Medi-Cal

Medi-Cal is California’s Medicaid program that provides medical services to the low income people at little or no cost. It is administered by the Centers for Medicare and Medicaid Services (CMS) and the California Department of Health Care Services (DHCS). County human services departments are responsible for administering the Medi-Cal program at the local level. Recent reports state that more than 12 million Californians are enrolled in Medi-Cal. This means about 1 in 3 Californians have Medi-Cal.

Medi-Cal

California has the nation’s largest Medicaid program. There was a huge increase in Medi-Cal enrollments largely due to the expansion that California opted into after the Affordable Care Act was passed which gives aid to a larger range of people. Now, people with slightly higher income are able to receive Medi-Cal regardless of disability, family status, financial resources, and other factors that were usually taken into account in eligibility decisions.

Effective May 1, 2016, California’s undocumented low-income children will now have access to full coverage through Medi-Cal. California is the largest state with more immigrants than any other, will now provide options to approximately 170,000 undocumented children.

Take Note

Medi-Cal provides a comprehensive set of health benefits including the following 10 “essential health benefits” required by the Affordable Care Act for all health plans:

  • Outpatient (ambulatory) services
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health and substance use disorder services, including behavioral health treatment
  • Prescription drugs
  • Programs such as physical and occupational therapy (known as rehabilitative and habilitative services) and devices
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Children’s services, including oral and vision care

The Medi-Cal Health Benefits Chart provides more details about specific services in the above categories. Medi-Cal also offers certain dental benefits for adults and children, and full-scope Medi-Cal members are offered vison benefits.

To improve its services, the DHCS states that to improve members’ access to services and to ensure they spend tax dollars efficiently, “nearly 80 percent of its members now receive care from a Medi-Cal managed care plan. Under these models access to health care is easier and the quality of care is improved.”*

Network

Plan options vary depending on the county you reside in. Most counties offer commercial plans including Anthem Blue Cross, Kaiser Permanente, Health Net, and Molina. Other counties offer public plans administered by the community. If a county only administers one plan, then all Medi-Cal members will be enrolled in that plan. Almost all Medi-Cal plans are “managed care plans” which means they function similar to an HMO. Medi-Cal Plans can be found in the Medi-Cal Managed Care Health Plan Directory.

Once the plan is selected, a doctor or doctor’s group must be chosen. Medi-Cal members must use a Medi-Cal doctor and facility that is in the group and plan that they have been enrolled in. Members can search for Medi-Cal Doctors on the Medi-Cal Managed Care Health Care Options Website.

In some areas only “Fee-For-Service” Medi-Cal is offered – contact Medi-Cal for how Fee-For Service Medi-Cal works.

The Future is Here

The California DHCS seeks to fulfill their vital role as California’s health care safety net by having the following mission and vision:

“…to provide Californians with access to affordable high-quality health care, including medical, dental, mental health, substance use disorder services, and long-term services and supports…and  to preserve and improve the physical and mental health of all Californians.” *

*All references and quotations from the DHCS can be found on the California Department of Health Care website by clicking here.