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Eight Tips to Successfully Apply for Medi-Cal

1. Apply as Soon as Possible:

Delaying an application generally works against the applicant. Medi-Cal can be retroactive up to 3 months. (For Jan 1 coverage, apply by April 30). Also, Medi-Cal allows a retroactive spend down on outstanding medical costs only to the month of application.

2. Make Sure Mailing Address on Application is Current:

Don’t list a vacant home as the mailing address. There are strict deadlines to respond to Medi-Cal notices. Use an address where mail is checked daily.

3. Submit all Correspondence by Certified Mail, Return Receipt Requested:

Many submissions to Medi-Cal are ignored or lost. You will need proof of submission.

4. Respond to all Requests in a Timely Manner:

Medi-Cal will deny cases if documents are not provided in a timely manner. If you can’t find a document, you have the right to ask Medi-Cal for help.

5. Appeal all Adverse Decisions:

File a formal appeal for all mistakes made by Medi-Cal, whether a denial or mistake in the share of cost. You can also work informally with the local office to correct the mistake, but absent an appeal, the mistake may never get fixed.

6. Go to Court if There is a Spouse at Home:

Where a spouse is at home, consider having the family hire a lawyer to file a PC 3100 petition. In many cases, the at home spouse can be allocated all of the couple’s income to support herself.

7. Don’t Forget the Estate Recovery:

A Medi-Cal approval is just the first step. Don’t forget the applicant may end up repaying Medi-Cal at death from the value of their exempt home, life insurance, or IRAs.

8. Don’t Assume the Applicant Does Not Qualify for Benefits:

Medi-Cal’s eligibility rules are surprisingly generous. Many assets are exempt (regardless of value), and California allows gifting of assets to qualify for benefits.

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