What Does Medi-Cal Cover?

Medi-Cal provides much more than emergency or basic medical care. California’s Medicaid program covers a comprehensive range of medically necessary health services—including doctor visits, hospital care, prescriptions, preventive care, mental health treatment, dental care, vision services and transportation.

Some people may also qualify for in-home care, skilled nursing, medical equipment and other long-term services and supports. The exact services available depend on the person’s eligibility category, medical needs, county and Medi-Cal health plan.

Important: A service normally must be medically necessary and provided by a doctor, facility or other provider authorized to bill Medi-Cal.

Medical Services Covered by Medi-Cal

Medi-Cal generally covers the same major categories of essential health benefits found in comprehensive private health insurance. Covered services may include:

• Primary and specialist care
  • Office visits with primary care doctors
  • Specialist consultations
  • Outpatient clinics and outpatient surgery
  • Chiropractic, podiatry and acupuncture when coverage requirements are met
• Hospital and emergency services
  • Emergency room treatment
  • Emergency ambulance transportation
  • Inpatient hospital care
  • Surgery and anesthesia
  • Organ and tissue transplants when medically necessary
• Laboratory and diagnostic services
  • Blood tests and other laboratory work
  • X-rays
  • Advanced imaging when medically necessary
• Maternity and newborn care
  • Prenatal visits
  • Labor and delivery
  • Postpartum care
  • Midwife and doula services when applicable
  • Breastfeeding education and support
• Resources
  • The California Department of Health Care Services provides an official list on its Essential Health Benefits page.
  • My Medi-Cal How to get the Health Care you need  pdf 
  • Video What is Medi Cal 

Prescriptions, Preventive Care and Rehabilitation

• Prescription drugs
  • Most outpatient prescriptions are administered through Medi-Cal Rx.
  • Some medications require prior authorization or use of a preferred drug first.
  • Many medications may be dispensed in supplies of up to 100 days.
• Preventive and wellness care
  • Recommended vaccinations
  • Cancer and other health screenings
  • Family planning services
  • Smoking-cessation assistance
  • Chronic-disease management
• Therapy and rehabilitation
  • Physical therapy
  • Occupational therapy
  • Speech therapy and audiology
  • Cardiac and pulmonary rehabilitation
  • Home health services when eligibility and medical-necessity rules are satisfied
• Medical equipment and supplies
  • Durable medical equipment
  • Orthotics and prostheses
  • Hearing aids and implanted hearing devices
  • Certain continuous glucose monitors and diabetic supplies
  • Blood-pressure monitors and other approved medical supplies

A prescription does not automatically guarantee coverage. The item must meet Medi-Cal’s benefit, medical-necessity and authorization requirements.

Dental, Vision and Hearing Benefits

• Medi-Cal Dental
  • Dental examinations and X-rays
  • Cleanings and preventive services
  • Fillings and crowns
  • Root canals
  • Tooth extractions
  • Periodontal treatment
  • Complete and partial dentures
  • Emergency treatment for dental pain
  • Orthodontics for children who meet the program’s requirements
• Vision care
  • A routine eye examination generally once every 24 months
  • Eyeglasses or contact lenses when program requirements are met
• Hearing services
  • Hearing examinations
  • Audiology services
  • Hearing aids and certain implanted hearing devices when medically necessary

More information:

• My web page — Medi-Cal Dental benefits
• My web page — Medi-Cal coverage for dental implants
• My web page — Medi-Cal vision benefits
• Official source — DHCS Medi-Cal Dental

Mental Health, Substance Use and Children’s Services

• Mental health care
  • Mental health evaluations and screenings
  • Individual and group psychotherapy
  • Psychiatric services
  • Outpatient mental health treatment
  • Specialty mental health services
  • Inpatient psychiatric treatment when medically necessary
• Substance use disorder treatment
  • Outpatient treatment
  • Residential treatment when authorized
  • Withdrawal management and detoxification
  • Medication-assisted treatment
  • Treatment for co-occurring mental health conditions
• Enhanced benefits for members under age 21
  • Children and young adults with full-scope Medi-Cal receive Early and Periodic Screening, Diagnostic and Treatment benefits, commonly called EPSDT.
  • EPSDT can cover medically necessary screening, diagnostic and treatment services needed to correct or improve a physical or behavioral condition—even when an adult’s coverage for the same service would be more limited.
  • Behavioral health treatment may be covered for children and young adults with autism when medically necessary.

Related information:

• My web page — Mental health coverage and resources
• My web page — Autism treatment and health insurance benefits
• My web page — Substance use disorder treatment

Transportation, In-Home Care and Long-Term Services

Medi-Cal may cover important services that ordinary private health insurance does not usually provide.

