What Benefits are Available to Me Under Medi-Cal?

Calendar Icon Updated January 15, 2019
Medi-Cal

There are a broad range of Medi-Cal benefits that are separated into 14 different categories. The health plan you have or the Medi-Cal program you are under will determine which benefit categories you are eligible for. 

Medi-Cal provides many of the optional benefits allowed by the federal Medicaid program. While their eligibility requirements vary widely by the program, their benefits are extensive and provide a comprehensive approach to health care. Once approved, you can utilize these benefits whenever necessary.

You may be approved for free coverage, partial pay coverage, or coverage for specific services. What you are approved for will depend on the program you applied under and your eligibility factors. Depending on your medical needs, coverage may be short term or ongoing.

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The 14 categories of benefits are as follows: ambulatory patient services, prescription drugs, emergency services, rehabilitation services and devices, hospitalization, lab services, maternity and newborn care, preventative medicine and chronic disease management, mental health & substance use disorder, pediatric services, dental, vision, non-emergency medical transportation services, and long-term care.

Ambulatory services include hospital and clinic outpatient services, podiatrist, chiropractors, and dialysis, chemotherapy, and radiation, as well as allergy and physician services. Emergency services include all emergency needs from ambulance transportation to emergency room costs. It even covers emergency dental services.

The prescription drug coverage provides a list of approved medications that patients can have covered. However, if you need a prescription that is not on the list, you can appeal to Medi-Cal, and it may be covered if you can demonstrate the medical need. The approved list includes at least one drug from each prescription class and category.

Rehabilitation services and devices cover physical, occupational, and speech therapy. It also covers medical equipment, supplies, prostheses, orthotics, and hearing aids. Cardiac and pulmonary rehabilitation services are covered under this category. Finally, this category of services also includes home health aides; 90-day skilled nursing facilities and acupuncture.

Hospitalization services include anesthesiology, inpatient procedures, organ and tissue transplants, and a variety of surgical services including bariatric and reconstruction. The lab services category covers labs, x-rays, and advanced imaging services like MRIs.

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Maternity and newborn care cover everything from prenatal care through to postpartum care and breastfeeding counseling. Pediatric services will cover most your everyday child health needs including screening, diagnosis, and treatment of illnesses.

The preventative Medicine and Chronic disease management category covers a variety of services including smoking cessation, family planning, and routine recommended exams. It also covers the cost of immunizations and HRSA’s Bright Futures Recommendations. Mental Health and Substance Use Disorder covers inpatient and outpatient services for mental health, substance abuse and treatment, detoxification, and specialty services.

The Dental and Vision categories both cover routine exams and emergency services. The vision plan also covers eyeglasses for qualified patients, and the dental plan also covers dentures, dental implants, crowns, and anterior root canals.

The long-term services category covers benefits such as personal care services, home and community-based care, self-directed personal assistance, and skilled nursing homes if they are needed for longer than 90 days. Non-emergency medical transportation services cover transportation when you are unable to use public or personal vehicles for medical care.

Eligibility Team

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