Description

Essential Health Benefits

​​Medi-Cal provides a comprehensive set of health benefits which may be accessed as medically necessary.

Essential Health Benefits Summary

A one-page Essential Health Benefits Summary is available for download.

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

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

Hospitalization

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

Maternity and Newborn Care

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

Mental health and Substance Use Disorder (SUD) Services

• Outpatient mental health services
• Outpatient specialty Mental health services
• Inpatient specialty mental health services
• Outpatient substance use disorder services
  • Residential treatment services
• Voluntary inpatient detoxification

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.

 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

Laboratory Services

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

 

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
• Behavior health treatment for children under 21

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.

Other

Dental

• 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

Transportation Services

Medi-Cal offers transportation to and from appointments for services covered by Medi-Cal. This includes transportation to medical, dental, mental health, or substance use disorder appointments, and to pick up prescriptions and medical supplies.

Nonemergency Transportation Services: Transportation by ambulance, litter van, or wheelchair van only when ordinary public or private conveyance is medically contra-indicated and transportation is required for a Medi-Cal benefit.

Nonmedical Transportation Services: Transportation by private or public vehicle for people who do not have another way to get to their appointment.

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

Disclaimer: The community resource directory information is deemed accurate and up-to-date, however, you should always contact the agency or provider to confirm this information and make an appointment. Be sure to confirm payment information with the provider, if payment is required. We are not affiliated to any of the organizations listed in this app/website. The information provided in this app/site is for the benefit of the community and and we are not liable for any information changed from the date we published this information. Please contact us if you like to make any changes in the information by emailing beracahsites@gmail.com