California Department of Healthcare Services

Medi-Cal Benefits, Frequently Asked Questions

Find answers to question you may have on a specific question, situation, on an individual, and on a specific program.  If you don't find the answer to your question below, contact the program from the Department of Health Care Services program contact list.

1. What is Medi-Cal?
2. Do I Have To Pay For Medi-Cal?  (Or, Is There A Co-Pay?)
3. What If I’m Pregnant?  (Or, I Have Temporary/Emergency Coverage For My Pregnancy.  What Does That Cover? And, When Does It End?
4. Is There A Special Program For Children and Pregnant Women?
5. What If I’m Disabled?
6. Are There Special Treatment Programs?  (Or, Are There Special Treatment Programs For Substance Abuse Or Mental Health?)
7. Can I Get Help From Medi-Cal With Medicare Costs?
8. Are There Special Programs for Parents Who Lose Medi-Cal Because of Full-Time Employment or Receipt of Child Support Payments?
9. What Laws and Statutes Govern Medi-Cal?
10. Can I Get A Doctor Referral Or A List Of Providers?
11. What Is The Difference Between Medi-Cal And Medicaid?
12. I Lost (or had stolen) My Medi-Cal Card. Where Can I Get Another Card?
13. I Was Told I Have To Pay A Co-Pay For My Medications, Is This True?
14. My Doctor/Dentist Told Me I Need To Get Special Authorization For A Procedure.  Where/who Do I Get It?
15. What if Medi-Cal denies Payment For A Service That Has Already Been Performed, Or If A Procedure Needs To Be Done?
16. What If Hospital Billing Is Denied?
17. How Can I Get Medication When It Is Not Covered?
18. How Do I Check The Status Of A Treatment Authorization Request (TAR)?
19. When Medication Is Not Covered By Medicare Or Medicaid, Will Medi-Cal Pay Part?
20. My Co-Pay Is Too High For My Income.  What Can I Do?
21. What Does Medi-Cal Cover?
22. How Do I Get Medi-Cal Services?
23. Are These Covered By Medi-Cal? (see list below)
    
    

1. What is Medi-Cal?

Medi-Cal is California’s version of the Federal Medicaid program, which is designed for low-income individuals, blind, and disabled.

2. Do I Have To Pay For Medi-Cal?  (Or, Is There A Co-Pay?)

Your Benefits Identification Card (BIC) will pay for many kinds of medical/dental expenses.  When your provider uses your BIC to verify your Medi-Cal eligibility, your provider will know if Medi-Cal will pay for a medical/dental treatment or if you need to make a “Co-Payment” for any treatment. 
For additional information: Medi-Cal What It Means To You

3. What If I’m Pregnant?  (Or, I Have Temporary/Emergency Coverage For My Pregnancy.  What Does That Cover? and, When Does It End?

If you are pregnant and cannot afford to pay for health care and some dental care, Medi-Cal can help pay for medical expenses for you and your unborn.  Many times you can get Medi-Cal at no cost to you, even if you have income.  For additional information: Medi-Cal What It Means To You

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4. Is There A Special Program For Children And Pregnant Women?

Women, Infants and Children (WIC) program:  916-928-8500 or toll-free 1-800-852-5770.

5. What If I’m Disabled?

To get Medi-Cal as a disabled person, you must have severe physical and/or mental problem(s) which will:

• Last at least 12 months in a row and,
• Stop you from working during those 12 months, OR
• Possibly result in death
  You must prove your disabling physical and/or mental problem(s) with medical records, tests, and other medical findings.  The medical problem must be the main reason why do not work.  For additional information: Medi-Cal What It Means To You 

6. Are There Special Treatment Programs? (Or, Are There Special Treatment Programs For Substance Abuse Or Mental Health?)

Special Programs offered by Medi-Cal:

• Pregnant Women
• Children
• Refugees
• Confidential medical services available to persons under age 21
• Former foster children program
• Additional services available to persons under age 21 through the Child Health and Disability Prevention (CHDP) and Early and Periodic Screening Diagnosis and Treatment (EPDST) programs
• Medical Support Enforcement
• Other
  
For additional information:  


• MEDI-CAL What It Means To You 
• Alcohol Drug Program
• Department of Mental Health
 

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7. Can I Get Help From Medi-Cal With Medicare Costs?

Medicare can be a supplement to Medi-Cal, if you are 65 years or over.  Medi-Cal can pick up what Medicare does not pay.

