Medi-Cal is a federal and state funded health insurance program for low-income, elderly and disabled persons who qualify for help. Medi-Cal provides no-cost, comprehensive health, dental and vision benefits for people who qualify. Medi-Cal beneficiaries do not pay premiums and they do not have any copayments for services.
Medi-Cal is California’s Medicaid program. It provides health care coverage for more than six million low-income children and families as well as elderly, blind, or disabled individuals. The Medi-Cal Program is administered by the California Department of Health Services. People can apply for Medi-Cal through their county social services department.
Medi-Cal beneficiaries use the same system of care that most Californians use for their health care needs. Medi-Cal is a managed care program that offers a choice of primary care physicians, a good selection of specialty care physicians and a medical Group where care is coordinated. We have partnered with local Medi-Cal providers to give you more choices for doctors, clinics, and hospitals in your neighborhood.
Healthy Families Program is a low cost insurance program administered by the State of California that provides comprehensive health, dental and vision coverage to children who do not have insurance today and do not qualify for no-cost Medi-Cal up to their 19th birthday. Healthy Families covers a range of health care services including physician visits, hospital care, prescription drugs, lab services, home health, dental, and mental health services.
When you enroll your children in Healthy Families, you choose the health, dental and vision insurance plans. The plans provide the health, dental and vision coverage for your children. This insurance pays most of your children’s costs for visits to doctors, dentists, and specialists. The insurance plans also contract with clinics, laboratories, pharmacies and hospitals for your children’s health care.
The cost to join is as little as $4 a month and maximum $45 per month for all children in a family depending on the family size. Parents, stepparents, foster parents, relatives, and legal guardians can apply for a child.
Who Can Qualify?
- Children living in California, who are U.S. citizens, nationals, or eligible qualified immigrants
- Children up to their 19th birthday
- Children without employer sponsored health insurance in the last 3 months
- Children who do not qualify for Medi-Cal
- Family income at or below 250% of the Federal Income Guidelines
- Click here for Medi-Cal and Healthy Family Guidelines
How to Apply
To apply for Healthy Families or if you have questions, please contact us at (949) 999-3905, Monday through Friday between 8:30 am to 5:30 pm. We will direct you to Certified Application Assistants (CAAs) in your area to provide free assistance in filling out application and answer your questions about the Program. Professional CAAs will help you determine your family income to see if your family qualifies for this program and help you complete the application at absolutely NO COST to the applicants. To find out the status of your application, please call toll free 1-800-880-5305 Monday through Friday, 8:00am to 8:00pm for more information.
If you already have Healthy Families and would like to inquire more about your benefits and other issues, please call Healthy Families directly at toll free (800) 880-5305, Monday-Friday, 8:00am to 8:00pm for assistance. There will be multilingual assistance over the phone according to the language you speak. Please listen to the telephone recording carefully for instruction.
Orange County Healthy Kids Program
The Healthy Kids Program is a new program being offered by CalOptima Kids Health Plan beginning January 1, 2007. The program provides low-cost medical, dental, and vision insurance to children who meet the following criteria for the program.
To be eligible for Healthy Kids Program in Orange County, children must meet the following requirements:
- Orange County resident
- Under 19 years of age
- Not eligible for Medi-Cal or the Healthy Families Program
- Do not have other private insurance
- Family income up to 300% of the Federal Poverty Level ($58,050 per year for a family of 4
Healthy Kids Programs offers 3 different types of benefits for children under 19 years of age:
- Medical and hospital insurance through CalOptima Kids health plan, including prescription medications
- Dental insurance through Safeguard Dental plan
- Vision insurance through Vision Service Plan
Healthy Kids has monthly premiums of $10 per child. In addition, there are $5 co-payments for office visits to the doctor, dentist and optometrist and for medications requiring a prescription. Preventive care services, like immunizations or routine annual check-ups (i.e. well care visits) are free.
How to Apply
To see if a child qualifies and enroll them in the Healthy Kids Program, the family must complete an application. The Children’s Health Initiative of Orange County (CHIOC) will have specially trained Certified Application Assistors at various locations throughout Orange County to assist with completing an application the number is (714) 246-8737
The Medicare program, is a federal program that helps senior citizens and certain other individuals pay for health care, is divided into parts; Part A, Part B, Part C, and Part D. Part C is called Medicare Advantage and is an alternative to Parts A and B. When Medicare was created in 1965 (original Medicare), it provided only two parts; Part A and Part B. Generally speaking, Part A is free to eligible recipients and helps pay for in-hospital care. Part B is optional and helps pay for regular medical care (e.g., doctor’s bills, X-rays, lab tests). Individuals who choose to enroll in Part B must pay a premium, a deductible, and co-payments. In 1997, Medicare Part C (Medicare Advantage) became available to persons who are eligible for Part A and enrolled in Part B. Under Part C, private health insurance companies can contract with the federal government to offer Medicare benefits through their own policies. In 2003, under the Medicare Prescription Drug, Improvement, and Modernization Act, Medicare Advantage became the new name for Medicare + Choice plans, and certain rules were changed to give Part C enrollees better benefits and lower costs. The law also created Part D, prescription drug coverage. In most Medicare Advantage Health Plans, patients generally must get their care and services from the Health Plan’s network of providers. Members of Medicare Advantage plans will be asked to choose a primary care doctor or Medical Group. Members that get health care outside of the plan’s network may have to pay for these services. In some cases, neither the Medicare HMO nor the Original Medicare Plan will pay for these services. Medicare HMO plans contracted with our Medical Groups operate much like the Medi-Cal or Healthy Families programs.
Medicare Advantage Special Needs Plans
The Medicare Modernization Act (MMA) created a Medicare Advantage option called “specialized MA plans for special need individuals” (“special needs plans” or “SNPs”). Medicare Advantage Special Needs Plans may limit their membership to people in certain long-term care facilities (like a nursing home), people eligible for both Medicare and Medi-Cal, or with certain chronic or disabling conditions. Special Needs Plans are available in limited areas. The Special Needs Plan is designed to provide Medicare health care and services to people who can benefit the most from special expertise of the plan’s providers, and focused care management. Special Needs Plans also must provide Medicare prescription drug coverage. Special Need Plans, generally provide extra benefits and lower co-payments than in the Original Medicare Plan. For example, a Special Needs Plan for people with diabetes might have additional providers with experience caring for conditions related to diabetes, have focused special education or counseling, and/or nutrition and exercise programs designed to help control the condition. A Special Needs Plan for people with both Medicare and Medi-Cal might help members access community resources and coordinate many of their Medicare and Medicaid services.
CalOptima is a County Organized Health System authorized by federal law to administer Medi-Cal benefits for Orange County residents. It is governed by a board of directors and manages the health care for approximately 290,000 Medi-Cal beneficiaries in Orange County. Since opening its doors in October of 1995, CalOptima has greatly improved access to health care for thousands of the county’s poor, disabled, and aged residents. Operating within a $790 million annual budget, CalOptima contracts with 11 health networks to provide health care to approximately 290,000 Medi-Cal beneficiaries. It also participates in California’s Healthy Families program and has the largest enrollment of any Healthy Families program provider in Orange County.