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Medi-Cal Hierarchy
Federal law specifies that individuals must be evaluated for medical coverage programs in a specific order. Eligibility should be determined in the following order:
Mega Mandatory
MC Program | Aid Code |
Supplemental Security Income/State Supplementary Payment (SSI/SSP) | 10, 20, 60 |
Addoption Assistance: | |
|
03, 07 |
|
09, 4A |
|
04 |
Foster Care: | |
|
42, 49 |
|
40, 43, 4K, 5K, 5L |
|
45, 46 |
|
4M |
Kinship Guardianship Assistance Program (KinGap): | |
|
4F, 4S, 4T, |
|
4G, 4W |
Pickle | 16, 26, 66 |
Disabled Adult Child (DAC) | 6A, 6C |
Disabled Widow/Widower | 36 |
Medicare Savings Programs (MSP): | |
|
80 |
|
8C |
|
8D |
|
8A |
Modified Adjusted Gross Income (MAGI) MC
MC Program | Aid Code |
MAGI MC Infant’s and Children Groups: Note: Children under the age of 19 receive full-scope MC under SB 75 as of May 1, 2016. Individuals aged 19-25 receive full scope MC under SB 104 as of January 1, 2020. |
|
|
M5, P4, P7, P8 (also includes 30, 31, 32, 33, 35, 3A, 3C, 3D, 3E, 3F, 3G, 3H, 3L, 3M, 3P, 3R, 3S, 3U, 3W, 4H, 4N, 4P, 4R) |
Full-scope Optional Targeted Low Income MAGI MC | T1, T2,T3,T5 |
MAGI MC Parent-Caretaker Relative: | |
|
M3, (also includes 30, 31, 32, 33, 35, 3A, 3C, 3D, 3E, 3F, 3G, 3H, 3L, 3M, 3P, 3R, 3S, 3U, 3W, 4H, 4N, 4P, 4R) |
|
M4 |
MAGI MC Pregnant Woman: | |
|
M7, M9 |
|
M8, M0 |
MAGI MC New Adult Group: | |
|
L6 |
|
M1 |
|
L7 |
|
M2 |
Other Coverage for Children and Pregnant Women
MC Program | Aid Code |
MCAP Pregnant Women |
0D, 0G |
MCAP linked infant and Children |
E6, E7 |
CCHIP
|
2C |
Non-MAGI MC (Optional Categorical)
MC Program | Aid Code |
Aged and Disabled (A&D) FPL Program: | |
|
1H, 6H |
|
1U, 6U |
Blind FPL Program | 2H |
250% Working Disabled Program (250% WDP) | 6G |
Tuberculosis Program limited services | 7H |
Non-MAGI MC (Medically Needy/Medically Indigent)
MC Program | Aid Code |
Aged Blind or Disabled (ABD) Medically Needy (MN): | |
|
14, 24, 64 |
|
17, 27, 67 |
|
13, 23, 63 |
|
C1, C3, C7 |
|
C2, C4, C8 |
|
D2, D4, D6 |
|
D3, D5, D7 |
Aid to Families with Dependent Children: | |
|
34 |
|
37 |
|
C5 |
|
C6 |
Medically Indigent (MI) Child: | |
|
82 |
|
83 |
|
C9 |
|
D1 |
MI Pregnant Woman: | |
|
86 |
|
87 |
|
D8 |
|
D9 |
Federal BCCTP: | |
|
0P, 0W |
|
0L, 0U, 0V |
Non-MAGI MC (State Only)
MC Program | Aid Code |
State BCCTP | 0N, 0R, 0T, 0X, 0Y |
MI Long Term Care State only | 53 |
Dialysis Only Program | 71 |
Total Parenteral Nutrition | 73 |
Anti-Rejection Medicine | 77 |
365-Day Postpartum | 76 |
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