8. Are There Special Programs For Parents Who Lose Medi-Cal Because Of Full-Time Employment Or Receipt Of Child Support Payments?

Yes, there may be other programs you are eligible for, please contact your County Welfare Department. 

9. What Laws And Statutes Govern Medi-Cal?

For information go to: www.oal.ca.gov , Cal. Code Regs, List of CCR Titles, Title 22 Social Security.  That has the regulations for Medi-Cal (CCR).  Refer to CDHS IntrAnet–Law & Regulations.

10. Can I Get A Doctor Referral Or A List Of Providers?

This service is not available through Medi-Cal fee-for-service.  We can not refer you to individual providers.   

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11. What Is The Difference Between Medi-Cal And Medicaid?

Medi-Cal is through the State of California only.  Medicaid is outside the State of California.

12. I Lost (or had stolen) My Medi-Cal Card. Where Can I Get Another Card?

If you did not receive your card, lost your card, your card was stolen, or the card you received in the mail has the wrong information on it, you may be ask for a Beneficiary Identification Card (BIC) from your County Welfare Department.  For additional information: Medi-Cal What It Means To You 

13. I Was Told I Have To Pay A Co-Pay For My Medications, Is This True?

Only if you have a Share of Cost (SOC).  Otherwise there is no required co-pay.

14. My Doctor/Dentist Told Me I Need To Get Special Authorization For A Procedure.  Where/who Do I Get It?

You are not responsible for processing paperwork for procedures. Your doctor’s office is responsible.

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15. What if Medi-Cal denies Payment For A Service That Has Already Been Performed, Or If A Procedure Needs To Be Done?

The reason for denial of payment varies for each individual. Example: It depends on what type of benefits that individual has, and what type of procedure was done. For additional information contact Electronic Data Systems (EDS) 916-636-1980.

16. What If Hospital Billing Is Denied?

The reason for denial of payment varies for each individual.  Example:  It depends on what type of benefits that individual has, and what type of procedure was done. For additional information contact Electronic Data Systems (EDS) 916-636-1980.

17. How Can I Get Medication When It Is Not Covered?

Request the pharmacy to send Medi-Cal a Treatment Authorization Request (TAR).  In an emergency, the pharmacy can dispense up to 72 hours worth of medication prior to getting a TAR.

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18. How Do I Check The Status Of A Treatment Authorization Request (TAR)?

Contact the Medi-Cal office (916) 552-9100 for the TAR Office (Medi-Cal Field Office) in your county.

19. When Medication Is Not Covered By Medicare Or Medicaid, Will Medi-Cal Pay Part?

Generally no, Medi-Cal cannot pay for a drug whose category is included under the Medicare Part D drug program.  Some drugs, such as benzodiazepines, some cough and cold medications, over-the-counter medications, barbiturates, some prescription vitamin and mineral products and some prescribed drugs used for weight gain, anorexia, and weight loss are excluded from the Medicare program but are covered by Medi-Cal.

20. My Co-Pay Is Too High For My Income.  What Can I Do?

Depending on upon your monthly income, Medi-Cal may determine that you have to meet a share of cost (SOC) before Medi-Cal will pay for your, or your family’s, medical expenses for the month.  For additional information: Medi-Cal What It Means To You 

21. What Does Medi-Cal Cover?

Medical, Dental, and Vision

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22. How Do I Get Medi-Cal Services?

• Call or go to your County Welfare Department to get a Medi-Cal application
• Fill out the application forms
• You may apply for Medi-Cal “retroactive benefits”
• When you apply for Medi-Cal, you will get a list of your rights and responsibilities
• Mail or take the completed application and necessary verification (proof) to the County Welfare Department
• It may take up to 45 days to process your Medi-Cal application
For additional information:  Medi-Cal What It Means To You

23. Are These Covered By Medi-Cal:

Yes, the following are covered by Medi-Cal: 
• Wheelchairs
• Wheelchair Repair
• Hearing Aids (subject to $1,510 annual cap per person)
• Battery for hearing aids and/or pace makers
• Eyeglasses
• Therapy
• Psychologist
• MRIs
• Chiropractic Care
• Acupuncture Care
• Non-emergency transportation for Dr. appointments
• Physical Therapy covered in LTC facility
• In-home services
Please contact your local county office for additional information.  For contact information, please visit the list of county offices.