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Frequently Asked Questions - Optional Benefits That Medi-Cal Will No Longer Pay

  1. What are optional benefits?
  2. Why will Medi-Cal no longer pay for these optional benefits?
  3. What are the optional benefits that Medi-Cal will no longer pay for?
  4. Is my Medi-Cal coverage affected?
  5. Who will be affected by these benefits that Medi-Cal will no longer pay for?
  6. When is the date that I will stop getting these benefits?
  7. Who can still receive these benefits?
  8. My doctor prescribed treatment for me before I reach 21 years of age; will I continue to receive the treatment when I turn 21?
  9. I am 21 years old or older and my doctor prescribed treatment for me before July 1, 2009; will I continue to receive the treatment after July 1, 2009?
  10. I am pregnant and my doctor prescribed treatment for me; how long after I have the baby will I continue to receive the treatment?
  11. I am developmentally disabled and I am living in a facility; will I still receive these benefits after June 30, 2009?
  12. I am being discharged from a nursing home to live back in the community; will I continue to receive these benefits after leaving the nursing home?
  13. I am a patient of a Federally Qualified Health Center (FQHC); will my benefits be affected?
  14. I am a patient of a Rural Health Center (RHC); will my benefits be affected?
  15. I am a patient of an Indian Health Clinic; will my benefits be affected?
  16. I am enrolled in a Medi-Cal Managed Care Plan (such as Cal-Optima); will my benefits be affected?
  17. My child is enrolled in California Children Services (CCS); will his/her benefits be affected?
  18. I am enrolled in the Genetically Handicapped Persons Program (GHPP); will my benefits be affected?
  19. I am a senior enrolled in the Program for All Inclusive Care for the Elderly (PACE); will my benefits be affected?
  20. Can I get these benefits if I have an emergency health problem?
  21. I do not belong to the exempted group of people; is there a way that I can get these benefits through the Medi-Cal Program?

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1.  What are optional benefits?

Answer: Optional benefits are benefits that the state chooses to provide under the Medi-Cal Program. In most cases these optional benefits are not required by federal law. Each state offers a different set of optional benefits to its recipients. California offers more optional benefits than any other state.

                                                                                                                                                 

2.  Why will Medi-Cal no longer pay for these optional benefits?

Answer: Because of the on-going crisis in the economy, our state has a huge budget short fall and some programs must be reduced to maintain the most crucial services.  As a result, a change in the Welfare and Institutions Code section 14131.10 was enacted.  Starting July 1, 2009, Medi-Cal will no longer pay for some benefits.  This change will affect only Medi-Cal beneficiaries age 21 and older.  Children with no full scope Medi-Cal will also be affected.

  

3.  What are the optional benefits that Medi-Cal will no longer pay for?

Answer: Benefits that the Medi-Cal program will no longer pay for are the following:

a. Acupuncture (use of small needles to treat pain and other problems)

b. Adult dental services

c. Audiology services (hearing exam)

d. Chiropractic services

e. Incontinence washes and creams

f. Dispensing Optician services, including services provided by a fabricating optical laboratory

g. Podiatry services (care of the feet)

h. Psychology services

i. Speech therapy services

 

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4.  Is my Medi-Cal coverage affected?

Answer: No. Your Medi-Cal coverage will not be affected. On the other hand, you may not receive these benefits any longer after June 30, 2009. Some people will continue to receive these services.

                                                                                                                                             

5.  Who will be affected by these benefits that Medi-Cal will no longer pay?

Answer: Most persons with Medi-Cal will be affected. A few groups of persons will continue to receive these benefits. They are:

a. Pregnant women will receive the optional benefit if it is part of their pregnancy-related care or for services to treat a condition that may cause problems in pregnancy.

b. Children or young adults who are 20 years old and younger and receive full scope Medi-Cal.

c. People who live in a licensed nursing home such as a Skilled Nursing Facility (SNF), Intermediate Care Facility (ICF), ICF for the Developmentally Disabled (ICF-DD) and Sub Acute Facility. 

  

6.  When is the date that I will stop getting these benefits?

Answer: July 1, 2009.

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7.  Who can still receive these benefits?

Answer: The following persons will continue to receive these benefits:

a. Pregnant women will receive the optional benefit if it is part of their pregnancy-related care or for services to treat a condition that may cause problems in the pregnancy.

b. Children or young adults who are 20 years old and younger and receive full scope Medi-Cal.

c. People who live in a licensed nursing home such as a Skilled Nursing Facility (SNF), Intermediate Care Facility (ICF), ICF for the Developmentally Disabled (ICF-DD) and Sub Acute Facility.    

8.  My doctor prescribed treatment for me before I reach 21 years of age; will I continue to receive the treatment when I turn 21?

Answer: Yes. You may continue to receive and complete the treatment after you reach 21 years of age. Your doctor must prescribe how long you will receive the treatment. Orders or prescriptions for “lifetime” treatment will not be accepted.

 

9.  I am 21 years old or older and my doctor prescribed treatment for me before July 1, 2009; will I continue to receive the treatment after June 30, 2009?

Answer: Yes. You may continue to receive and complete the treatment after June 30, 2009. Your doctor must prescribe how long you will receive the treatment. Orders or prescriptions for “lifetime” treatment will not be accepted.

 

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10. I am pregnant and my doctor prescribed treatment for me; how long after I have the baby will I continue to receive the treatment?

