Cell and Gene Therapy (CGT) Access Model-
Medi-Cal Member Frequently Asked Questions (FAQs)
Updated June 27, 2025
The following FAQs provide additional guidance and clarification for Medi-Cal members regarding the CGT Access Model. As the Department of Health Care Services (DHCS) receives additional questions, this FAQ will be updated. For general information about the CGT Access Model, please refer to the General FAQs.
General
What might my CGT treatment journey look like under Medi-Cal's CGT Access Model?
A member's journey receiving CGT treatment may include the following:
- Consultations with hematologists and other specialists
- Comprehensive evaluation at the treatment center including physical needs, behavioral health needs, and social support needs
- Coordination of care and supportive services for members and families navigating the treatment process
- Disease management in preparation for CGT
- Fertility preservation services
- Gene therapy infusion and recovery services
- Post-treatment follow-up care
How do I know which CGT SCD medication I will receive through Medi-Cal's CGT Access Model?
Medi-Cal's CGT Access Model will cover the two federal Food and Drug Administration (FDA)-approved CGT medications for treatment of sickle cell disease (SCD). This includes, CASGEVY™, which is made by Vertex Pharmaceuticals, Inc., and LYFGENIA™, which is made by bluebird bio, Inc. Your doctor will determine which CGT SCD medication is most appropriate for your individual circumstances and submit the necessary request on your behalf so you can participate in the CGT Access Model and receive the CGT SCD medication.
Can CGT medications for SCD affect my fertility (ability to have children)?
Yes, chemotherapy used in stem cell transplants during CGT treatments may impact your fertility (ability to have children). However, because of this fact, fertility preservation services are covered and available to members under Medi-Cal's CGT Access Model. You are encouraged to discuss fertility preservation options with your doctor once approved for but before starting CGT treatment. Please see the Covered CGT Access Model Services, Including Fertility Preservation Services section of this FAQ for more information.
Eligibility
Am I eligible to participate in Medi-Cal's CGT Access Model and receive CGT SCD medications?
Medi-Cal members must meet all of the following criteria:
Have a documented medical diagnosis of SCD;
Be actively enrolled in full-scope Medi-Cal at the time the CGT medication is received (note: both Medi-Cal managed care and fee-for-service (FFS) members may be eligible for CGT therapies);
Have Medi-Cal as their primary payer;
Receive one of the two CGT medications from a participating provider (effective July 1, 2025 for LYFEGNIA and September 1, 2025 for CASGEVY; and
Satisfy all CGT Access Model requirements as well as published Medi-Cal policy as outlined in the Medi-Cal Provider Manual and applicable All Plan Letter.
Accessing CGT Access Model Services
How do I access CGT SCD medications under Medi-Cal's GCT Access Model?
If you have Medi-Cal FFS, you should consult with your doctor to determine eligibility and learn more as well as for information on accessing CGT SCD medications. Medi-Cal FFS providers can assist members with accessing one of the two CGT SCD medications.
Medi-Cal managed care members should contact their doctor or Medi-Cal managed care plan (MCP) to determine eligibility and learn more about CGT services. Medi-Cal MCPs are responsible for care coordination and assisting members with accessing one of the two CGT sickle cell disease medications. For more information on Medi-Cal MCP care coordination and other requirements, please review the applicable All Plan Letter on DHCS' website. Each Medi-Cal MCP includes a point of contact, which can be found in the Medi-Cal Managed Care Health Plan Directory.
If approved for participation in Medi-Cal's CGT Access Model to receive LYFGENIA, where will that happen?
LYFGENIA treatments are only available and administered at Qualified Treatment Centers (QTCs) centers that have the appropriate experience and training to do so. There are currently eight (8) QTCs that offer LYFGENIA in California, which are bulleted below. You may search for QTCs closest to you on this website: LYFGENIA™ (lovotibeglogene autotemcel) Qualified Treatment Center Locator. Your LYFGENIA patient navigator (available with mybluebirdbio enrollment) may also assist you with identifying a QTC closet to you.
Northern California:
UCSF Benioff Children's Hospital
Oakland 747 52nd Street, Oakland, CA 94608
510-428-3000
UCSF Benioff Children's Hospital San Francisco
1975 4th Street, San Francisco, CA 94158
415-476-2188
Lucile Packard Children's Hospital at Stanford
725 Welch Road, Palo Alto, CA 94304
650-725-3158
Southern California:
UCLA
757 Westwood Plaza, Los Angeles, CA 90095
310-260-6909
310-825-6708
Children's Hospital Los Angeles
4650 Sunset Blvd., Los Angeles, CA 90027
323-361-4624
City of Hope National Medical Center
1500 E Duarte Road, Duarte CA, 91010
1-800-826-4673
Loma Linda University Children's Hospital
11234 Anderson Street, Loma Linda, CA 92354
909-558-4000
Loma Linda University Medical Center
11234 Anderson Street, Loma Linda, CA 92354
909-558-4000
If approved for participation in Medi-Cal's CGT Access Model to receive CASGEVY, where will that happen?