• Transportation to covered services
  • Non-Medical Transportation for members who have no other way to reach a covered appointment
  • Non-Emergency Medical Transportation by ambulance, wheelchair van or litter van when ordinary transportation cannot safely be used
  • Transportation to medical, dental, mental health and substance use appointments
  • Transportation to pick up prescriptions and medical supplies
• In-Home Supportive Services
  • Eligible people who are aged, blind or disabled may receive assistance that helps them remain safely at home.
  • Services may include personal care, meal preparation, housework, accompaniment to medical appointments and protective supervision when the applicable requirements are met.
• Long-term services and supports
  • Skilled nursing facility care
  • Home and Community-Based Services
  • Personal care services
  • Community First Choice services
  • Enhanced Care Management for certain members with complex needs

Related information:

• My web page — IHSS In-Home Supportive Services
• My web page — Qualifying for Medi-Cal nursing-home benefits
• My web page — CalAIM, board-and-care and community support services
• Official source — DHCS transportation services

How You Receive Medi-Cal Services

Having Medi-Cal does not mean that every provider or service is automatically covered. How you obtain care depends on the way your Medi-Cal coverage is administered.

• Managed care plan
  • Most Medi-Cal members receive medical care through a managed care plan.
  • You ordinarily select or are assigned a primary care doctor.
  • You may need a referral before seeing certain specialists.
  • Except for emergencies and other protected circumstances, you generally must use the plan’s provider network.
• Fee-for-Service Medi-Cal
  • You must use a doctor or facility enrolled in Medi-Cal and willing to accept Fee-for-Service Medi-Cal.
  • Some services still require prior authorization.
• Benefits administered separately
  • Prescription drugs are generally handled through Medi-Cal Rx.
  • Dental care may be administered separately from the member’s medical plan.
  • Specialty mental health and substance use services may be provided through the county.

Always check the member identification card and contact the appropriate plan before receiving nonemergency care. Ask whether the provider accepts your particular Medi-Cal plan—not merely whether the office “accepts Medi-Cal.”

My web page — Choosing and using a Medi-Cal managed care plan.

Does Medi-Cal Pay Everything?

Many Medi-Cal members pay no monthly premium and little or nothing when receiving covered services. However, that does not mean every type of care is covered without conditions.

• A service may have to be medically necessary.
• Prior authorization may be required.
• The provider must ordinarily participate with Medi-Cal or the member’s Medi-Cal plan.
• Managed care members may need a referral or authorization before seeing a specialist.
• Purely cosmetic, experimental or noncovered services may be excluded.
• Some benefits have frequency, age or medical-condition requirements.
• Limited-scope Medi-Cal does not provide all the benefits available through full-scope Medi-Cal.

Medi-Cal With a Share of Cost

Some people whose income is above the regular Medi-Cal limit qualify under the Aged, Blind and Disabled Medically Needy program. They may be assigned a monthly Share of Cost that must be met before Medi-Cal begins paying covered expenses for that month.

A Share of Cost is not the same thing as an annual insurance deductible. Depending on the circumstances, health, dental, Medicare supplement and other allowable premiums or medical expenses may help reduce or eliminate it.

• My web page — How to eliminate or reduce Medi-Cal Share of Cost
• My web page — Share of Cost worksheets and calculator
• My web page — Working Disabled Program

Frequently Asked Questions

• Does Medi-Cal cover preexisting conditions?
  • Yes. Eligibility and coverage cannot be denied because a person already has a medical condition.
• Can I use any doctor who accepts Medi-Cal?
  • Not necessarily. If you belong to a managed care plan, the doctor ordinarily must participate in that specific plan and medical group. Always verify before making an appointment.
• Does Medi-Cal cover emergency care?
  • Yes. Medi-Cal covers medically necessary emergency services. In a genuine emergency, call 911 or go to the nearest emergency room.
• Does Medi-Cal cover dental and vision care?
  • Yes, but individual services must meet Medi-Cal’s coverage rules. Dental or vision benefits may be administered separately from your medical plan.
• Can I have Medi-Cal with Medicare or employer insurance?
  • Yes. Medi-Cal may be secondary to Medicare or other health insurance. The other coverage ordinarily pays first, and Medi-Cal may help with remaining covered expenses.
• Where can I find the exact benefits of my Medi-Cal plan?
  • Review the plan’s Member Handbook or Evidence of Coverage and call Member Services using the telephone number on your identification card.

Eligibility and Help With Your Medi-Cal

• My web page — Medi-Cal income eligibility
• My web page — Renewing Medi-Cal
• My web page — Reporting changes to Medi-Cal
• My web page — County offices and Medi-Cal contact information
• Official source — DHCS Essential Health Benefits

Benefit rules, provider participation and authorization requirements can change. Confirm coverage with your Medi-Cal plan, county or treating provider before receiving nonemergency services.