Answer: You may still receive the treatment for up to 60 days after you have your baby.

  

11. I am developmentally disabled and I am living in a facility; will I still receive these benefits after June 30, 2009?

Answer: Yes.  You will continue to receive these benefits if you live in a Skilled Nursing Facility (SNF), Intermediate Care Facility (ICF), ICF for the Developmentally Disabled (ICF-DD) and Sub Acute Facility. 

 

12.  I am being discharged from a nursing home to live back in the community; will I continue to receive these benefits after leaving the nursing home?

Answer: No. A person being discharged from a nursing home may continue to receive these benefits only if they are:

a. A pregnant woman, and it is part of their pregnancy-related care or for services to treat a condition that may cause problems in pregnancy.

b. Children or young adults who are 20 years old and younger, and receive full scope Medi-Cal.

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13. I am a patient of a Federally Qualified Health Center (FQHC); will my benefits be affected?

Answer: Yes. The only Optional Benefits that Medi-Cal will continue to pay for at FQHCs are adult dental services (that are required by federal law), psychology services, and optometry services.

The following persons may continue to receive all services from an FQHC:

a. Pregnant women can receive the optional benefit if it is part of their pregnancy-related care or for services to treat a condition that may cause problems in pregnancy.

b. Children or young adults who are 20 years old and younger who receive full scope Medi-Cal.

c. People who live in a licensed nursing home such as a Skilled Nursing Facility (SNF), Intermediate Care Facility (ICF), ICF for the Developmentally Disabled (ICF-DD) and Sub Acute Facility. 

14. I am a patient of a Rural Health Center (RHC); will my benefits be affected?

Answer: Yes. The only Optional benefits that Medi-Cal will continue to pay for at RHCs are adult dental services (that are required by federal law), psychology services, and optometry services.

The following persons may continue to receive all services from an RHC:

a. Pregnant women can receive the optional benefit if it is part of their pregnancy-related care or for services to treat a condition that may cause problems in pregnancy.

b. Children or young adults who are 20 years old and younger who receive full scope Medi-Cal.

c. People who live in a licensed nursing home such as a Skilled Nursing Facility (SNF), Intermediate Care Facility (ICF), ICF for the Developmentally Disabled (ICF-DD) and Sub Acute Facility. 

15. I am a patient of an Indian Health Services Clinic; will my benefits be affected?

Answer: Yes. The only Optional benefits that Medi-Cal will continue to pay for at IHS are adult dental services (that are required by federal law), psychology services, and optometry services.

 The following persons may continue to receive all services from an Indian Health Clinic:

a. Pregnant women will receive the optional benefit if it is part of their pregnancy-related care or for services to treat a condition that may cause problems in pregnancy.

b. Children or young adults who are 20 years old and younger who receive full scope Medi-Cal.

c. People who live in a licensed nursing home such as a Skilled Nursing Facility (SNF), Intermediate Care Facility (ICF), ICF for the Developmentally Disabled (ICF-DD) and Sub Acute Facility. 

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16. I am enrolled in a Medi-Cal Managed Care Plan (such as Cal-Optima); will my benefits be affected?

Answer: Yes. The only persons in Medi-Cal Managed Care Plans who will continue to receive the services that Medi-Cal will no longer pay for are:

a. Pregnant women will receive the optional benefit if it is part of their pregnancy-related care or for services to treat a condition that may cause problems in pregnancy.

b. Children or young adults who are 20 years old and younger and receive full scope Medi-Cal.

c. People who live in a licensed nursing home such as a Skilled Nursing Facility (SNF), Intermediate Care Facility (ICF), ICF for the Developmentally Disabled (ICF-DD) and Sub Acute Facility.

 If you have more questions about your managed care plan, please contact the plan member help line. The phone number of this help line is located on your plan ID card.

   

17. My child is enrolled in California Children Services (CCS); will his/her benefits be affected?

Answer: No. The current changes in Medi-Cal benefits for adults do not affect CCS benefits.  Your child's CCS benefits will not change. If you have more questions about the CCS program, please call your county CCS program or you may go to the CCS website at www.dhcs.ca.gov/services/ccs

  

18. I am enrolled in the Genetically Handicapped Persons Program (GHPP); will my benefits be affected?

Answer: No. Your benefits under GHPP will remain the same as long as your case remains active with GHPP. If you have more questions about GHPP, please call the GHPP office at 1-800-639-0597 or you may go to the GHPP website at www.dhcs.ca.gov/services/ghpp

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19. I am a senior enrolled in the Program for All Inclusive Care for the Elderly (PACE); will my benefits be affected?

Answer: No. The services you receive through the PACE program will remain the same.

 

20. Can I get these benefits if I have an emergency health problem?

Answer: Yes. Limited dental services for the relief of pain and infection are a benefit for services provided by your dentist to treat a dental emergency.  All other optional benefits are covered if you are treated in the clinic by a physician or if you are treated in an emergency room by a physician. The optional benefit must be related for the treatment of your emergency health problems. For example, you cannot get a hearing exam if you are being treated for a fractured bone.

 

21. I do not belong to the exempted group of people; is there a way that I can get these benefits through the Medi-Cal Program?

Answer: You may still get these benefits as follows:

a. If the benefit is part of a Home Health Agency service;

b. You have Medicare and these benefits are covered by Medicare Part B;

c. The service is provided by a licensed physician;

d. The service is provided in a hospital outpatient clinic.