Medi-Cal is a program that pays medical expenses for people with low income. This includes people who are aged, disabled, or have high medical costs. If you meet the requirements of the program, Medi-Cal will help pay for doctor visits, hospital stays, prescription drugs, rehabilitation, and other medical services.

Medi-Cal is California’s part of a national health coverage program called Medicaid. Each state runs its own Medicaid program. The states have to follow certain national Medicaid rules, but they have flexibility in how they run their programs. The state Medicaid programs are paid for with a combination of county, state, and federal money.

You can think of Medi-Cal as a single program that you can qualify for in many different ways. The different ways to get Medi-Cal are called eligibility categories. There are over 90 eligibility categories, each with its own rules and requirements.

This article will explain the Medi-Cal benefit in more detail and describe some of the most common eligibility categories for people with disabilities. It will also explain how you can keep your Medi-Cal coverage if you lose it because of a change in income, and how Medi-Cal may help pay for the premiums of other insurance programs.

Medi-Cal Services

Medi-Cal pays for a wide variety of medical expenses:

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

Depending on how you qualify for Medi-Cal, the program may pay for all of these services (full-scope Medi-Cal) or just some of them (partial-scope Medi-Cal).

Like other health coverage plans, Medi-Cal has rules about what it will cover. For example, Medi-Cal only pays for prescriptions that are on its list of accepted drugs. Along the same lines, it may refuse to pay for certain procedures like cosmetic surgery, and it will require that you get prior authorization for some services. If Medi-Cal decides not to pay for something and you think it should, you can appeal the decision.

Who pays when you have more than one health coverage

Depending on your situation, you might get employer-sponsored coverage, Medi-Cal, and Medicare all at the same time. This can sound confusing, but it can help you, because one form of coverage may pay for costs that your other coverage won't pay for.

The rules about how your different types of coverage pay for things are very complicated, so it’s important to check with your health coverage plans when you have questions about which plan will pay for what expenses.

Generally speaking, Medi-Cal will only pay for expenses that it covers and that your other coverage won't pay for. The Centers for Medicaid and Medicare Services has a helpful pamphlet on Medicare and Other Health Benefits: Your Guide to Who Pays First.

Note: The Affordable Care Act (ACA) of 2010, has made big changes to our nation’s health care system and there will be more changes over the next few years. DB101 has been and will continue to be updated to reflect these changes. For more information, visit Covered California.