Access for Infants and Mothers Program Banner

Frequently Asked Questions

What do I do if my income is less than the MCAP guidelines?

If your income is less than the MCAP guidelines you may be eligible for no-cost Medi-Cal. The MCAP will forward the application to the Department of Social Services office near you for a Medi-Cal eligibility determination.

What makes an application complete?

A complete application includes copies of all required documentation if you have not provided SSNs/ITTNs on the application for all members of the federal tax household, and the application form must be filled out completely including signatures.

Can I fax my application?

Yes you can fax your application to 1-888-889-9238 this fax line is free.

Back to Top

Can I send copies of the application?

Yes, you can use a copy of the application. Also, send valid copies of your income documents instead of originals, if you did not provide SSNs/ITINs.

Can I apply in person? If not, where do I mail my MCAP application?

No, you can not apply in person. All applications are processed via mail. Applications can be sent in via regular or priority mail to:

Medi-Cal Access Program
P.O. Box 15559
Sacramento, CA 95852-0559

Applications can be sent via overnight mail to:

Medi-Cal Access Program
625 Coolidge Drive Ste 100
Folsom, CA 95630

Where can I get help filling out the application?

You can call MCAP at 1-800-433-2611. All help is free.

Back to Top

How soon will I know when I'm enrolled?

Normal processing time for a complete application is 10 days. You will receive a letter from the MCAP once enrolled. If the application is incomplete, you will receive a letter requesting the additional information needed and the processing time will be longer. You will receive an evidence of coverage booklet and an insurance card from the health plan you selected once enrolled in MCAP. The effective date of coverage is 10 days after enrollment.

Can I send copies of my income documentation?

Yes, do not send originals.

Back to Top

How soon can I see a doctor through MCAP?

You can see a MCAP doctor as of the effective date of coverage. However, keep in mind that you must call the doctor to make an appointment.

What are the benefits of having MCAP as opposed to pregnancy-related restrictive Medi-Cal only?

MCAP offers comprehensive benefits, including pregnancy and non-pregnancy related service. For more information, you can request a copy of the evidence of coverage from the health plan of your choice.

Do I still have a co-payment when I go to the doctor?

No, MCAP does not have co-payments or deductibles.

Back to Top

Will MCAP pay for birth control after my baby is born?

Refer to your health plan’s benefits chart and evidence of coverage.

Can I see a doctor in a county neighboring the one in which I live?

You should contact your health plan to see if they will allow you to see a specific provider.

Back to Top

Will MCAP cover high risk pregnancies?

Yes.

Can I continue to see my current doctor?

Please call your health plan to find out if the doctor is an MCAP participating provider.

Are vision and dental covered with MCAP?

Refer to your health plan's benefits chart.

Back to Top

Can I change doctors if it doesn't work out with my new MCAP doctor?

Any requests to transfer doctors must be made through the Health Plan.

Back to Top

Do I list my children if they live with me only half of the time?

Yes, if they are claimed as dependents on your federal tax return.

Back to Top

Who selects my provider and the hospital at which I will deliver my baby?

The pregnant woman can select her provider through the health plan. Depending on the health plan contract, the provider will inform you of the hospital where you will deliver your baby.

How do I obtain a non-obstetrical specialist while in the MCAP?

Call your health plan's customer or member services. If you are in an EPO, you can do a self referral. If you are in an HMO, you need to obtain a referral from your primary care provider.

Back to Top

How can I find out if my obstetrician and delivering hospital are part of the MCAP?

Call your health plan's customer or member services, or refer to your health plan's provider directory.

Can I transfer to a different health plan if my doctor or delivering hospital is no longer recognized as an MCAP provider by my original health plan?

No. If your obstetrician or delivering hospital is no longer contracting with your current health plan, call your plan's customer or member services for assistance. The plan will either assist you in choosing a new provider or hospital, or allow you to continue seeing your current obstetrician and delivery hospital to provide continuity of care.

Can I obtain brand name drugs when a generic substitution is available for my prescriptions?

Only if the provider indicates that the brand name drug cannot be substituted with a generic drug.

Back to Top

Will the MCAP cover treatment for complications beyond the last day of the month after the 60 day following delivery of my baby?

