Mega Mandatory

Mega Mandatory groups are programs:

  • Required by Federal law, or
  • The MC is included in some other programs aid code (i.e. Foster Care).

An individual who is eligible for a Mega Mandatory aid code will remain in the household for income and household size determination purposes, however, they must not be granted a MAGI MC aid code.

Exception: Parent/Caretaker relatives may be eligible for MAGI MC.

Mega Mandatory groups include:

  • Supplemental Security Income/State Supplemental Program (SSI/SSP) is a federal program that provides monthly case payments to aged individuals over 65 and blind and disabled individuals of any age. MC is included with the cash aid code.
  • Foster Care is a program for children whose needs are met in whole or in part by public funds. Children removed from their homes and placed in Foster Care must have an immediate MC determination to ensure immediate access to healthcare services. MC is included with the cash aid code.
  • Former Foster Youth (FFY) MC is available to individuals who were in the Foster Youth program on their 18th birthday, coverage extends to age 26 and income is not considered for the eligibility determination. Refer to Extended Medi-Cal Eligibility for Former Foster Youth (FFY) 18 to 26 Years of Age. 
  • Adoption assistance is a cash program to facilitate the adoption of hard-to-place children who would require permanent foster care placement without such assistance.
  • Kinship Guardianship Assistance Payment (Kin-Gap) is a federal program for children in guardianship placement receiving cash assistance. MC is included with the cash aid code.
  • Pickle - The 1976 Pickle Amendment to the Social Security Act, requires that zero share-of-cost MC benefits be granted to any ABD individual or couple who meet the following conditions:
    • Currently Receiving RSDI benefits
    • Was eligible for and received RSDI and SSI and/or SSP benefits at the same time after April 1977
    • Was discontinued from SSI and/or SSP After April 1977
    • Received an RDSI cost of living adjustment (COLA) after being discontinued from SSI and/or SSP, and
  • Would be entitled to receive SSI and/or SSP if the RSDI COLA received after SSI and/or SSP ineligibility was disregarded.
  • Disabled Adult Child (DAC) is a program that disregards RSDI provides zero share-of-cost MC to eligible individuals.
  • Disabled Widow/Widower - Federal regulations under Section 9116 of OBRA '87 have established a new group of persons who are potentially eligible for Pickle Medi-Cal, effective July 1, 1988. These persons are widow(er)s, age 60 through 64, whose SSI payments have been discontinued due to entitlement to, or an increase in, RSDI widow(er)s benefits. Eligibility continues under these provisions until they become eligible for Part A of Medicare.
  • Medicare Savings Programs, including:

Related Topics

Medi-Cal Hierarchy