What’s the Difference Between Medi‑Cal and Medicaid Insurance?
Medi-Cal is Medicaid — it’s simply California’s version of the Medicaid program. The confusion comes from the different names and the fact that each state runs Medicaid under its own rules, which can affect eligibility, coverage, and enrollment.
Some people may not realize that states have their own Medicaid programs, and it’s easy to mix up the similar-sounding names. However, if you’re a California resident, state-specific information about Medi-Cal will be the most relevant to your situation.
Whether you’re a current Californian looking for affordable care or you’re moving from another state, Medi-Cal can be a valuable resource. In this guide, the Freeway team shares the distinction between Medi-Cal and Medicaid, including basic eligibility requirements, what’s included, and how to apply.
What Is Medi‑Cal? California’s Medicaid Program
Medi‑Cal is a California government program that offers affordable health coverage to low-income individuals who make below a certain percentage of the federal poverty level. If you qualify, the government subsidizes your care so you can get treatment at a low or no cost. It’s there to make sure you can see a doctor when you’re sick, get medicine when you need it, and even get regular checkups to keep you healthy.
There are multiple levels of Medi-Cal plans. Part A primarily covers inpatient hospital and emergency care. Most people don’t pay anything at all for Part A, as it’s covered by taxes. Part B covers outpatient care like regular doctor’s appointments and ongoing care. Depending on your situation, you may have to pay a premium for Part B care. However, it will be at a majorly discounted rate.
Who’s Eligible for Medi-Cal?
Because Medi-Cal is designed specifically to help low-income Californians, you have to fit certain requirements to qualify and get subsidized health coverage. To see if you can get Medi‑Cal, they look at a few things:
- Income: In California, you need to make less than 138% of the federal poverty level to qualify for Medi-Cal. The exact amount will depend on your family size.
- California residency: Because Medi-Cal is state-specific, you have to live in California to get Medi‑Cal. You do not always have to be a U.S. citizen or have a green card.
- Citizenship or immigration status: As of January 1, 2026, you need to have a satisfactory immigration status to enroll in Medi-Cal. However, if you were already enrolled before that deadline, you can still renew regardless of your immigration status.
- Age: Adults ages 19 and older can apply, while children under 19 can qualify through family plans.
- Family size: Medi-Cal eligibility is linked to the federal poverty level, which varies based on family size. A single income supporting one person may not qualify, but that same income supporting a family might.
- Pregnancy: If you’re pregnant and have a low income, you may qualify for prenatal and postnatal healthcare through.
- Disability: If you have a disability, no matter how old you are, you may be able to get Medi‑Cal if your income and savings are within certain limits.
What Is Medicaid? A Nationwide Program
Medicaid is a nationwide program that helps people in the United States get cheap health insurance. To qualify for Medicaid, you have to have a low income. Typically, you have to make below a certain percentage of the federal poverty level. Each state administers its own Medicaid program, so details can vary by state.
Who’s Eligible for Medicaid?
In the United States, access to Medicaid depends on rules set by the federal government and by each state. Therefore, the requirements for Medicaid eligibility may be a little different depending on where you live.
In most cases, you can qualify if you’re an adult with legal residency status who makes below the poverty threshold outlined in your state’s Medicaid program. Children can also qualify under family plans. There can also be some special rules and exceptions if you’re pregnant or disabled.
| Feature | Medi-Cal | Medicaid |
| What It Is | California’s version of Medicaid | Federal Medicaid program administered by each state |
| Who Runs It | CA Dept. of Health Care Services + federal funding | Each state’s Medicaid agency + federal funding |
| Eligibility Rules | California-specific income and immigration rules | Varies by state |
| Coverage | Includes all ACA essential health benefits | Includes federally required benefits + optional state add-ons |
| Enrollment Period | Year-round | Year-round |
| Extra Programs | Medi-Cal Dental, Medi-Cal Vision | Varies by state |
What Is Covered by Medi‑Cal?
