Institutionally Deemed Medi-Cal: Commonly Asked Questions

What is institutionally deemed Medi-Cal?

Institutional deeming is a program that enables children between the ages of 3 and 18 to receive full-scope Medi-Cal coverage when their family income is too high. With institutionally deemed Medi-Cal, only income specifically designated to the child, such as a trust or child support, will be considered. Institutional deeming is part of a program called the Home and Community Based Services waiver program, also known as Medicaid waiver.

What is Medicaid Waiver?

In essence, Medicaid Waiver is a federal government waiver that reimburses the State of California for a portion of the cost of services for individuals on the waiver.

Who is eligible for Medicaid Waiver?

In order to be eligible for Medicaid waiver, an individual must meet the following criteria: Be a client of the regional center, live at home, have a social security number, have two or more “qualifying conditions” or extensive medical needs, and be currently utilizing a “qualifying service” with a value of $1000 a year or more. Respite is not a qualifying service if a child is 5 years of age or younger.

What does the process look like for applying for institutionally deemed Medi-Cal?

If an individual meets the above criteria, then the regional center can send a referral to the local county Medi-Cal office for institutionally deemed Medi-Cal. At that point, the individual will be sent a Medi-Cal packet from the county. That entire packet needs to be filled out, including income.

Why do I have to include my income if institutionally deemed Medi-Cal does not count the parent’s income?

I get this question a lot. Institutional deeming is considered to be the last option. You only qualify for institutionally deemed Medi-Cal if your child does not qualify for any other type of Medi-Cal. Because of this, your income is run through the system to determine if your child is eligible under any other program first. If they are not, then the paperwork will be processed for institutionally deemed Medi-Cal.

Department of Developmental Services Regional Centers

Regional Centers are 21 private, nonprofit organizations contracted by the State of California to coordinate lifelong services and support for individuals with developmental disabilities and their families.

Once an individual’s eligibility has been determined through the Intake process, service coordination and planning is initiated with the development of a person centered written plan. Services are individually determined and are provided to assist with opportunities to maximize consumers’ opportunities to live independent, productive, and satisfying lives as members of our community.

Regional Centers assist eligible consumers to apply and access other social service agencies and public benefit programs; and may provide funding for services. Some examples of services funded by Regional Center are: infant education; family support services such as respite and specialized day care; and community living arrangements such as residential care and supported living.

People with developmental disabilities are entitled to the same rights and protections as any other person under the laws of California and the Constitution of the United States. State law provides additional specific rights to people with developmental disabilities. These rights include, but are not limited to: treatment and rehabilitation services; dignity, privacy, and human care; education; to be free from harm; advocacy services; social integration and community participation. Regional Centers are committed to ensuring and protecting these civil, legal and service rights to which our consumers and applicants are entitled.

Galt Advocacy LLC works with you to leverage Regional Center services to best advantage, to apply for Regional Center services if needed, as well as utilize Regional Center to help you to receive IHSS and Protective Supervision if a hearing is needed. We work closely with the Regional Center to maximize your ability to receive support and services that will provide maximum benefit.

Alta California Regional Center
Phone: 916-978-6400

Central Valley Regional Center
Phone: 559-276-4300

Eastern Los Angeles Regional Center
Phone: 626-299-4700

Far Northern Regional Center
Phone: 530-222-4791

Frank D. Lanterman Regional Center
Phone: 213-383-1300

Golden Gate Regional Center
Phone: 415-546-9222

Harbor Regional Center
Phone: 310-540-1711

Inland Regional Center
Phone: 909-890-3000

Kern Regional Center
Phone: 661-327-8531

North Bay Regional Center
Phone: 707-256-1100

North Los Angeles County Regional Center
Phone: 818-778-1900

Redwood Coast Regional Center
Phone: 707-445-0893