Scope of Medi-Cal Benefits

The scope of Medi-Cal benefits and the funding source for each coverage group are dependent on an individual's citizenship or immigration status.

For many immigrants who are ineligible for federally funded full-scope Medi-Cal, California uses state funds to provide full-scope Medi-Cal. If an individual is not eligible for federally funded or state-funded full-scope Medi-Cal, they may still qualify for restricted-scope Medi-Cal, which covers emergency, pregnancy-related services, and long-term care.

Individuals Eligible for Federally-Funded Full-Scope

The following citizenship or immigration statuses are potentially eligible for federally-funded full-scope MC Benefits:

Individuals with U.S. citizenship,
Lawful Permanent Residents (LPRs) who are exempt from or have met the five-year bar,
Cuban/Haitian Entrants,
Migrants legally residing in the United States and its territories under the Compact of Free Association (COFA), such as citizens from the Marshall Islands, Micronesia, or Palau,
Lawfully present individuals under the age of 21 or pregnant.

Five-year bar

Federal law states that QNCs are eligible for federally funded full-scope Medi-C if they have resided in the United States for a minimum of five years, unless they are exempt. In California, QNCs who would meet the eligibility requirements for federal full-scope Medi-Cal except for the five-year bar are granted state-funded full-scope Medi-Cal until they are eligible for federally funded full-scope Medi-Cal.

Individuals who previously had certain immigration status and adjust their status to LPR are exempt from the five-year bar.

The following categories are exempt from the five-year bar:

Refugees,
Asylees,
Individuals granted withholding of deportation or removal
Cuban or Haitian entrants,
COFA migrants (citizens of Compact of Free Association nations),
Survivors of trafficking (and qualifying family members),
Amerasian immigrants who are LPRs.

Additionally, the following individuals are exempt from the five-year bar:

Veterans or active-duty service members (including their families),
Under age 21,
Pregnant (including individuals up to 12 months postpartum).

Individuals Eligible for State-Funded Full-Scope

The following non-citizens are potentially eligible for State-funded full-scope MC benefits:

Lawful Permanent Residents (LPRs) who have not met the five-year bar,
A non-citizen permanently residing in the United States under color of law (PRUCOL),
Survivors of Human Trafficking or Serious Crime pursuing T Visa status (the client must at least have the intent to apply for the T visa),
Survivors of Human Trafficking or Serious Crime and can verify that they have applied for or been approved U Visa status,
Refugees,
Asylees,
Conditional Entrants,
Parolees,
Deportation withheld,
Expansion freeze populations.

State Aid Codes

Beginning January 1, 2027, these individuals will be granted or transitioned to state-funded full-scope aid codes (1C, W9, 1D, V4, 1J, Y1, 1K, V5, 1M, Y2, 1N, V6, W5, W6, 0K,). Additional information on the transition to state-funded full-scope aid codes is found in the Aid Code Crosswalk resource.

Managed Care Plans

Beginning January 1, 2027, Individuals receiving coverage under a state-funded full-scope aid code are not eligible to enroll in a managed care plan.

Undeclared Status

Any person who does not wish to declare or verify citizenship, immigration status, Social Security number, or birthplace may receive only restricted-scope benefits.

Status/Healthcare Coverage Entitlement Charts

For Employment Authorization Document Codes, refer to Immigration Status and Healthcare Coverage Eligibility in Reference Materials.

For details on immigration status and scope of coverage, refer to Eligibility Based on Immigration Status in Reference Materials.