Medi-Cal is the Medicaid program in California. It provides health coverage to people with low income and asset levels who meet certain eligibility requirements. If you live in the County of Santa Clara, California, and need help with Medi-Cal, we can help. In this post, we will review everything you need to know about Medi-Cal in Santa Clara County – including who is eligible for Medi-Cal, Medi-Cal income limits, how to apply for benefits, Social Services Agency (SSA) contact information, and Medi-Cal providers in Santa Clara County, including Anthem Blue Cross Partnership Plan.
Before we get into Medi-Cal eligibility guidelines, first, we will explain what Medi-Cal is about and California’s Medicaid expansion.
Next, we will explain the Medi-Cal eligibility guidelines in detail, including the income limit, which is the most important.
We will then walk you through the 3 ways you can apply for Medi-Cal in Santa Clara County.
Additionally, we will provide SSA contact information, including the phone number and hours of operation.
Lastly, we will answer the most frequently asked questions about Medi-Cal in Santa Clara County, including what Medi-Cal covers.
Table of Contents:
Medi-Cal is California’s Medicaid public health insurance program. Medi-Cal provides free or low-cost medical services for children and adults with limited income (and limited resources for some Medi-Cal programs).
The program is supported by federal and state taxes.
Effective January 1, 2014, the Affordable Care Act (ACA) expanded Medi-Cal coverage to previously ineligible adults (childless, non-disabled, non-elderly).
Medi-Cal Program and Services include:
In Santa Clara County, the Medi-Cal program is managed by the Social Services Agency (SSA).
In addition to Medi-Cal benefits, the SSA also handles CalFresh, CalWORKs, and General Relief applications and benefits.
Furthermore, MyBenefits Calwin is the website for Santa Clara County Residents to apply for and to view their benefits online.
Continue reading below for MyBenefits Calwin account information.
Effective January 1, 2014, The Affordable Care Act (ACA) expanded Medicaid benefits to low-income, childless adults between the ages of 19-64 who meet the low or no income requirements.
Also, starting on January 1, 2020, a new law in California gave full-scope Medi-Cal to young adults under the age of 26, and immigration status does not matter.
This is referred to as the Young Adult Expansion. All other Medi-Cal eligibility rules, including income limits, will still apply.
Furthermore, beginning May 1, 2022, a new law in California will give full-scope Medi-Cal to adults 50 years of age or older and immigration status does not matter.
This is referred to as the Older Adult Expansion. All other Medi-Cal eligibility rules, including income limits, will still apply to this new group.
There are three ways you can qualify for Medi-Cal:
First, you can qualify if you meet the income limits.
To see if you qualify based on income, look at the chart below. Income numbers are based on your annual or yearly earnings.
Second, you can also get Medi-Cal if you are:
Third, if you are enrolled in one of the following programs, you can also get Medi-Cal:
The Santa Clara County Medi-Cal income limit follows the California Medi-Cal Income Limit and is calculated as a percentage of the Federal Poverty Line (FPL).
To be eligible for Medi-Cal, you cannot make more than the income guidelines outlined below:
Below are the California Medi-Cal income limit charts, one showing eligibility for children and the other showing eligibility for adults.
First is the income limit for children by age category.
Find the age category your child falls into and you will see the income limit by household size.
| ">California Medicaid Income Limit – Children | ||||||
| ">Children Medicaid Ages 0-1 | ">Children Medicaid Ages 1-5 | ">Children Medicaid Ages 6-18 | ">Children Separate CHIP | |||
| ">% FPL | " data-sheets-numberformat="">100% | " data-sheets-numberformat="">266% | " data-sheets-numberformat="">266% | " data-sheets-numberformat="">266% | " data-sheets-numberformat="">322% | |
| "> | ||||||
Next, you will find below the income limit for adults by category.
Find the category you fall into and you will see the income limit by household size.
| ">California Medicaid Income Limit – Adults | ||||||
| ">Pregnant Women Medicaid | ">Adults (Medicaid) Parent/ Caretaker | ">Seniors & People w/ Disabilities (Medicaid) | ">Adults (Medicaid) Expansion to Adults | |||
| ">% FPL | " data-sheets-numberformat="">100% | " data-sheets-numberformat="">213% | " data-sheets-numberformat="">114% | " data-sheets-numberformat="">100% | " data-sheets-numberformat="">138% | |
| "> | ||||||
There are several ways to apply for Medi-Cal in Santa Clara County:
The BenefitsCal website is a fast, easy way for Santa Clara residents to apply for and manage public assistance services online, including Medi-Cal.
With a BenefitsCal account, you can perform the following tasks online:
If you currently have a BenefitsCal account, click here to log in and apply for or manage your Medi-Cal benefits.
However, if you do not currently have a BenefitsCal, click here to sign up for one. It only takes a few minutes.
The video below does a great job of explaining in detail how to sign up for a BenefitsCal account, and apply for and manage your benefits online.
We recommend watching the video in order to save time in navigating the BenefitsCal website.
Applications for the Medi-Cal Program can be completed in person at an SSA office location.
