What Are the Health Services Covered by Medi-Cal?

If you qualify for Medi-Cal, it can pay for various health services. These include prescriptions, inpatient care, outpatient care, dental, vision, and long-term care. In most cases, you get your Medi-Cal benefits through a managed care program. Managed care plans are insurance companies or local non-profits responsible for delivering your health care.

Vision Care

Vision care is a vital part of overall health, whether you need prescription glasses or contact lenses or if you have an eye condition such as glaucoma. It’s essential to get regular checkups, and even people who don’t have a visual problem can benefit from having a routine eye exam every two years.

Riverside county Medi-Cal offers vision care for eligible beneficiaries, which means that all eye exams are covered. In addition, it includes eyeglasses (frame and lenses), contact lens testing, and certain laser vision correction services.

However, the type of vision coverage you receive will depend on your age and previous eye health. For example, younger and middle-aged adults without a history of eye problems may not need as many visits as older patients, so it’s best to talk to a local Medicaid office or your plan provider about the details of your coverage.

Vision insurance is a health and wellness benefit that assists you in lowering the cost of routine preventative eye care (eye examinations) and prescription eyeglasses (glasses and contact lenses).

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Inpatient and Outpatient Care

Inpatient services are generally reserved for people with severe or chronic health issues that require long-term care. They also include psychiatric care and mental health treatment.

The costs for inpatient care are higher than outpatient care, as the hospital has more resources and staff. As a result, it can be a burden for both patients and insurance companies.

On the other hand, outpatient care is a lower-cost option that requires less time and effort from medical professionals. Depending on your condition, you may be able to receive outpatient care in a doctor’s office or at an ambulatory surgery center, for example.

Outpatient care can be performed in facilities co-owned or linked closely with hospitals. These facilities often have dedicated outpatient surgery centers, walk-in clinics, and doctor’s offices open for outpatient care.

Prescription Drugs

California provides health coverage through the Medicaid program to qualifying low-income individuals and families. In addition, Medi-Cal covers medically necessary prescription and non-prescription over-the-counter (OTC) medications for eligible members in various ways.

Prescription drug benefits cover FDA-approved prescription drugs prescribed by a physician and dispensed at a pharmacy. 

Many prescription drugs are on the state’s Preferred Drug List, or PDL, a list of medications approved by the Food and Drug Administration that provide high-quality and high-effectiveness treatment for specific diseases. However, some drugs not on the PDL may require preapproval before being dispensed.

In the meantime, a pharmacist at your outpatient pharmacy or a hospital emergency room can give you a 72-hour emergency supply of medication. You can also request a non-emergency, emergency supply of medication through your doctor’s office or clinic.

Dental Care

Dental care prevents health problems like tooth decay and gum disease. But unfortunately, fewer than 20 percent of children receive regular dental checkups and treatment.

Medicaid covers preventative services like checkups, cleanings, x-rays, and treatments like fillings, crowns, and root canals. It also covers emergencies such as oral surgery and trauma cases.

Many states offer dental benefits for Medicaid enrollees in addition to health insurance. However, state programs determine what types of dental care they will cover. While most states provide emergency dental services for adults, only half offer comprehensive dental care.

Despite this, the Affordable Care Act significantly improved dental care for children and adolescents, making it more accessible to families who have limited incomes or can’t afford private insurance. In the meantime, Medicaid coverage for adult enrollees varies dramatically from state to state.

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Long-Term Care

You may be eligible for long-term care services if you need help with everyday activities, such as bathing and dressing, eating, or using the bathroom. The help can be provided at home, in a nursing home, or a community setting.

Many people need long-term care when they get older or have a severe health condition. It can be necessary for an extended period, but it can also come on suddenly, such as after a stroke or heart attack.

Medi-Cal covers most of the costs associated with long-term care services. However, you must meet specific income requirements and have assets that will not be spent down to qualify for benefits.

The state also provides a Share of Cost (SOC) Medi-Cal program for higher-income individuals who cannot afford to pay their nursing home fees. SOC Medi-Cal allows you to pay a small personal needs allowance each month, and then Medi-Cal will cover the rest of your nursing home costs.

Many people with disabilities and seniors in California rely on Medi-Cal to pay for their long-term care. For example, among residents in nursing facilities, about 59 percent use Medi-Cal funds, and nearly 100 percent of residents in homes for the developmentally disabled rely on funding through the program.