Medi-Cal, California’s Medicaid program is a medical assistance program established by Title XIX of the Social Security Act. The Medicaid program is a no-cost or low-cost public health insurance program that provides needed health care services for low-income and disabled individuals.
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Californians are automatically eligible for Medi-Cal with no share of cost if they receive benefits from one of the following programs:
Persons who meet particular income and resource requirements are potentially eligible for Medi-Cal benefits if they are:
Medi-Cal eligibility will be expanded effective January 1, 2014.
For more information, visit the California Department of Health Care Services Website: http://www.dhcs.ca.gov/dataandstats/statistics/Pages/RASB_Medi-Cal_Overview.aspx
Medi-Cal offers a broad range of services. Some services are federally mandated, while the state has elected to offer optional services available under the Medicaid program. Medi-Cal services include, but are not limited to:
The availability of services may be limited to certain eligible groups. All services rendered must meet certain requirements, including medical necessity and may require prior authorization. Credit - http://www.dhcs.ca.gov/dataandstats/statistics/Pages/RASB_Medi-Cal_Overview.aspx
Medi-Cal covers a core set of services, including doctor visits, hospital care, and pregnancy-related services, as well as nursing home care for individuals age 21 or older through either a fee-for-service or managed care delivery system. For a majority of enrollees, Medi-Cal provides covered services through managed health plans in all 58 counties. The ACA ensures all Medi-Cal health plans offer a comprehensive package of items and services, known as essential health benefits. Essential health benefits must include:
Starting in 2014, the array of mental health and substance use disorder services will expand to better meet the needs of individuals eligible for Medi-Cal. The following mental health benefits will be available through Medi-Cal managed care plans or the fee-for-service delivery system:
The following substance use disorder service benefits will also be made available to eligible Medi-Cal beneficiaries:
Many of these services are covered by Medi-Cal today or will be added in 2014 and will be available for both current and new enrollees. Dental care, vision services and speech therapy are generally available only to children and youths under age 21, but certain adults and pregnant women are also eligible for these services. Dental services will be available to all adults starting May, 2014.
Dental care, vision services and speech therapy are generally available only to children and youths under age 21, but certain adults and pregnant women are also eligible for these services. Dental services will be available to all adults starting May, 2014.
For more information on dental services through Medi-Cal fee-for-service, please visit the Denti-Cal website at: http://www.denti-cal.ca.gov/. For more information on dental services in Sacramento or Los Angeles County through dental managed care plans, please visit the Denti-Cal website at: http://www.denti-cal.ca.gov/WSI/ManagedCare.jsp?fname=ManagedCarePlanDir.
The Medi-Cal program operates under two primary care delivery models: Fee-For-Service (FFS) Medi-Cal and Medi-Cal Managed Care. In the FFS Medi-Cal model, health care providers are reimbursed through a Medi-Cal Fiscal Intermediary. In the Medi-Cal Managed Care model, the California Department of Health Care Services contracts with health insurance organizations to provide services to groups of Medi-Cal eligibles in specific counties. Benefits paid under the Medi-Cal Managed Care plan vary by contract and any non-covered managed care services are paid through the FFS Medi-Cal delivery model. Specialty Medi-Cal programs such as Mental Health, Developmental Services and Personal Care Services are administered through other state departments.