HELPING LOW-INCOME PATIENTS NAVIGATE COMPLEX INSURANCE SYSTEM
Transitions Clinic Network (TCN) is a network of community health clinics that serve returning community members. TCN clinic programs are led by Community Health Workers (CHWs) with lived experience of incarceration and reentry and support people with their healthcare and reentry. TCN hosts a monthly Frequently Asked Questions (FAQ) column, a space where we answer questions about health care and empower individuals to prepare for healthy reentry. This summer we are re-featuring some key articles from past years.
What is Medi-Cal?
Medi-Cal is health insurance for people in the community who make less than $1,564 per month. Medi-Cal is California’s version of Medicaid, which is the nation’s public health insurance program for people with low-income. Almost everyone who is coming home from incarceration is eligible for Medi-Cal. You may not be eligible for Medi-Cal if you are covered under another health insurance plan, such as one through your family or spouse.
Why should I care about health insurance?
While you are incarcerated at CDCR, the state pays for your health care services. In the community, when you see a doctor or get medications, payment is required. Health insurance, such as Medi-Cal, helps pay for these services. Otherwise, you will have to pay out of your own pocket.
What does Medi-Cal pay for?
Medi-Cal covers “medically necessary” care. This includes doctor and dentist appointments, prescription drugs, vision care, mental health care, and substance use disorder and/ or alcohol treatment. Many clinics in the community accept Medi-Cal. You should ask if your doctor or clinic accepts Medi-Cal before getting care or you may get a bill.
Services that Medi-Cal pays for include:
- Emergency room visits
- Routine physical exam (medical check-up)
- Substance use disorder and/or alcohol treatment (including buprenorphine, Methadone and Naltrexone)
- Mental health treatment
- Hepatitis C & HIV treatment
- Blood tests
- Eye exams & glasses
- Prescription medications
- Routine dental care
Services that Medi-Cal does not pay for:
- Vitamins and supplements
- Over-the-counter medications (medications you can buy on your own at the store without a doctor’s prescription)
- Anything considered cosmetic instead of “medically necessary”
Medicare and Medi-Cal sound very similar. Are they the same thing?
No. Medicare is health insurance for people 65 and older or those who are on social security disability insurance (SSDI), regardless of income. Medi-Cal is health insurance for people who are low-income. You can be enrolled in both plans at the same time if you meet the criteria. This is called “dual eligibility.”
When is the best time to apply for Medi-Cal? Can I apply before I leave prison?
You will need Medi-Cal when you’re home in the community and want medical services. You will want to apply for Medi-Cal before leaving. Your application goes to the county where you will be released. The prison has social workers with the Transitional Case Management Program (TCMP) that will help you apply 30-90 days before release. If you are within 30 days of release and have not yet seen a social worker to apply, submit a Request for Interview (Form #22). Once you are out, you need to contact your county’s local social service office to request they turn on your health insurance. If you move to a new county, your Medi-Cal needs to be transferred to your new county.
We are thrilled to communicate with you inside! If you have healthcare-related questions about reentry, feel free to write us at:
Transitions Clinic Network
2403 Keith Street
San Francisco, CA 94124
Or call our Reentry Health Hotline today at (510) 606-6400 to speak with a CHW and to see if there’s a TCN program in your community of return. We accept collect calls from CDCR. We are open Monday to Friday, 9am-5pm.