What are the Medi-Cal Benefits?
Medi-Cal currently provides a core set of health benefits, including doctor visits, hospital care, immunization, pregnancy-related services and nursing home care. The Affordable Care Act ensures all Medi-Cal health plans offer what is known as Essential Health Benefits (EHB). These ten comprehensive services include the following categories:
- Outpatient (Ambulatory) services
- Emergency services
- 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.
Take a look at the Medi-Cal Health Benefits Chart (PDF) to learn more about the services in each category. For a definition of any of the terms used, please browse the Federal Healthcare.gov Glossary.
Dental Benefits are available May 1, 2014
Dental benefits for adults 21 and older have been restored by the Center for Medicare and Medicaid Services.
The following benefits have now been restored:
- Exams and x-rays
- Fluoride treatments
- Anterior root canals (front teeth)
- Prefabricated crowns
- Full dentures
- Other medically necessary dental services
Denti-Cal adult benefits that will remain in place and do not change as a result of the restoration:
- Pregnancy-related services
- Emergency services
- Services provided to residents of an Intermediate Care Facility/Skilled Nursing Facility
- Services provided to consumers of the Department of Developmental Services
Dental and vision services are available with some limitation.
Mental Health and Substance Use Disorder Services Benefits
The following mental health benefits are now available through Medi-Cal:
- Individual and group mental health evaluation and treatment (psychotherapy)
- Psychological testing when clinically indicated to evaluate a mental health condition
- Outpatient services for the purposes of monitoring drug therapy
- Outpatient laboratory, drugs, supplies and supplements
- Psychiatric consultation
- All Specialty mental health services currently provided by County Mental Health Plans will continue to be available.
The following substance use disorder services are now available through Medi-Cal:
- Voluntary Inpatient Detoxification
- Intensive Outpatient Treatment Services
- Residential Treatment Services
- Outpatient Drug Free Services
- Narcotic Treatment Services