Medi-Cal Benefits Division
The Benefits Division is responsible for managing and ensuring the uniform promulgation of federal and state laws and regulations regarding Medi-Cal benefits and policies affecting more than 150,000 providers of medical services to almost 10 million Medi-Cal beneficiaries. Through a process based upon published scientific, policy, and practice evidence, including systematic reviews, individual studies published in peer-reviewed health journals, evidence-based treatment guidelines published by organizations whose primary mission is to conduct objective analyses of the effectiveness of treatments and interventions, or evidence-based clinical practice guidelines published by professional and scientific societies, the Benefits Division adds, limits, modifies, or eliminates services to increase patient safety, reduce risk, and reduce cost of care. The division is a primary liaison with the federal Centers for Medicare & Medicaid Services for amendments to the Medicaid State Plan and coordinates with other divisions and state departments to ensure compliance with state and federal requirements under the State Plan.
The division also has responsibility for the oversight and management of the Every Woman Counts (EWC) program, the largest breast cancer detection program in the nation, serving 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 carries out patient and provider education to increase awareness of the importance of screening and the availability of services for disparate high-risk populations, and it conducts required quality assurance and program evaluation activities.
- Benefits Division: (916) 552-9400