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Determining Eligibility for Health Care Programs
Eligibility for public health care programs is generally based on income, age, residency status, family size, and other situations such as pregnancy and disability.
Alameda County has created a comprehensive chart that shows eligibility for health care plans and programs in 2014. Use this tool to determine which plans clients are eligible for.
How to Use This Chart
The 2014 Eligibility Chart for health care programs in Alameda County is intended to make it easier to determine client eligibility for various programs. Begin by looking at the age of the client, and if he/she has any special status (e.g., disabled, pregnant).
Next, look at their residency status and then estimate the household/family income. Use this information to determine which health care program the
individual is likely to be eligible for.
Note: Legal Permanent Residents (LPRs) with less than 5 years residency may be treated differently in 2014. Previously, LPRs with less than 5 years residency were eligible for state only funded Medi-Cal if they met all other eligibility requirements for the program. Beginning sometime in 2014, this will change.
- As of legislation passed in June 2013, LPRs with less than 5 years residency, between 0 and 138% FPL, and without dependent children, will be eligible for a Covered California plan. The state will cover their premium costs, cost-sharing, and any Medi-Cal benefits not offered through their plan. Starting in 2014, or when the California Department of Health Care Services and Covered California have operational capability, this group will enroll into Covered California during open enrollment but remain eligible for state-only Medi-Cal if they miss the open enrollment period. Until such operational capability is reached, LPRs with less than 5 years residency will remain covered under Medi-Cal.
- LPRs with less than 5 years residency, with Medi-Cal eligible children, will still be eligible for state-only Medi-Cal (same as current policy). LPRs with < 5 years residency and greater than 138% FPL to 400% FPL are eligible for tax credits to purchase a Covered California plan.
- Adults and families who have been Legal Permanent Residents for 5 or more years and are below 138% FPL are eligible for Medi-Cal. Those between 138% FPL and 400% FPL are eligible for Covered California.
Expanded Program & Population Information
For more information on health care plans, including information on enrollment, coverage, payment, contact, and follow-up, see Coverage, Service Eligibility, and Payment.
For more information on specific populations and a description of the programs related to health and health access that clients may
be eligible for, see Context and Information for Specific Populations.
Next Section: Eligibility Chart, Health Care in Alameda County: 2014