CASGEVY treatments are only available and administered at Authorized Treatment Centers (ATCs) that have the appropriate experience and training to do so. There are 6 ATCs that offer CASGEVY in California. You may search for ATCs closest to you on this website: Authorized Treatment Center Locator | CASGEVY® (exagamglogene autotemcel).
Northern California:
UCSF Benioff Children's Hospital San Francisco
1975 4th Street
San Francisco, 94158
Benioff Children's Hospital Oakland
747 52nd St.
Oakland, 94609
(510) 428-3885 ext. 5183
amy.solari@ucsf.edu
Southern California:
City of Hope National Medical Center
1500 East Duarte Road
Duarte, 91010
(800) 826-4673
genetherapy@coh.org
Children's Hospital of Orange County
1201 W. La Veta Avenue
Orange, 92868
UCLA Health
757 Westwood Plaza
Los Angeles, 90095
310-260-6909
Children's Hospital Los Angeles
4650 Sunset Boulevard
Los Angeles, 90027
(323) 361-4624
Covered CGT Access Model Services, Including Fertility Preservation Services
What benefits and services can I receive under Medi-Cal's CGT Access Model?
What types of fertility preservation services are NOT included under the Model?
Some examples of services that are NOT included are as follows:
Embryo (fertilized egg) creation
Embryo (fertilized egg) storage
In-vitro fertilization (occurs outside the body with provider assistance)
How can I get connected to resources?
Medi-Cal members who are considering or in the process of receiving bluebird bio's LYFGENIA gene therapy treatment will receive Patient Navigators through my bluebird support, who can:
Connect members with a QTC, which is a specialized hospital trained to administer bluebird bio gene therapies.
Provide educational materials on a variety of topics, including gene therapy, fertility, sickle cell disease, and product-specific information.
Help members understand their insurance coverage and out-of-pocket costs and may be able to connect them with financial assistance programs.
Support members through the treatment journey and connect them to resources.
Determine eligibility for and coordinate additional treatment-related support programs, such as travel and lodging assistance
Please note that my bluebird support is available to members at no cost, and there is no obligation to move forward with CGT SCD treatment. To get connected with a Patient Navigator, please complete my bluebird support's Program Enrollment Form.
Medi-Cal members who are starting treatment with Vertex Pharmaceuticals' CASGEVY may enroll in Vertex Connects to receive a Case Manager, who can:
Spend time getting to know you so they can provide meaningful support
Answer questions about the treatment process and share useful guides to help members and their families prepare for each step of treatment
Coordinate the logistics of your treatment journey
Determine eligibility for and coordinate additional treatment-related support programs, such as travel and lodging assistance
Enrollment in Vertex Connects Patient Support is not required to receive CASGEVY. However, a completed Vertex Connects enrollment form is needed to receive case management services and determine eligibility for certain program offerings. Members will receive a Vertex Connects enrollment form once they are prescribed CASGEVY treatment by their healthcare team.
What expenses are covered for the Medi-Cal member by the CGT therapy manufacturer if travel is necessary to receive fertility preservation services?
CGT therapy manufacturers are responsible for providing reimbursement to eligible members for mileage, tolls, and parking upon presentation of valid receipt, consistent with all applicable manufacturer policy. Manufacturers may also arrange transportation (via air, train, bus, car rental) for the member and caregivers to and from the fertility preservation provider. If an overnight stay is required, CGT therapy manufacturers may provide a modest single hotel room for up to two nights per visit and a reasonable per diem for food expenses for both the member and their parent/caregiver.
For more specific information about eligibility for travel coverage and reimbursement as well as for assistance with travel arrangements, members receiving bluebird bio's LYFGENIA, should work with their assigned Patient Navigator and utilize my bluebird support. Similarly, members receiving Vertex's CASGEVY should directly work with their Vertex Connects patient support team.
What benefits and services are NOT part of Medi-Cal's CGT Access Model and how will I receive them?
Aside from the two CGT medications and, if needed, fertility preservation services, all other medical and non-medical services are not covered under the CGT Access Model and will be provided and covered depending on your Medi-Cal eligibility, as follows:
Medi-Cal FFS:
FFS providers must deliver and bill DHCS directly for all other medical and non-medical CGT-related services, including transportation (outside of the cost of the drug, fertility preservation, and qualifying lodging, meals, and travel expenses necessary to receive fertility preservation services as noted above).
Medi-Cal Managed Care:
The member's Medi-Cal managed care plan must cover all other medical and non-medical CGT-related services, including transportation (outside of the cost of the drug, fertility preservation, and qualifying lodging, meals, and travel expenses necessary to receive fertility preservation services, as noted above).
Feedback
Where can I learn more about Medi-Cal's CGT Access Model and/or provide feedback?
Information about Medi-Cal's CGT Access Model is available on DHCS' website, which is available at the following link: Feedback, questions, and comments may also be submitted to DHCS via email at dhcscgt@dhcs.ca.gov.