Medi‑Cal coverage, just like Covered California plans, includes the 10 comprehensive services known as “essential health benefits” as designated by the Affordable Care Act. That means Medi-Cal plans must include:
- Outpatient (ambulatory) services (doctor visits)
- Emergency services
- Hospitalization
- Maternity and newborn care
- Mental health and substance use disorder services, including behavioral health treatment
- Prescription drugs
- Programs such as physical and occupational therapy (known as rehabilitative and habilitative services) and devices
- Laboratory services
- Preventive and wellness services and chronic disease management
- Children’s services, including immunization, oral, and vision care
Does Medi-Cal Include Dental and Vision Coverage?
In addition to standard health coverage as required under the Affordable Care Act, Medi‑Cal also offers dental and vision plans for qualifying adults and children. However, they may come at an added cost. Dental plans may also cover some orthodontic care in certain situations. To learn more about dental benefits and eligibility, you can contact your nearest Freeway Insurance agent or visit Denti‑Cal.
Vision benefits are also available for those with full‑scope Medi‑Cal benefits. All Medi‑Cal members are eligible for a routine eye exam once every 24 months, at which time they can check the health of their eyes and determine if they need corrective lenses.
How To Apply and Enroll in Medi-Cal (Year-Round Enrollment)
Enrolling in Medi-Cal is easy. You can directly apply online, over the phone, or at a county office. Or, you can work with a professional Freeway insurance agent who can walk you through the process.
During the application, you’ll share basic information about your income and household. You may have to submit documents verifying your income. Once you’re approved, you’ll have to complete a yearly income verification check to make sure you still qualify.
You can enroll in Medi-Cal at any time of year, so you don’t have to worry about limited enrollment deadlines. Unlike open enrollment for private health plans through the Covered California marketplace, which runs from November 1 through January, enrollment for Medi‑Cal is open year‑round. As long as you meet income restrictions, you can apply.
Need Help Finding Medi-Cal or Affordable Health Insurance? Freeway Can Help
As California’s form of Medicare, Medi-Cal provides essential healthcare coverage to people across the state. Medi-Cal isn’t a separate program from Medicaid, so you don’t need to worry about applying to multiple programs. If you have a low income and struggle to get healthcare, Medi-Cal could be the answer.
Finding the right healthcare can be a challenge, from determining which programs you qualify for to choosing a plan that fits your budget. Regardless of whether you qualify for Medi-Cal, the Freeway team is here to help.
Freeway Insurance can help you determine your eligibility for California health coverage, then offer you an assortment of affordable health plans that fit your budget. Call (800) 777‑5620 to speak with an agent, get your free health insurance quote online, or visit our location.
FAQs
Learn more about how Medi-Cal and Medicaid work by reviewing these common questions and answers:
Can Immigrants Qualify for Medi-Cal?
Yes, immigrants with appropriate legal residency status can qualify for Medi-Cal coverage. Prior to January 2026, undocumented immigrants were also eligible, and if you already have coverage, you can still renew it. However, the rules changed in January 2026, and undocumented immigrants are no longer able to enroll in new plans.
How Do I Know If I Qualify for Medi-Cal or Medicaid?
You can find out if you qualify by visiting the California Department of Healthcare Services website and using its eligibility tool. Or, you can work with an insurance agent to walk you through the process and check your eligibility.
How Is Medi-Cal Funded?
Medi-Cal is funded by a combination of federal, state, and local taxes. Taxpayer money subsidizes coverage costs so people with the lowest incomes can still get healthcare at no or low cost. Depending on their coverage, Medi-Cal recipients may also contribute by paying a discounted premium.
Can I Have Both Medi-Cal and Private Insurance?
You can have Medi-Cal and private coverage. If your employer offers coverage, you can use Medi-Cal for qualifying expenses that your employer plan doesn’t cover. You can also purchase a marketplace plan alongside Medi-Cal, although you wouldn’t be eligible for any extra subsidies if you already had full Medi-Cal coverage.
Can You Use Medi-Cal Outside of California?
You can use your Medi-Cal coverage outside of California, but only for emergencies. Medi-Cal offers reimbursement for emergency services if you have a serious medical emergency while traveling out of state. However, it wouldn’t cover routine care, so if you move or need healthcare in another state, you’ll want to look at other options.
