What Is Medi-Cal?
Medi-Cal is California’s version of the Federal Medicaid program. Medi-Cal offers no-cost and
low-cost health coverage to eligible people who live in California. The Department of Health Care Services (DHCS) oversees the Medi-Cal program and your local county office manages most Medi-Cal cases for DHCS.
What Are the Requirements for Medi-Cal?
To qualify for Medi-Cal, you must live in the state of California and meet certain rules. You must give income and tax filing status information for everyone who is in your family and is on your tax return.
- Income – Each program under Medi-Cal has set income limits based on a percentage of the Federal Poverty Level.
- Immigration – Most Medi-Cal programs require individuals to have satisfactory immigration status. However, certain programs such as prenatal care and emergency Medi-Cal are available for those without satisfactory immigration status.
- Disability – Those receiving SSI can receive Medi-Cal coverage as well as those not receiving SSI but who are disabled under the definition of disability by the Social Security Administration.
What Does Medi-Cal Cover?
Outpatient (Ambulatory) Services
- Physician services
- Hospital outpatient & outpatient clinic services
- Outpatient surgery (Includes anesthesiologist services.)
- Allergy care
- Treatment therapies (chemotherapy, radiation therapy, etc.)
- Emergency Room services
- All inpatient and outpatient services that are necessary for the treatment of an emergency medical condition, including dental services, as certified by the attending physician or other appropriate provider.
- Ambulance services
- Inpatient hospital services
- Anesthesiologist services
- Surgical services (bariatric, reconstructive surgery, etc.)
- Organ & tissue transplantation
Maternity and Newborn Care
- Prenatal care
- Delivery and postpartum care
- Breastfeeding education
- Nurse midwife services
- Licensed midwife services
Mental health and Substance Use Disorder (SUD) Services
- Outpatient mental health services
- Outpatient specialty Mental health services
- Inpatient specialty mental health services
- Outpatient substance use disorder services
- Residential treatment services
- Voluntary inpatient detoxification
- Coverage is at least the greater of one drug in each U.S. Pharmacopeia (USP) category and class.
- Beneficiaries may receive up to a 100-day supply of many medications.
Programs such as physical and occupational therapy (known as Rehabilitative & Habilitative Services) and devices
- Physical therapy
- Speech therapy / Audiology
- Occupational therapy
- Cardiac rehabilitation
- Pulmonary rehabilitation
- Skilled nursing facility services (90 days)
- Medical supplies, equipment and appliances (including implanted hearing devices)
- Durable medical equipment
- Hearing aids
- Home Health Services
- Outpatient laboratory and X-ray services
Pediatric Services Including Oral and Vision Care
Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) is a Medi-Cal benefit for individuals under the age of 21 who have full-scope Medi-Cal eligibility. EPSDT provides periodic screenings to determine health care needs and, in addition to the standard Medi-Cal benefits, a beneficiary under the age of 21 may receive extended services as medically necessary.
- Emergency dental services
- Dental implants and implant-retained prostheses
- Basic preventive, diagnostic, and repair services
- Routine eye exam once in 24 months
- Eyeglasses and contact lenses
Medi-Cal offers transportation to and from appointments for services covered by Medi-Cal. This includes transportation to medical, dental, mental health, or substance use disorder appointments, and to pick up prescriptions and medical supplies.
Long Term Services and Supports
- Skilled Nursing Facility services (91+ days)
- Personal Care Services
- Self-Directed Personal Assistance Services
- Community First Choice Option
- Home and Community Based Services
How Do I Apply for Medi-Cal?
You can apply for Medi-Cal at any time of the year by mail, phone, fax, or email. You can also apply online. It may take up to 45 days for your local county office to process your Medi-Cal application. If you apply for Medi-Cal based on disability, it may take up to 90 days.
Skyline Benefit is a Covered California’s certified insurance agency. If you have any questions about your Medi-Cal eligibility, benefits or application, call us today at (714) 888-5112