What is Full-Scope of benefits Medi-Cal (Medical sic) Coverage
While Medi Cal does have details and information on “Full Scope” you’ll probably find the best, most accurate summaries following the links below, from the Actual Insurance Companies contracted to provide and manage the Health Services for you.
Medi-Cal Managed Care HMO – Health Care Options
Here you can review and choose the HMO that you want to deliver your Medi-Cal health Care.
Learn more:
- Disability Rights.org –
- What are Medi Cal Managed Care Plans? What do I need to know?
- Medi-Cal Managed Care Health Plan Directory
- Poor Care Co-Ordination? New contracting process Deficient Oversight CA Health Line *
- Disability Rights – Medi Cal provider HMO’s, what are they? What do I need to know about them?
- Medi-Cal Managed Care – Health Care Options
- EOC’s, Forms & Income Charts from Insure Me Kevin.com
- Medi-Cal Managed Care Provider Search
- Sacramento? dhcs.ca.gov//mmcd health plan dir
- Exemption from enrolling in a Health Care Plan
- health care options.dhcs.ca.gov
- health care options.dhcs.ca.gov/Med Exemption WEB
- You May Get A Medical Exemption If:
- • You have a complex medical condition; AND
• The care you get from your Regular Medi-Cal doctor for the complex medical condition
cannot be changed, because your condition could get worse; AND
• Your Regular Medi-Cal doctor is NOT part of a plan in your county. You may see
more than one Regular Medi-Cal doctor. If you do, have the form filled out by the
doctor who sees you most often. Ask your Regular Medi-Cal doctor if he or she is part
of a Plan in your county. This should be done before you submit this form.
- • You have a complex medical condition; AND
- You May Get A Medical Exemption If:
- Provider Search – Statewide Fee for Service
- See our webpage on IMR Independent Medical Review
Depending on how you qualify for Medi-Cal, the program may provide a
Full-Scope of benefits Teen Health Rights.org
Medi-Cal pays for all of these services
or just some of them (partial-scope Medi-Cal). DB 101
Primary Medical Care
- Doctor visits
- Diagnostic testing
- Emergency services.
- Surgery
- Hospitalization.
- Dental, Vision & hearing services
- Vision
- Hearing
- Health screenings for kids
- Preventive and wellness services and chronic disease management.
- Mental Health CHCF Fact Sheet
- Substance abuse CHCF Article
- Maternity
Ongoing Care & Recovery
- Personal care services (IHSS)
- Occupational & physical therapy
- Outpatient drug abuse services
- Nursing facility stays
- Adult day health care
Other medical related costs
- Medical supplies
- Durable medical equipment
- Transportation to doctor visits
- Transportation costs for children with disabilities
- Nutrition Food & Meals
More Details
- My Medi-Cal brochure
- dhcs.ca.gov/Medi-Cal_EHB_Benefits
- dhcs.ca.gov/Benefits_services.aspx
- dhcs.ca.gov/Benefits-Chart
- Check with your HMO Providers Evidence of Coverage
- Insure Me Kevin.com – Medi Cal HMO same coverage as Covered CA HMO! Provider list may differ!
- Medicaid Medi Cal CHIP grew by 4 million during COVID 19 Modern Health Care *
#My Medi-Cal
How to get the Health Care
You Need
24 pages
Smart Phones - try turning sideways to view pdf better
- Medi Cal Explained CHCF
- Our Webpages on
- Medi Cal Benefits
- Denti Cal
- Medi-Cal – MAGI Income Eligibility Criteria
-
BIC Benefits Identification Card
#Covered CA Certified Agent
No extra charge for complementary assistance
- Appoint us as your broker
- 17 Reasons to appoint us as your agent - broker
- Set Consultation Meeting via Phone, Skype or Zoom
- VIDEO on ARPA Stimulus and more Covered CA Subsidies
- Videos on how great agents are
Medi Cal (medical sic) out of state emergency coverage?
