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What is Medi-Cal?

MEDI-CAL IS CALIFORNIA'S VERSION OF MEDICAID. Medicaid is a federal and state program that provides healthcare coverage for individuals with disabilities, complex medical needs and people with low-incomes.

While Medi-Cal primarily serves low-income individuals, there are income exclusions for children with Developmental Disabilities or Complex Medical Needs.

I already have private Insurance. Why do I need Medi-Cal?

Having both private insurance and Medi-Cal means you get comprehensive coverage, with private insurance paying first and Medi-Cal covering the rest . This helps reduce out-of-pocket expenses and ensures access to a whole range of services (like IHSS, dental, vision, long-term care) and significant discounts (like reduced utility bills) only available to Medi-Cal members.

Private Insurance: Primary Payer

Covers routine healthcare, hospital care, prescription drugs, emergency services, mental health, and some rehabilitation services.

Medi-Cal: Secondary Payer

Covers costs that private insurance does not, including copays, deductibles, and services excluded from private plans.

Comprehensive Coverage

Together they ensure access to necessary medical services while reducing out-of-pocket expenses for beneficiaries.

Types of Medi-Cal Coverage Explained

1. Full-Scope Medi-Cal: Managed Care

A managed plan like Health Net, LA Care, or Anthem Blue Cross coordinates your care.

  • Select a Primary Care Physician and get referrals for in-network specialists
  • Covers doctor visits, hospital care, prescriptions, mental health, dental and vision

2. Full-Scope Medi-Cal: Fee-for-Service

(difficult to get but the best)

Also called Straight Medi-Cal, where Medi-Cal pays providers directly for service. See any provider accepting Medi-Cal without referrals.

  • For those with specific medical needs or on HCBS Waivers
  • Ideal for people with complex medical conditions needing specialized care

3. Restricted-Scope Medi-Cal

Also called Emergency Medi-Cal, provides limited coverage for emergency service but doesn't cover routine doctor visits or preventive care.

4. Share of Cost (SOC)

For people whose income is too high but who have significant medical expenses. Pay a portion of your medical costs before Medi-Cal coverage starts.

5. Medically Needy Medi-Cal

For those who don't qualify based on income but have substantial medical needs requiring specialized care and support.

6. Dual Eligibility (Medi-Medi)

For individuals who qualify for both Medi-Cal and Medicare. Medi-Cal covers what Medicare does not, providing more comprehensive coverage.

Full-Scope Medi-Cal Covers:

Doctor Visits

Regular check-ups and medical appointments covered by Medi-Cal ensure preventive care and timely treatment for enrollees.

Hospital Care

Medi-Cal provides coverage for inpatient and emergency services when medical treatment requires hospitalization.

Prescriptions

Medication coverage helps ensure that enrollees can afford the prescriptions they need to manage their health conditions.

Mental Health

Counseling and psychiatric services for mental wellbeing of Medi-Cal beneficiaries alongside physical health.

Long-term Care

Ongoing support for those with chronic conditions or disabilities requiring continuous assistance.

FFS (Straight) Medi-Cal may pay:

Insurance co-pays, deductibles and out-of-pocket expenses