Well, some would argue that Medicare actually helps adult people, whereas Medi-Cal really is better for children and prenatal mothers than the general population it serves. My opinion? They could all be better. But I’ll stop with opinions now…..
Medicare – Federal Health Insurance plan for seniors and the disabled. Contrary to what some may believe, you can be a 20 year old with Medicare. Most people under 65 with Medicare receive federal disability, like SSI or SSDI. In that regard, even some people who receive disability don’t qualify for Medicare because of the work credit eligibility requirements. I think that’s the limit as to who qualifies, although if you are a dependent child with parents who have Medicare you are probably covered as well.
Medi-Cal – This is California’s version of Medicaid. Medicaid is the program name used by other states, like New York, but they don’t have to. Basically Medicaid comes out of a federal law that forces states to offer basic health coverage for specific populations. In California that is Medi-Cal.
The eligibility requirements are again fairly strict; I’m not so sure you can qualify for it unless you are either under 21 or over 65, have dependent children, or receive any public assistance through the state (SSI, IHSS, TANF, Food Stamps, etc.)
Many people who qualify for food stamps do not qualify for Medi-Cal. Also, there seems to be a loophole that also gives anyone with a “chronic disability” access to Medi-Cal. We are exploring this, because on the surface it looks like just a letter from a doctor suffices for this, rather than making it a requirement that one receives disability. But I haven’t been able to exploit the loophole and most people end up being forced to use CMS.
There is also a population of people, mostly seniors, who are what we call “Medi-Medi”. That means they are Medicare and Medi-Cal recipients; in social service agencies that charge a fee or at clinics or hospitals, these people actually have better coverage than most private health insurance because they can double dip.
All of these programs require you to be under a certain income though. In Medicare if you are over a certain income you have a share of cost, that sometimes can be extremely high. With Medi-Cal, you can qualify based on income but also be charged a ridiculous share of cost based on property ownership and assets – a fatal flaw in the system. It forces even low-income people to pay exorbitant sums out of pocket, like a deductible, that can literally be $1000 dollars plus.
CMS – County Medical Services – is the only other way adults can access health care, and you know all about the hoops one must jump through there. If you are 0-165% of the poverty level, you are eligible to receive as needed services at no cost. Otherwise there is a share of cost.
The worst thing about CMS: You have to sign a lien agreement if you don’t qualify for the low-income service! In essence, the county is asking people who fall through cracks to give up future assets just to have basic, minimal medical procedures or services – at full cost, not a negotiated rate. True bullshit. Opps – sorry, another opinion.