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:  
  • Title IV-E Adoption Assistance

03, 07
  • State-Only (Cash) Adoption Assistance
 09, 4A
  • (MC only) Adoption Assistance
 04
Foster Care:  
  • Title IV-E Foster Care
 42, 49
  • State-Only (Cash) Foster Care
 40, 43, 4K, 5K, 5L
  • (MC only) Foster Care
 45, 46
  • Former Foster Care
 4M
Kinship Guardianship Assistance Program (KinGap):  
  • Title IV-E KinGap
 4F, 4S, 4T,
  • State Only (Cash) KinGap
 4G, 4W
Pickle 16, 26, 66
Disabled Adult Child (DAC) 6A, 6C
Disabled Widow/Widower 36
Medicare Savings Programs (MSP):  
  • QMB
 80
  • SLMB
 8C
  • QI-1
 8D
  • QWDI
 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.

  
  • Full-scope MAGI MC
 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:  
  • Full-scope MC
 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)
  • Restricted-scope MC
 M4
MAGI MC Pregnant Woman:  
  • Citizen/LPR

    • Note: Individuals who were previously receiving Full Scope, and report an increase in earnings that puts them over 138% must be evaluated for TMC prior to pregnancy aid codes.

 M7, M9
  • Undocumented Individual
 M8, M0
MAGI MC New Adult Group:  
  • Full-scope MC, disabled/blind with no Medicare and income ≤128% FPL
 L6
  • Full-scope MC
 M1
  • Restricted-scope MC, disabled/blind with no Medicare and income ≤128% FPL
 L7
  • Restricted-scope MC
 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

  • NOTE: CCHIP is only available in participating counties, including Santa Clara County.

 2C

Non-MAGI MC (Optional Categorical)

MC Program Aid Code
Aged and Disabled (A&D) FPL Program:  
  • Full-scope MC
 1H, 6H
  • Restricted-scope MC
 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):  
  • Full-scope Zero SOC MC
 14, 24, 64
  • Full-scope Share-of-Cost MC
 17, 27, 67
  • Long Term Care Full-scope MC
 13, 23, 63
  • Restricted-scope Zero SOC
 C1, C3, C7
  • Restricted-scope SOC MC
 C2, C4, C8
  • Long Term Care Restricted-scope MC Zero SOC
 D2, D4, D6
  • Long Term Care Restricted-scope MC SOC
 D3, D5, D7
Aid to Families with Dependent Children:  
  • Full-scope Zero SOC
 34
  • Full-scope SOC
 37
  • Restricted-scope Zero SOC
 C5
  • Restricted-scope SOC
 C6
Medically Indigent (MI) Child:  
  • Full-scope MC
 82
  • Full-scope SOC MC
 83
  • Restricted-scope MC
 C9
  • Restricted-scope SOC MC
 D1
MI Pregnant Woman:  
  • Full-scope MC
 86
  • Full-scope SOC MC
 87
  • Restricted-scope MC
 D8
  • Restricted-scope SOC MC
 D9
Federal BCCTP:  
  • Full-scope MC
 0P, 0W
  • Restricted-scope MC
 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

Related Topics

MAGI MC

Non-MAGI MC