What Medi-Cal Covers
Medi-Cal covers most medical care including doctor visits, hospital stays, prescriptions, mental health, dental and vision for adults, and long-term care in many cases.
What It Doesn't Always Cover
- Experimental treatments
- Out-of-state non-emergency care
- Some elective procedures
- Certain prescription brands without prior authorization
How Dual-Eligible Coordination Fills the Gaps
For beneficiaries who also have Medicare, the two systems combined cover almost everything. Medi-Cal pays Medicare cost-sharing, and Medicare opens up the broader provider network.
What We Coordinate
When a client is dual-eligible, we make sure both programs talk to each other - verifying that providers are in both networks and that prescriptions are covered under both.