Apply for Medicaid (Medi-Cal in California)

Medicaid is a Federally-funded, income-based program that provides medical care to needy families. If you qualify for Medicaid, it will essentially act as a secondary health insurance provider to cover things your typical insurance does not. Medicaid is administered by your state and each state administers the program a little differently. For example, California's Medicaid program is called Medi-Cal.

Wikipedia Medicaid Link

Wikipedia Medi-Cal Link

Medicaid and SSI:

1. Why you must apply to SSI first: You are going to want to apply to Medicaid based on your child's disability. Medicaid will require that you first apply for SSI Disability benefits before they will complete your application for Medicaid Disability benefits (See Step 5)

2. I applied for SSI Disability benefits and was approved: If you qualify for at least $1 in SSI benefits, your are automatically approved for Medicaid benefits. You will want to contact your local Medicaid office to make sure they understand that your child is disabled.

3. I applied for SSI and was denied: While qualifying for SSI makes you automatically qualified for Medicaid, being denied SSI does not necessarily mean you will be denied Medicaid benefits. The income requirements for Medicaid are less stringent than those for SSI.

Some Additional Things You Will Want to Know:

Beyond SSI and Medicaid, each state has it's own additional programs to assist the disabled. Most of these programs will require that you have applied for Medicaid benefits before they will process your application for their services.

Many states have Medicaid disability waivers which means that you will be automatically approved for Medicaid based on disability rather than income. This means that when you apply for Medicaid, you will want to specify that you are applying on behalf of your disabled child. For example, in California, you will want to contact Medi-cal and request "A full Medi-cal evaluation, not an evaluation for special programs alone." Also in California, you will want to request that your case worker complete a "DAPD Packet in accordance with Medi-cal Program Guide Section 5-4".

How to Apply:

It will be best to do an internet search for the Medicaid department in your state otherwise, you can try beginning at the Federal Medicaid site.

In California:

Medi-Cal Homepage

The first thing you will want to do is contact your Regional Center (Early Intervention) case worker. You need to request a Department of Developmental Services Institutional Deeming Medicaid Waiver Referral.

Once you have that referral, you will want to contact your nearest Medi-Cal office and request an application. Once again, be sure to inform them that your child is disabled and you want the following:

- A FULL Medi-cal evaluation - not and evaluation for special programs alone.
- Your case-worker to complete a DAPD Packet in accordance with Medi-Cal Program Guide Section 5-4
- Attach the Institutional Deeming Medicaid Waiver Referral

All Medicaid / MediCal dollars are not the same. How you are approved determines where the funds come from for your child's care. California will first try to approve you based upon your income. If they cannot approve you based on your income, they will approve you based upon the Institutional Deeming Waiver.

Four Possible Outcomes:

1. You will be approved for full-scope, no-cost Medi-Cal coverage

2. You will be approved for restricted Medi-Cal coverage

3. You will be approved for Share of Cost (SOC) Medi-Cal coverage
If you are approved for SOC coverage, Medi-Cal will let you know what your monthly SOC is. This is the amount of money that you must pay out-of-pocket in any given month before Medi-Cal assistance will be made available to you.

3. You may be denied Medi-Cal coverage

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