Using Medi-Cal Benefits

Learn the benefits Medi-Cal provides and how to use them to access doctor visits, hospital care, immunization, and more.

Once your Medi-Cal application is approved, every eligible person in your household will receive a Medi-Cal Benefits Identification Card (BIC). To use your benefits, take this card with you any time you see a health care provider.

Medi-Cal coverage pays for medical visits, hospital care, prescription drugs, pregnancy-related treatment, mental health treatment, some dental services, and other medical services. Immigration status and age determines to what extent of eligible benefits, you may access. U.S, citizens and those with satisfactory immigrant status may receive full list of services below.

Visit the California Department of Health Care Services' Medi-Cal FAQ and What you need to know when you apply and enroll in Medi-Cal (PDF), as well as San Francisco's Managed Care providers, San Francisco Health Plan and Anthem Blue Cross Partnership Plan, for answers to other frequently asked questions.

Note: Essential Health Coverage is not automatically given to Medi-Cal recipients.

Essential Health Benefits

The Affordable Care Act ensures all Medi-Cal health plans offer what are known as Essential Health Benefits (EHB). These benefits are organized into the ten categories listed below, each with its own specific services included. You can download a one-page Essential Health Benefits summary here.

1) Outpatient (Ambulatory) Services

  • Physician services
  • Hospital outpatient & outpatient clinic services
  • Outpatient surgery (Includes anesthesiologist services.)
  • Podiatry
  • Chiropractic
  • Allergy care
  • Treatment therapies (chemotherapy, radiation therapy, etc.)
  • Dialysis/hemodialysis

2) Emergency Services

  • Emergency Room services
  • All inpatient and outpatient services that are necessary for the treatment of an emergency medical condition, including dental services, as certified by the attending physician or other appropriate provider.
  • Ambulance services

3) Hospitalization

  • Inpatient hospital services
  • Anesthesiologist services
  • Surgical services (bariatric, reconstructive  surgery, etc.)
  • Organ & tissue transplantation

4) Maternity and Newborn Care

  • Prenatal care
  • Delivery and postpartum care
  • Breastfeeding education
  • Nurse midwife services

5) Mental Health and Substance Use Disorder (SUD) Services, including Behavioral Health Treatment

  • Outpatient mental health services
  • Outpatient specialty Mental health services
  • Inpatient specialty mental health services
  • Residential treatment services
  • Voluntary inpatient detoxification
  • Individual and group mental health evaluation and treatment (psychotherapy)
  • Psychological testing when clinically indicated to evaluate a mental health condition
  • Outpatient services for the purposes of monitoring drug therapy
  • Outpatient laboratory, drugs, supplies and supplements
  • Psychiatric consultation
  • Intensive Outpatient Treatment Services
  • Outpatient Drug Free Services
  • Narcotic Treatment Services

All Specialty mental health services currently provided by County Mental Health Plans will continue to be available.

6) Prescription Drugs

  • Coverage is at least the greater of one drug in each U.S. Pharmacopeia (USP) category and class.
  • Beneficiaries may receive up to a 100-day supply of many medications.

7) Programs such as Physical and Occupational Therapy (known as Rehabilitative & Habilitative Services) and Devices

  • Physical therapy 
  • Speech therapy
  • Occupational therapy
  • Acupuncture
  • Cardiac rehabilitation
  • Pulmonary rehabilitation
  • Skilled nursing facility services (90 days)
  • Medical supplies, equipment and appliances (including implanted hearing devices)
  • Durable medical equipment       
  • Orthotics/prostheses
  • Hearing aids
  • Home Health Services

8) Laboratory Services

  • Outpatient laboratory and X-ray services
  • Various advanced imaging procedures are covered based on medical necessity.

9) Preventive and Wellness Services and Chronic Disease Management

  • United States Preventive Services Task Force  A & B recommended preventive services
  • Advisory Committee for Immunization Practices recommended vaccines
  • Health Resources and Service Administration's Bright Futures recommendations
  • Preventive services for women recommended by the Institute of Medicine
  • Family planning services
  • Smoking cessation services

10) Pediatric Services Including Oral and Vision Care

  • Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) is a Medi-Cal benefit for individuals under the age of 21 who have full-scope Medi-Cal eligibility.  EPSDT provides periodic screenings to determine health care needs and, in addition to the standard Medi-Cal benefits, a beneficiary under the age of 21 may receive extended services as medically necessary.

 

In addition to the ten categories of Essential Health Benefits above, the following services are also covered by Medi-Cal.

Dental

Dental benefits for adults 21 and older are available with some limitation. For information about Medi-Cal dental benefits, visit the Medi-Cal Dental program page. You can find a Medi-Cal dentist on the Denti-Cal Search Engine.

  • Emergency dental services
  • Dentures
  • Dental implants and implant-retained prostheses
  • Basic preventive, diagnostic, and repair services
  • EPSDT and pregnant women receive extended dental benefits.

Vision

  • Routine eye exam once in 24 months
  • Eyeglasses for eligible individuals under the age of 21 and pregnant women through postpartum

Non-Emergency Medical Transportation Services

  • Ambulance, litter van, or wheelchair van only when ordinary public or private conveyance is medically contra-indicated and transportation is required for obtaining needed medical care for a Medi-Cal benefit.

Long Term Services and Supports

  • Skilled Nursing Facility services (91+ days)
  • Personal Care Services
  • Self-Directed Personal Assistance Services
  • Community First Choice Option
  • Home and Community Based Services