CA Medi Cal – Out-of-state medical care is limited to the following:
(a) (1) When an emergency arises from accident, injury or illness; or
(2) Where the health of the individual would be endangered if care and services are postponed until it is feasible that he/she return to California; or
(3) Where the health of the individual would be endangered if he/she undertook travel to return to California; or
(4) When it is customary practice in border communities for residents to use medical resources in adjacent areas outside the State; or
(5) When an out-of-state treatment plan has been proposed by the beneficiary’s attending physician and the proposed plan has been received, reviewed and authorized by the Department before the services are provided; and the proposed treatment is not available from resources and facilities within the State.
(6) Prior authorization is required for all out-of-state services, except:
(A) Emergency services as defined in §51056.
(B) Services provided in border areas adjacent to California where it is customary practice for California residents to avail themselves of such services. texas.gov/medicaid
-
- Medi Cal Treatment Authorization Request
- 540-1 (a) (5) When an out-of-state treatment plan has been proposed by the beneficiary’s attending physician and the proposed plan has been received, reviewed and authorized by the Department before the services are provided; and the proposed treatment is not available from resources and facilities within the State
- Medi Cal Treatment Authorization Request
Links & References
Learn More ==>
Misc
Medi-Cal enrollees not sure how to use coverage california health line.org
Medi Cal only covers outside of CA for emergencies and very special circumstances. Cornel Law * Medi Cal Treatment Authorization Request
Medi-Cal pays $415 to $575/month or MORE to HMO’s to take care of you Learn More⇒ Insure Me Kevin.com 3.4.2016 5.11.2014
If you are over 55, Medi-Cal will? bill your estate for the premiums?
Historical
Problems with Medi-Cal Computer system to process payments in Fee For Service Program CA HealthLine 2.20.2015
- Medi-Cal – MAGI Income Eligibility Criteria
- Medi Cal – Long Term Care & Nursing Home Estate Recovery – Strategic Planning
- Get Instant Quotes for Covered CA
Medi Cal Contact Information
- Medi Cal Contact Sheet
- [email protected] regarding general Medi-Cal eligibility. If the question contains specific details the county or the district office that handles your case must answer.
- Medi-Cal Member & Provider helpline, at (800) 541-5555.
- California Department of Health Care Services 1-844-253-0883
- [email protected]
- [email protected] Ms. Leslie Benson
- IHSS In Home Supportive Services
- Direct Phone # for Medi Cal 866.613.3777 (Anthem Blue Cross?)
Ombudsman
- Ombudsman Webpage
- Phone: 1-888-452-8609
- Email: [email protected]
- The Office of Ombudsman cannot approve/terminate/reinstate Medi-Cal eligibility; alter aid codes, change/update addresses, change/update name or initiate inter-county transfers.
Complex Questions Assistance
- Health Consumer Alliance at 1-888-804-3536.
- Disability Rights California at 1-800-776-5746.
- Covered CA Facebook Page
- HICAP – Health Insurance Counseling & Advocacy Program
- CA Health Care Advocates – 1-800-434-0222 Volunteer counselors can help you understand your specific rights and health care options
- Medi Cal Consulting Services
- National Center on Law & Elder Rights - Case Consultation for Professionals
- VITA Volunteers Income Tax Assistance
- Medi Cal - Technical Comprehensive Reference Materials
- Our webpage on education, research & tutoring for a fee
- aging.ca.gov/Medicare_& Medi Cal Counseling
- Elder Care locator
Medi-Cal for All Children program
SB 75 Eligibility and [email protected]
Medi Cal - #County Office Lookup
See our Main Webpage on Medi Cal contact information
Cal AIM
https://www.chcf.org/resource/focus-on-calaim/calaim-resources-cbos/
https://calmatters.org/health/2023/01/medi-cal-eligibility/
https://www.dhcs.ca.gov/Documents/Budget-Highlights/DHCS-FY-2023-24-GB-Highlights.pdf
https://ebudget.ca.gov/2023-24/pdf/BudgetSummary/FullBudgetSummary.pdf
https://www.dhcs.ca.gov/CalAIM/Pages/CalBH-CBC.aspx
https://ebudget.ca.gov/2023-24/pdf/BudgetSummary/HealthandHumanServices.pdf
https://ebudget.ca.gov/2023-24/pdf/BudgetSummary/FullBudgetSummary.pdf
What’s the difference in The Aged-FPL Program, no share of cost, and Medi-Cal with a share of cost.