To begin the process you will need to locate the Social Services Regional Center that serves your area.
You should be prepared to spend a minimum of two hours at the Social Services Regional Center
Unless there is an emergent need for medical care, benefits may not be issued on the same day.
In addition to Medi-Cal, households can apply for CalFresh, General Relief, and CalWORKs at the following locations, which are open from 8 a.m. to 5 p.m. Monday through Friday except for county holidays:
See below for a list of SSA office locations in Santa Clara County:
1867 Senter Road
San Jose CA 95112
1919 Senter Road
San Jose, CA 95112
1330 W. Middlefield Road
Mountain View, CA 94043
379 Tomkins Court
Gilroy, CA 95020
Each of the above-listed office locations has a dropbox where you can submit documents as part of your Medi-Cal application.
In addition, the following offices also have dropbox locations.
When submitting a document through a dropbox, remember to include your name and case number on all submitted documents.
1870 & 1877 Senter Road
San Jose CA 95112
1879 Senter Road
San Jose CA 95112
Here’s the phone number to call to speak to a live person regarding Medi-Cal in Santa Clara County:
Call the Social Services Agency (SSA) during business hours Monday – Friday 7:00 am – 5:00 pm at 1-408-758-3800.
When you first qualify for Medi-Cal, you are covered under Medi-Cal Fee-for-Service.
However, you must choose a health plan within 30 days. If you do not choose a plan within 30 days, the State will choose a plan for you.
If you find only one health plan, the county has chosen this plan for you. Please wait for your health plan information mailer in the mail.
If you find multiple health plans listed, please explore each plan and choose the one that suits you and your family’s needs.
Below is a list of Medi-Cal Managed Care Health Plan options available in Santa Clara County, California.
| ">Plan Name | ">Phone Number |
| " data-sheets-hyperlink="https://mss.anthem.com/california-medicaid/home.html">Anthem Blue Cross Partnership Plan | ">(800) 407-4627 TTY/TDD (888) 757-6034 |
| " data-sheets-hyperlink="http://www.scfhp.com/">Santa Clara Family Health Plan | ">(800 ) 260-2055 TTY/TDD (800) 735-2929 |
| ">Specialty Health Plan | |
| " data-sheets-hyperlink="https://onlok.org/pace/">On Lok PACE | ">(888) 886-6565 (TTY: 711) |
When you enroll in (join) a Medi-Cal plan, you must choose a primary care provider (PCP).
Your PCP is the doctor or clinic you go to when you are sick or need a checkup.
To locate a Medi-Cal provider near you, click here to search the database of providers.
Once you are on the website, select a program (see image below) to search for doctors, dentists, hospitals, medical clinics, and dental clinics near you.
Here are some of the most frequently asked questions about Medi-Cal in Santa Clara County:
Medi-Cal eligibility is based mainly on income, and in some cases, the property you own.
Medi-Cal has no sign-up period, therefore you can apply at any time.
Once you apply for Medi-Cal, a County Eligibility Worker will decide if you qualify.
Here’s what you can expect after you apply for Medi-Cal in Santa Clara County:
First, Complete & Submit Application.
See above for the multiple ways you can apply for Medi-Cal in Medi-Cal in Santa Clara County.
Next, you will be required to submit paper documents to verify your income, citizenship, or other information that cannot be verified electronically or is questionable.
Within 45 Days of the day you apply for Medi-Cal, you will get a Notice of Action (NOA) in the mail.
The Notice of Action will let you know if your Medi-Cal application was approved or denied.
If your Medi-Cal application is approved:
Santa Clara County has two managed care plans, Santa Clara Family Health Plan and Anthem Blue Cross.
All plan enrollment and changes are handled by Medi-Cal Managed Care Health Care Options.
There are three ways to enroll or change your Medi-Cal managed care plan:
Phone – 1-800-430-4263
In-Person – Monday – Friday 8 am-12 pm & 1 pm-5 pm
Benefit Assistance Center
1867 Senter Rd.
San Jose, 95112
South County Social Services
1879 Tomkins Ct.
Gilroy, 95020
North County Social Services
1330 W. Middlefield Rd.
Mt. View, 94043
It depends. Medi-Cal only tries to recover its costs for medical assistance after your death when a recipient is age 55 or over, or when a member of any age is cared for at an institution, such as a nursing home.
However, Medi-Cal does not seek payment during your lifetime or the lifetimes of your surviving spouse, disabled son or daughter, or while your child is under 21 years of age.
If you are under 55, you can sign up for Medi-Cal knowing that nothing will happen to your assets unless you are institutionalized.
For those over age 55 or in an institution, the Department of Health Care Services may present a claim for the cost of your care. It would be paid from your estate at the time of your death.
For eligible adults, there is no premium, no co-payment, and no out-of-pocket costs.
Additionally, children have a monthly premium of $0 to $13 per child, up to a family maximum of $39 per month.
We hope this post on Medi-Cal in Santa Clara County was helpful.
If you have further questions about Medi-Cal in Santa Clara County, please let us know in the comments section below.
Be sure to check out our other articles about Medi-Cal in California, including:
