Medically Indigent

A Medically Indigent person is one who does not qualify under any other MC program (including MAGI). There are two categories of Medically Indigent individuals:

Medically Indigent Adult Exceptions (MIA-X's)
Medically Indigent Children (MICs)

For purposes of this section, individuals are considered 21 years of age on the first day of the month following the month in which they reach age 21, unless they turn 21 on the first day of the month.

MIA Exceptions

To qualify as potentially eligible as a MIA Exception, the person must be between 21 and 64 years old, and must meet at least one of the following conditions at the time of application:

Be in a skilled nursing facility or intermediate care facility
Be a refugee with less than 8 months residency
Be a pregnant woman

Medically Indigent Child

Medically Indigent Children (MICs under age 21):

Are neither linked to, nor a recipient of PA
A child who is not eligible as an AFDC-MN person because s/he is not living with a relative

Blind or Disabled Child

A person under 21 who meets the definitions of blind or disabled may choose to apply and receive MI. However, in most cases, ABD-MN status is preferred due to budgeting differences which may lower the share of cost (SOC). The choice to apply as MI or ABD can be made by a person acting on behalf of the child under 21.

Reminder: A disabled person who is age 18 or older is considered an adult.

Foster Children

Children in Foster placement living in California and placed by California are eligible for MC:

On the basis of the information provided by the public agency on form MC 250.
Without consideration of the property or income of the child's natural or foster parents.

Adopted Children

Children under the Aid for Adoption of Children program living in California and placed by California are eligible for MC.

Other Foster/Adopted Children

Children who are federally eligible under the Adoption Assistance Program (AAP) or Foster Care Program (FCP) and are not living in California must receive Medicaid from the state in which they reside.

AAP or FCP federally eligible children placed by another state and living in California are eligible for MC.

Treatment of MIA Pregnant Women

If a pregnant woman is verified as being temporarily disabled (receiving SDI, has doctor's statement, etc.), then she has AFDC-MN linkage in those month(s) only. The month after the temporary disability ends, the woman would then become a MIA exception (if pregnant) or an ineligible MIA if no other linkage exists. Issue 60-Day Postpartum benefits if not otherwise eligible for full-scope benefits.

Note: MIA pregnant women are granted aid code 86 (No SOC) or 87 (SOC).

Eligibility for the Newborn

If the mother remains eligible for full-scope MC, the newborn may receive services authorized by the mother's card for the month of birth and for the following month. Due to “Deemed Eligibility” (DE) rules, most newborns are automatically deemed eligible for Medi-Cal at birth until age one.

The 60-Day Postpartum Program provides restricted benefits only to the mother. Services to the newborn are not covered by the Postpartum card.

The Medi-Cal Family Budget Unit (MFBU) consists of those individuals who will be included in the Medi-Cal eligibility and SOC determination. Refer to the following for definitions of MFBU members.