Explaining California’s expansion of full scope Medi-Cal for undocumented youth ages 19 to 25

Mar. 16, 2021 / By

A blue stethoscope and blue pen lay on top of an open notebook.

Image courtesy of Pixabay.

 

At the start of 2020, immigrant rights advocates celebrated another victory in access to healthcare for the undocumented community — the Young Adult Expansion initiative.

This initiative, a result of Senate Bill 104, has expanded full-scope Medi-Cal coverage to undocumented youth in California between the ages of 19 and 25. California had previously made a similar move for youth under the age of 19 with the passage of Senate Bill 75.

In this explainer, we’ve broken down the basics on what the Young Adult Expansion is and what you need to know to benefit from this expansion.

 

What is the Young Adult Expansion and why should I care?

The Young Adult Expansion means that undocumented youth in California between the ages of 19 and 26 now have access to full-scope Medi-Cal, so they can now have many healthcare services covered by their Medi-Cal, not just emergency services.

Youth under 19 years old previously became eligible for full-scope Medi-Cal coverage due to Senate Bill 75. So all undocumented youth in California under 26 years old now have covered access to more healthcare services! This includes testing and treatment for COVID-19.

 

What is included in full scope Medi-Cal coverage?

Full scope Medi-Cal differs from restricted scope coverage in that it also includes alcohol and drug treatment, dental, eye, medical, mental health care, and family planning services. All “medically necessary” services are provided through Medi-Cal without co-payments. 

Both full and restricted scope cover emergency services, ambulance and emergency room services and all other services “that are necessary for the treatment of an emergency medical condition.”

See this page for more details on Medi-Cal benefits.

 

How do I find out if I am eligible for full scope Medi-Cal?

Eligibility for the young adult expansion is based on age and income. Full scope Medi-Cal had previously been expanded to youth under the age of 19. Thanks to this expansion, those youth should continue to have full scope Medi-Cal coverage once they turn 19 years old.

Undocumented youth who are over the age of 19 and under 26 can enroll into this Medi-Cal coverage by using this link to find a local health center to assist them. You’ll want to have the following information like identification documents and proof of income ready. The household income being reported when applying should fall beneath 138% of the federal poverty level. This income considered at the federal poverty level depends on the size of a family. Those amounts can be found here.

To find out where your household income sits in comparison to the federal poverty level, use this guide.

To apply for Medi-Cal, visit this page from the Department of Health Care Services. You can apply by mail, in-person at a county social services office, or online through Covered California.

 

I already had Medi-Cal. What’s different for me? What’s the same?

If you already had Medi-Cal in the restricted scope area and are eligible for this, then more benefits have been added to what your Medi-Cal covers.

If you were in this age group when the law took effect on Jan. 1, 2020, you may have received a notice about this change and an enrollment package in the mail instructing you to choose a health plan. That means you would not have had to apply to Medi-Cal again, as you should have been transferred into full scope coverage — you just had to select a plan for your coverage.

“People new to this managed care world with full-scope coverage are given codes that trigger a package to get sent to them, where they choose their plan,” said Liz Ramirez, director of training and education for Maternal and Child Health Access. “If one is not selected in 30 days then it gets defaulted and one is chosen for them.”

You can still change this plan later, just know that the start date for your chosen plan depends on when you make the selection.

According to Ramirez, if you want a health plan change to be active by the next month, then the change should be made with Maximus before the 20th day of the current month. Any change made after this date won’t be recognized until two months from when you make the change. 

So if you change your health plan on March 21, then expect it to become your active plan in May. This is because by then, a capitated payment was already sent for your current plan.

Depending on your health plan, you should be able to continue seeing local clinics and doctors you were already visiting. It may be helpful to ask them if they work with any Medi-Cal plans in your county, so you can apply for that plan.

 

What happens when I turn 26 years old?

Though you may not be eligible for this full scope coverage, Medi-Cal may provide emergency services coverage and there may be free or low-cost services available through counties and community health centers. Visit this page to learn more about each of these options.

 

Will this cover any COVID-19 related services?

It will! No cost testing and treatment for COVID-19 is available to people covered by Medi-Cal. Additionally, people without insurance or with private insurance that does not cover COVID-19 related services qualify for Medi-Cal coverage of these tests and treatments.

 

Could this make me be considered a public charge?

No. The 2019 public charge rule of the Trump administration was recently blocked by a federal court, meaning that all Medi-Cal is safe to use as U.S Citizenship and Immigration Services does not consider it in public charge decision making. This also applies to CalFresh and public housing.

That public charge rule applied to federally funded programs, and while Medi-Cal is funded with some federal money — the Medi-Cal young adult expansion is funded by dollars from the state of California. So even if the rule hadn’t been blocked, full scope coverage for undocumented youth under 26 years old would not put you at risk of being considered a public charge.

Medical treatments and vaccinations for the COVID-19 virus are not considered in public charge determinations.

 

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Carlos Omar

Carlos Omar

Carlos is a longtime resident of North Long Beach who graduated from CSULB's journalism program in 2019. While there, he held multiple editorial positions at the Daily 49er and served as managing editor for the inaugural edition of DIG en Español. His passion for social change was sparked by growing up in an underinvested portion of the city, and continues to be fueled by the desire to see a day when all people live in healthy communities.