09 shows that medically needy families were responsible for 34.68% of Medi-cal’s enrollment. The next largest enrollment categories also aided those most in need with families needing public assistance accounting for 18.67% of enrollment and those with disabilities accounting for 13.31% of enrollment.