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What Types of Facilities Does Medi-Cal Cover?

Medi-Cal is California's version of Medicaid. It offers medical insurance to families and individuals who are aged or disabled, with income levels below the federal poverty limit. Under the program, adults and children receive medical coverage, but dental coverage is only offered to children under the age of 18. In addition to covering pharmaceutical needs and visits to primary physicians and specialists, Medi-Cal covers many facilities to ensure the health and safety of its recipients.

  1. Long Term Care

    • Long Term Care (LTC) facilities offer round-the-clock care for patients with terminal medical conditions, permanent disabilities, dementia, recovery form an injury or an illness that is expected to last longer than 30 days. They are often called nursing homes. Private insurance rarely covers long-term care facilities unless a person has special coverage. For this reason, a person should check into Medi-Cal eligibility when a loved one is admitted to an LTC facility.

    Hospitals

    • Medi-Cal covers all California county hospitals and most private hospitals. Services include semi-private rooms, surgical facilities, diagnostic testing and laboratory work. It is important that the hospital knows the patient is on Medi-Cal to ensure that services and physicians used by the patient accept Medi-Cal.

    Clinics

    • Medi-Cal coverage includes many inpatient and outpatient clinics such as facilities that offer dialysis treatments, chemotherapy, heroin detoxification, rehabilitation and physical therapy. It also includes centers for AIDS programs, adult day health care, psychological services and hospice care programs. Some clinics specializing in vision, audiology, speech therapy, acupuncture and chiropractic are also covered.

    Durable Equipment

    • Medicare often covers durable equipment such as oxygen, sleep apnea machines, Nebulizers, blood glucose monitors, insulin, catheters, beds, wheelchairs, walkers, crutches orthotics and prosthetics. To be covered, the facility must be contracted with Medi-Cal and there needs to be a medical reason why the equipment is needed. Preapproval may be required.

    In-Home Care

    • Even though it is not a facility, Medi-Cal does cover in-home care to patients who require assistance in everyday living activities such as bathing, dressing, shopping, cooking and cleaning. For basic needs, the patient may choose his own state-licensed providers. Medi-Cal also covers in-home nurse care to limit the length of stay at a hospital. A nurse who tends to the medical needs such as wound care, administering medicine and intravenous care provides this service.

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