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What Services Does Medi-Cal Cover?

Medi-Cal aids California residents who cannot afford health care by providing health care for free or at a reduced cost. Medi-Cal also provides for children in the foster care system, pregnant women, individuals with specific diseases and those with disabilities. The program covers the gamut of health care needs. In understanding the importance of preventative care especially for children, Healthy Families has been developed to ensure children have access to proper check-ups and care regardless of a family's financial issues.

  1. Clinic, Hospital and Physician Services

    • Medi-Cal covers clinic visits as well as the costs of physician consults as necessary. Depending on your income level you might have a certain monthly co-pay to meet each month. These co-pays are individual or family based depending on the number of people covered on your plan. If you need to go the emergency room or are admitted to the hospital, Medi-Cal pays for these services as well. If you require surgery of any type other than emergent, the procedure must be pre-approved.

    Mental Health, Long Term Care and Drug/Alcohol Counseling

    • To keep the members healthy, Medi-Cal allows for certain types of counseling and mental health coverage. By paying for such preventative measures, it often costs less in the long term than having patients who are repeatedly hospitalized for mental health or drug issues. Long-term care is also provided for those without the mental capacity to care for themselves and for the elderly. All of these services go through the medical case manager who helps determine the best course of action for each patient in need of such services.

    Pharmacy, Vision, Hearing and Durable Medical Equipment

    • If Medi-Cal patients require specialty equipment or medication, Medi-Cal covers the charges related to such needs. This can include hearing aids, glasses, wheelchairs, pacemakers and batteries for such equipment. Visits to specialty doctors to help maintain a level of comfort in life despite any disability can be charged through the Medi-Cal office. When seeking medications, it is necessary to work with the pharmacist to verify patients receive Medi-Cal-approved prescriptions. This often means generic versions of drugs as available to help keep the cost down for the state.

    Waivers

    • This portion of Medi-Cal allows for services aimed specifically at certain diseases, age ranges or those with disabilities. As the standard for being accepted into the program is financial hardship, these waivers allow for entrance into the Medi-Cal program for other reasons. This waiver program helps those with debilitating illnesses and aids in providing assisted living for the elderly. This can include in-home medical equipment for ailments such as diabetes, cardiac issues and handicaps.

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