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Medi-Cal program helps those with special needs
By Rita Baum
Applicants for Medi-Cal at the Santa Clara County Assistance Application Center enter a large, high-ceilinged reception room that, devoid of its functional furnishings, could easily be imagined as a ballroom. But nothing as cheerful or grand as a ball occurs here. The rows of couches, benches and chairs hold scores of patient individuals of various ages and backgrounds, speaking among themselves in a dozen different languages as they wait to be called by an eligibility worker to learn if they are eligible for Medicaid, called Medi-Cal in California.
Managed by the Santa Clara County Social Services Agency, Medi-Cal is a federal and state tax-supported program that pays for or assists with medical costs for one of every five Californians, mostly people of low income or with special needs. Many seniors receive assistance through this program, although it is not exclusively a program for seniors. In fact Medi-Cal provides medical assistance to needy individuals of all ages, including those in the prenatal stage.
A large percentage of Medi-Cal beneficiaries are at or below the federal poverty level, $926 per month for an individual or $1,248 for a couple, with a gradually increasing amount for each added family member. But according to assistant Social Services program manager Theresa Nelson, "The program is not necessarily only for the poor--there are programs that allow higher income limits. Each case is considered on an individual basis." A young adult with a well-paying job might be eligible for Medi-Cal but have a co-payment, and a 65-year-old person who owns a house and car and other assets may be eligible for long-term care as well as regular Medi-Cal benefits.
Most Medi-Cal recipients are hard-working individuals--commonly called the working poor--whose incomes are too low to pay for medical care for themselves and their families but too high to be linked to any other public assistance programs.
As of late last year, this group totaled nearly 88,000 Santa Clara County residents, representing 30 different ethnic groups. More than half are of Hispanic descent, with Vietnamese and Caucasian the second and third most prevalent. Approximately 30,000 beneficiaries are age 12 or younger, and nearly 12,000 are over age 60, with the remainder in the 13 to 59 age group. San Jose has the largest percentage of Medi-Cal recipients, but every city in the county has its share of Medi-Cal cardholders. More than half of the healthcare beneficiaries are U.S. citizens, but people of 144 countries are served.
Income, property and various life situations are determining factors in the Medi-Cal eligibility process. Medi-Cal assists the poor, pregnant women, disabled, aged, blind, families with children, immigrants, dialysis patients, the mentally ill, alcohol and drug abusers, and some undocumented persons who are pregnant or in emergency situations. The Medi-Cal eligibility process is not burdensome; in fact, it can now be completed exclusively by mail or by coming into the office to meet with an eligibility worker--except in minor consent services.
Minor consent services include pregnancy, birth control-related or mental health services for minors who want to apply on their own. Nellie Jorge, director of the Department of Employment and Benefit Services, says, "Many people who think they do not qualify for Medi-Cal benefits are in fact eligible and are encouraged to apply."
The process begins with a visit or a telephone call to the center, where the request for an application can be made in any language. There are approximately 12 languages spoken among the center's various staff members, and interpreters are available for an additional dozen or so languages. Proof of Santa Clara County residency, income status and identification, such as a Social Security card, driver's license, naturalization documents or alien registration card, must be furnished. If documentation is missing, notification of eligibility and receipt of a Medi-Cal card will be delayed until it is provided.
The possession of a Medi-Cal card provides dental and vision services, glasses and a full range of health and preventive care services from an HMO, primary care management system, or a list of providers. Hospital care is available from contracting hospitals. In situations where the beneficiary's monthly income exceeds the amount Medi-Cal considers necessary living expenses (called maintenance costs) the beneficiary may be required to pay a share of the medical cost (SOC).
Medi-Cal is sometimes confused with Medicare, the federal health insurance program administered by the Social Security Administration that is available to persons 65 and older, regardless of income. Certain disabled and blind persons may also receive Medicare regardless of age. It is possible to receive both Medicare and Medicaid benefits.
Although income and property are the basic qualifiers for receipt of Medi-Cal benefits, there are exceptions to the general eligibility guidelines. A home and car are considered exempt property. People who have income at or below the federal poverty level are automatically eligible for benefits if property limits are met. And in some situations, an individual or family who owns a home and has a monthly income of three times the federal poverty level may qualify for Medi-Cal because of special circumstances, such as the costly care and treatment of kidney dialysis, a severely disabled child or long-term care. Beneficiaries with higher incomes pay a small fee or share of cost.
Santa Clara County's Children's Health Initiative's (CHI) goal is to provide no-cost and low-cost comprehensive health insurance coverage to all of the approximately 71,000 children of uninsured low- and middle-income families. CHI includes three programs: Medi-Cal, Healthy Families and Healthy Kids.
Healthy Kids is a new locally funded program that pays for the healthcare needs of children who do not qualify for Healthy Families or Medi-Cal. Children whose family incomes are between 250 percent and 300 percent of the federal poverty level and children without legal status are covered in this program. A family that owns a home and has monthly income of up to $5,900 for a family of six may qualify if circumstances justify. The Healthy Kids program uses no state or federal funds. It is supported by the Proposition 10 Tobacco Tax, the Santa Clara County tobacco settlement, and local foundation grants, notably from Silicon Valley technology companies.
Rita Baum is a Los Gatos resident. She has a master's degree in gerontology and has worked in the field of aging for more than 20 years.
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Sunnyvale, California Since 1994
