MC Access Program (MCAP) Formerly AIM

MCAP is a health insurance program established in California for pregnant individuals and infants. MCAP is not a Medi-Cal program; it is administered by the Department of Health Care Services (DHCS).

MCAP provides full coverage private health insurance to pregnant individuals regardless of their immigration status during pregnancy and for 365-days days following pregnancy. All other family members are not eligible for MCAP.

MCAP will mail expectant mothers a Infant Registration form 30 days before the expected due date. The expectant mother will need to complete the form and send it to MCAP within 30 days of the delivery. The baby’s coverage will not begin until MCAP receives the required Infant Registration form. When the completed form is received the child will be enrolled on the Medi-Cal Access Infant Program (MCAIP). MCAIP newborn coverage continues until the first birthday based on the mother’s MCAP eligibility and the second year of coverage can continue if the family income continues to qualify.
MCAIP registered babies are covered via the Medi-Cal Managed Care health care delivery system.

The State's toll-free phone number for MCAP is 1-800-433-2611 available Monday-Friday 8AM to 8PM and Saturday 8AM to 5PM.

Eligibility Criteria

To qualify for MCAP an applicant must meet the following criteria:

Must be pregnant at the time of application.
Must be a California resident with intent to remain.
Must have family income between 213% and 322% of the Federal Poverty Level at time of application.
Must not be a Medi-Cal or Medicare recipient at the time of application.

Note: Medi-Cal recipients with an unmet SOC who have not been certified on MEDS are not considered to be MC recipients at the time of application. Individuals determined to be eligible with a SOC who meet all other MCAP criteria may apply for the MCAP program.

Must Not have maternity benefits through private insurance.

Exception: Applicants may have other health coverage with a maternity-only deductible or copayment greater than $500 and still be eligible for MCAP.

Cost

Due to the implementation of premium reduction the cost contribution has been reduced to zero dollars ($0) for MCAP effective July 1, 2022.

Prior to July 1, 2022, MCAP subscribers would pay 1.5% of their Modified Adjusted Gross Income. Individuals have the option to pay the total cost upfront or make monthly payments for one year. A $50 discount would be given to individuals who pay the full 1.5% upfront.

Once accepted into MCAP, individuals would receive monthly billing statements. Payments would be made to:

MC Access Program

P.O. Box 7191

Pasadena, CA 91109-7191

1-800-433-2611

Individuals whose payments were more than 90 days late would be reported to credit agencies.

Individuals were required to pay the full 1.5% even if they cancel MCAP mid-year unless their pregnancy is terminated in the first trimester.

Care Providers/Covered Services

In Santa Clara County, subscribers must enroll in the MC Managed Care Anthem Blue Cross HMO Plan. Once the individual is enrolled, a Blue Cross Provider Directory will be mailed so the individual can choose their provider.

Individuals who enrolled in MCAP after July 1, 2017 are eligible for the same services offered in a MC Managed Care Plan. The individual will be mailed an MC Benefits Identification Card (BIC).

EW Notification

If MC with a SOC is established at intake, the MCAP applicant must be instructed to report to her MC EW when MCAP coverage is approved.

MCAP Transition to MC

Pregnant individuals who report a decrease in income below 213% were previously automatically transitioned to MC. Individuals now have the option of maintaining their MCAP coverage until the end of their pregnancy to allow for continuity of care and avoid gaps in coverage.

Pregnant individuals have the ability to select MCAP or MC coverage by using the Keep or Switch link on the Consumer Home in CalHEERS. The Keep or Switch link only appears when there is a pregnancy reported.

The EW or Service Center Representative (SCR) may return the client to their previous coverage if the client switched coverage in error. A reminder and attestation check box informs the EW or SCR that returning the client to their previous eligibility does not reactivate enrollment and that manual coordination with the MCAP administrators (MAXIMUS) or County of Responsibility is required to reactivate coverage and prevent gaps in coverage. The [Save] button activates once the user has checked: “I have coordinated the enrollment”.

Before the individual can transition from MAGI MC back to MCAP, the worker must confirm that:

The Unsolicited DER containing the MCAP to MAGI MC transition has been processed in CalSAWS.
CalHEERS Eligibility results have been loaded and authorized by the EW.
MAGI MC eligibility results have been sent and processed by MEDS.

[Refer to Job Aid: Medi-Cal MAGI Eligibility Review] for CalSAWS functionality of MCAP transition to MAGI MC.

Notice of Action

If a client is returned to MCAP by CalHEERS administrative override, BRE will not be called if there is no data change. After processing the case, once there is a successful interface the MAGI MC Termination Notice of Action will be created.