Which overrides if you have IHSS. In Home Support Services
See our Medi Cal related pages above
My client has a share of cost with Medi-Cal of $439, and they currently have IHSS. and IHSS states NO SHARE OF COST
Here’s my question, that is complicated to me.
They also qualify under the Aged-FPL Program which is has NO share of cost.
So does that mean they do not have to Pay the $439 to their Care-provider.
They have a Medicare Part B premium,
an additional policy for vision, and dental as a medical deduction.
Please advised.
Do they have to pay in sharing the cost for a CAREGIVER $439 or NOT
We are in Alameda County.
See our IHSS FAQ Section
My child wants to play sports at his public school. They are telling me that Medi-Cal isn’t good enough. What can I do?
We are unable to find anything online about high schools requiring health insurance. Please send us they letter from your school.
3. What is the difference in coverage between Medi-Cal and Covered California?
Medi-Cal is health coverage, just like the coverage offered through Covered California. Medi-Cal provides benefits similar to the coverage options available through Covered California, but often at lower or no cost to you or your family. All of the health plans offered through Covered California or by Medi-Cal include the same comprehensive set of benefits known as “essential health benefits.”
Essential health benefits consist of:
Outpatient (Ambulatory) services
Emergency services
Hospitalization
Maternity and Newborn care
Mental Health and Substance Use Disorder Services, including Behavioral Health Treatment
Prescription Drugs
Programs such as physical and occupational therapy (known as Rehabilitative & Habilitative Services) and devices
Laboratory services
Preventive and wellness services & chronic disease management
Children’s (Pediatric) services, including oral and vision care.
A recent survey of Medi-Cal members by the California Healthcare Foundation (CHCF) found that 90% of respondents rate Medi-Cal as a good or very good program. Medi-Cal emphasizes prevention-oriented health care that promotes health and well-being and works to ensure members receive the right care at the right time. dhcs.ca.gov/Medi-Cal FAQs
if I got full scope medi cal do I have to purchase supplemental insurance
Depends on what you mean by “supplemental?” The “health” insurance portion of Medi-Cal is pretty comprehensive. Most everything is zero co-pay. Even dental is covered. Take a look at the Summary of benefits for the HMO you get assigned to. See if there are any gaps your concerned about.
I don’t know why they want Medicare for All, with 30 percent of California’s on Medi-Cal, it might look more like Medi Cal for all. Did we get to keep our doctors?
You might want to look at:
Life Insurance, you can get a quote right on this page.
Does Full Scope Medi-Cal work as HMO plan or not?
See above about Mandatory HMO Enrollment
My son is disabled, he has a developmental and mental condition. He receives medicare and medi-cal. Could you please let me know if he is eligible for Full Scope Medicare [Medi-Cal].
He needs dental work and according to the dentist he is not covered.
Mother and care taker.
Does he get SSI? That would qualify him for full scope Medi Cal.
See above for information on Dental for Medi Cal
Did your son qualify for Medi Cal under the aged and disabled program?
See the rules in Western Poverty Guide Page 78
This page might be easier to read on CA Health Care Advocates. Do you meet the qualifications?
Here’s contact information for Medi Cal. Do you have an online portal with them? What county are you in?
Try calling Denti Cal 1-800-322-6384
I have been providing IHSS In Home Supportive Services for a friend, we applied for full scope medical
please me on how to follow thru,
See our IHSS FAQ Section