No. Your MCAP coverage will end on the last day of the month in which the 60th day following the end of the pregnancy occurs.

How do I obtain urgent or emergency care during non-business hours?

Call your primary care provider or your medical group. The answering service will connect you with the advice nurse or the doctor on call to give you further directions.

Back to Top

What if my pregnancy is unsuccessful?

If your pregnancy ends on or after the date your coverage starts, you’re still responsible for paying the 1.5% contribution amount. However, you’ll be covered through the last day of the month in which the 60th day following the end of your pregnancy occurs. If you are no longer pregnant before your start date of coverage, your coverage will not begin. If notification to the program is received after start date of coverage, documentation by a licensed or certified health care professional must be submitted indicating the date your pregnancy ended.

What if my pregnancy ends in the first trimester?

If your pregnancy ends within your first trimester on or after your coverage starts, you may be eligible for a reduced contribution. The MCAP will need documentation by a licensed or certified health care professional indicating the end date of your pregnancy. MCAP determines if you are eligible to only pay 1/3 of your 1.5% contribution amount.

What if I don’t notify MCAP that my pregnancy ended within 30 days?

You must notify MCAP that your pregnancy ended. If you do not notify MCAP that your pregnancy ended within 30 days after the end of your pregnancy, you will not receive timely notification of your disenrollment. Your coverage will still end the last day of the month in which the 60th day following the end of your pregnancy occurs or of your estimated delivery date.

Back to Top

What if I don’t notify MCAP that my pregnancy ended within 60 days?

You must notify MCAP that your pregnancy ended. If you do not notify MCAP that your pregnancy ended within 60 days, the MCAP will disenroll you the last day of the month in which the 60th day following the end of your pregnancy occurs. The MCAP cannot cover medical services received after the last day of the month in which the 60th day following the end of your pregnancy.

What if I have medical bills after the end of my pregnancy coverage?

If you receive medical services after the last day of the month after the 60th day from the end of your pregnancy, MCAP will not pay for these services. If you have other health coverage, you will need to contact them to see if they will help with those medical bills. You will be responsible for any medical services you receive after your coverage ends.

What if I need medical services after the end of my pregnancy coverage?

MCAP cannot pay for any services received after the last day of the month in which the 60th day following the end of your pregnancy occurs. If you need other health coverage, you may qualify for no-cost Medi-Cal or for coverage under CoveredCA. Look in your local telephone White Pages for the Department of Social Services office near you to obtain information about Medi-Cal. You may also call Covered CA at 1-800-300-1506.

Back to Top

I have to pay a deductible or copayment of more than $500 for maternity-only services under my other health insurance plan. Can I still apply for MCAP?

Yes, applicants may have other health coverage with a maternity-only deductible or copayment greater than $500 to be eligible for the MCAP.

What if my other health insurance plan has deductible or copayment more than $500 for all benefit services, not just maternity-only services? Can I still be eligible for the MCAP?

You will not be eligible for the MCAP. The deductible or copayment must be for maternity-only services.

Do I have to use my other health insurance plan instead of the MCAP health plan if I am eligible for MCAP?

Pregnancy and non-pregnancy related services will be covered by both your private health insurance plan and your MCAP coverage. However, you must use the MCAP health plan network providers in order for the MCAP health plan to pay for services. See the Coordination of Benefits section in your plan’s Evidence of Coverage booklet or call your MCAP plan for more information.

Back to Top

What if my health coverage changes?

If your health coverage changes you must call MCAP or write to the MCAP at the address shown below.

Medi-Cal Access Program
P.O. Box 15559
Sacramento, CA 95852-0559
FAX: 1-888-889-9238

What if I have questions about my MCAP plan?

If you have any questions about your MCAP plan, contact your MCAP plan.

What if I have more questions about my other coverage?

If you have any questions about your other insurance coverage, contact your other health plan.

Are maternity benefits for a paid surrogate mother covered by the MCAP?

Maternity benefits are not covered by the MCAP for paid surrogate mother. A paid surrogate mother is a subscriber who in advance of her pregnancy entered into agreement to become pregnant and deliver a child for another person as intended parent, in exchange for monetary compensation other than actual medical or living expenses.

Back to Top