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Benefits Division - About Us

The Benefits Division is responsible for managing and ensuring the uniform application of federal and state laws and regulations regarding Medi-Cal covered services and policies affecting more than 150,000 providers of medical services to 11.3 million Medi-Cal recipients. The Benefits Division adds, limits, modifies, or eliminates services to increase patient safety, reduce risk, and reduce cost of care.

The division is one of the Department of Health Care Services' primary liaisons with the federal Centers for Medicare & Medicaid Services for amendments to the Medicaid State Plan. As such, it coordinates with other divisions within DHCS and State departments to ensure compliance with state and federal requirements under the State Plan.

The division includes medical consultants and a research scientist who review medical evidence – including studies published in peer-reviewed health journals as well as evidenced-based treatment and clinical practice guidelines published by professional organizations and scientific societies – to determine which treatments and medicines are most effective and provide the highest quality of care.

The Every Woman Counts (EWC) program is part of the Benefits Division. It is the largest breast cancer detection program in the nation and serves more than 260,000 women annually. EWC provides breast clinical services – such as mammograms, clinical breast exams, and diagnostic tests – to low-income California women ages 40 and over with inadequate or no health coverage.

EWC also provides cervical clinical services – such as pap smears, HPV (Human Papilloma Virus) tests, and cervical diagnostic tests – for low-income, uninsured, and underinsured California women ages 21 and older. In addition, EWC promotes the importance of screening and the availability of these services for disparate high-risk populations. It also conducts required quality assurance and program evaluation activities. ​

Last modified on: 11/19/2014 11:36 AM