Full-Scope of benefits Medi-Cal Coverage

Depending on how you qualify for Medi-Cal, the program may provide a

Full-Scope of benefits Teen Health Rights.org

 

Medi-Cal pays for all of these services
or just some of them (partial-scope Medi-Cal).  DB 101

 

Primary Medical Care

  • Doctor visits
  • Diagnostic testing
  • Emergency services
  • Surgery
  • Hospitalization
  • Prescription drugs
  • Dental services
  • Health screenings for kids

Ongoing Care & Recovery

  • Personal care services (IHSS)
  • Occupational & physical therapy
  • Outpatient drug abuse services
  • Nursing facility stays
  • Adult day health care

Other medical related costs

  • Medical supplies
  • Durable medical equipment
  • Transportation to doctor visits
  • Transportation costs for children with disabilities

More Details

My Medi-Cal brochure

dhcs.ca.gov/Medi-Cal_EHB_Benefits

dhcs.ca.gov/Benefits_services.aspx

dhcs.ca.gov/Benefits-Chart

Check with your HMO Providers Evidence of Coverage

Insure Me Kevin.com – Medi Cal HMO same coverage as Covered CA HMO!  Provider list may differ!

Misc

 

Medi-Cal enrollees not sure how to use coverage california health line.org

Medi Cal only covers outside of CA for emergencies and very special circumstancesCornel LawMedi Cal Treatment Authorization Request

Medi-Cal pays $415 to $575/month or MORE to HMO’s to take care of you  Learn More⇒ Insure Me Kevin.com    3.4.2016   5.11.2014

If you are over 55, Medi-Cal will? bill your estate for the premiums?

 

Historical

Problems with Medi-Cal Computer system to process payments in Fee For Service Program  CA HealthLine 2.20.2015

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16 comments on “Full Scope Medi-Cal – Benefits & Coverages

  1. Medi Cal out of state emergency coverage?

    My 2c, contact Tx Medicaid ASAP!

    https://hhs.texas.gov/services/health/medicaid-chip

    CA Medi Cal – Out-of-state medical care is limited to the following:

    (a) (1) When an emergency arises from accident, injury or illness; or

    (2) Where the health of the individual would be endangered if care and services are postponed until it is feasible that he/she return to California; or

    (3) Where the health of the individual would be endangered if he/she undertook travel to return to California; or

    (4) When it is customary practice in border communities for residents to use medical resources in adjacent areas outside the State; or

    (5) When an out-of-state treatment plan has been proposed by the beneficiary’s attending physician and the proposed plan has been received, reviewed and authorized by the Department before the services are provided; and the proposed treatment is not available from resources and facilities within the State.

    (6) Prior authorization is required for all out-of-state services, except:

    (A) Emergency services as defined in §51056.

    (B) Services provided in border areas adjacent to California where it is customary practice for California residents to avail themselves of such services. http://www.cdss.ca.gov/shd/res/htm/ParaRegs-Medi-Cal-Out-of-State-Coverage.htm

    Medi Cal Treatment Authorization Request

    • See our Share of Cost page, link above.

      If your monthly income is higher than the limits to qualify for SSI or the A&D FPL program, but you meet the asset-level requirements, you may still be eligible for Medi-Cal with a share of cost (SOC).

      I don’t know that IHSS is relevant as to whether you qualify for Aged and Disabled and your income is low.

      Check all of my links for the reference material.

  2. My client has a share of cost with Medi-Cal of $439, and they currently have IHSS. and IHSS states NO SHARE OF COST

    Here’s my question, that is complicated to me.

    They also qualify under the Aged-FPL Program which is has NO share of cost.

    So does that mean they do not have to Pay the $439 to their Care-provider.

    They have a Medicare Part B premium,

    an additional policy for vision, and dental as a medical deduction.

    Please advised.

    Do they have to pay in sharing the cost for a CAREGIVER $439 or NOT

    We are in Alameda County.

    • Please double check your paper work and let me know for sure, if your client qualified under Aged & Disabled with or without a share of cost. See our answer to your other question. It depends on the clients income.

      Which of four IHSS Programs did your client qualify for?

      The IHSS Residual (IHSS-R) Program is for people who are not eligible for full-scope Medi-Cal. It provides a maximum of 283 hours of services per month for people with severe disabilities and a maximum of 195 hours for people with disabilities that are not severe.

    • We are unable to find anything online about high schools requiring health insurance. Please send us they letter from your school.

      3. What is the difference in coverage between Medi-Cal and Covered California?​​​​

      Medi-Cal is health coverage, just like the coverage offered through Covered California. Medi-Cal provides benefits similar to the coverage options available through Covered California, but often at lower or no cost to you or your family. All of the health plans offered through Covered California or by Medi-Cal include the same comprehensive set of benefits known as “essential health benefits.”

      Essential health benefits consist of:

      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 & Habilitative Services) and devices
      Laboratory services
      Preventive and wellness services & chronic disease management
      Children’s (Pediatric) services, including oral and vision care.

      A recent survey of Medi-Cal members by the California Healthcare Foundation (CHCF) found that 90% of respondents rate Medi-Cal as a good or very good program. Medi-Cal emphasizes prevention-oriented health care that promotes health and well-being and works to ensure members receive the right care at the right time.​ https://www.dhcs.ca.gov/services/medi-cal/eligibility/Pages/Medi-CalFAQs2014a.aspx

    • Depends on what you mean by “supplemental?” The “health” insurance portion of Medi-Cal is pretty comprehensive. Most everything is zero co-pay. Even dental is covered. Take a look at the Summary of benefits for the HMO you get assigned to. See if there are any gaps your concerned about.

      I don’t know why they want Medicare for All, with 30 percent of California’s on Medi-Cal, it might look more like Medi Cal for all. Did we get to keep our doctors?

      You might want to look at:

      Life Insurance, you can get a quote right on this page.

  3. My son is disabled, he has a developmental and mental condition. He receives medicare and medi-cal. Could you please let me know if he is eligible for Full Scope Medicare [Medi-Cal].

    He needs dental work and according to the dentist he is not covered.

    Mother and care taker.

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