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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 are known as Essential Health Benefits (EHB). These ten comprehensive services include the following categories:

  1. Outpatient (Ambulatory) services
  2. Emergency services 
  3. Hospitalization
  4. Maternity and Newborn care 
  5. Mental Health and Substance Use Disorder Services
  6. Prescription Drugs
  7. Programs such as physical and occupational therapy (known as Rehabilitative & Habilitative Services) and devices
  8. Laboratory services
  9. Preventive and wellness services & chronic disease management
  10. Children’s (Pediatric) services, including oral and vision care. 

Take a look at the Medi-Cal Health Benefits webpage 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.

Adult Dental Benefit Full Restoration Effective January 1, 2018 

Medi-Cal offers comprehensive preventative and restorative dental benefits to both children and adults. You can find a Medi-Cal dentist on the Denti-Cal Provider Referral List, or by calling 1-800-322-6384.

In addition, Senate Bill 97 (Chapter 52, Statutes of 2017) fully restored adult optional dental benefits that were not restored in May 2014.  This policy is effective January 1, 2018.  Restored benefits will include, for example: Laboratory processed crowns, posterior root canal therapy, periodontal services, and partial dentures, including denture adjustments, repairs, and relines. The full dental benefits are listed in the Dental Provider Handbook, Section 5, Manual of Criteria, posted on the Denti-Cal website. More information is available on the DHCS Medi-Cal Dental Program website.

Adult Dental benefits that will remain in place and do not change as a result of the 2014 or 2018 restorations:

  • 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

Mental Health and Substance Use Disorder Services Benefits

The following substance use disorder services are now available through Drug Medi-Cal for Beneficiaries who reside in an opt-in Drug Medi-Cal Organized Delivery System (DMC-ODS) county:
  •  Outpatient Services 
  •  Intensive Outpatient Services
  •  Residential Treatment (multiple levels of care for all enrollees and no bed limitation)
  •  Withdrawal Management
  •  Narcotic Treatment Services
  •  Recovery Services
  •  Case Management
  •  Physician Consultation
  •  Additional Medication Assisted Treatment (optional)
  •  Partial Hospitalization (optional)

 

For beneficiaries who do not reside in an opt-in DMC-ODS county, the following Drug Medi-Cal benefits are available:

  • Outpatient Services
  • Intensive Outpatient Services
  • Perinatal Residential Treatment (16 bed limitation)
  • Inpatient Hospital Detoxification
  • Narcotic Treatment Program Services

 

For more information on the DMC-ODS Waiver benefits, please visit the DMC-ODS webpage.

Last modified on: 11/28/2017 4:31 PM