Intro to Medi-Cal

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Covered California and Calheers

The California Healthcare Eligibility, Enrollment, and Retention System (CalHEERS) is the system supporting the Covered CA insurance exchange. A request is sent from the CalSAWS system to CalHEERS. Then CalHEERS responds to the request with an eligibility determination for MAGI Medi-Cal using the information provided in the request.

CalHEERS

Suppose an individual's income is too high for Medi-Cal. In that case, they may qualify to purchase health insurance through Covered California which offers “premium assistance,” to help lower the cost of health care for individuals and families who enroll in a Covered California health plan and meet income rules. Income must be under the Covered California program income limits to qualify for premium assistance.

Covered California is the State’s health insurance marketplace

What is Medi-Cal?

California's medicaid program. Provides healthcare coverage to low-income individuals and families. Offers free or low-cost medical services and is funded by the federal and state taxes.