Medi-Cal Benefits

Medi-Cal

Medi-Cal provides a core set of health benefits, including doctor visits, hospital care, immunization, pregnancy-related services and nursing home care. The Affordable Care Act ensures that all Medi-Cal health plans offer what is known as “essential health benefits." These 10 comprehensive services include the following categories:

  • 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 and habilitative services) and devices.
  • Laboratory services.
  • Preventive and wellness services and chronic disease management.
  • Children’s services, including oral and vision care.

Take a look at the Medi-Cal health benefits chart to learn more about the services in each category. For a definition of any of the terms used, please browse the Covered California online glossary or the glossary at the federal site HealthCare.gov.

Dental Benefits

Medi-Cal also provides dental benefits for adults and children.

You can find a Medi-Cal dentist through the Denti-Cal search engine.

For information on children’s dental services, visit the Denti-Cal website.

The following dental benefits are available for adults:

  • Exams and X-rays.
  • Cleanings.
  • Fluoride treatments.
  • Fillings.
  • Anterior root canals (front teeth).
  • Prefabricated crowns.
  • Full dentures.
  • Other medically necessary dental services.

Learn more about dental benefits and get further clarification by calling (800) 322-6384 or visiting Denti-Cal.

Vision Benefits

Vision benefits are covered for those with full-scope Medi-Cal benefits. For information about Medi-Cal eligibility, individuals can contact their county human services agency. Vision benefits are described below.

Routine Eye Exam Once Every 24 Months

  • All Medi-Cal members are eligible for a routine eye exam, which checks the health of the eyes and tests for an eyeglass prescription.
  • Only members under 21 years old and residents of a nursing home receive coverage for eyeglasses (frames and lenses).

Other Services

  • Contact lens testing may be covered if the use of eyeglasses is not possible due to eye disease or condition.
  • Low-vision testing is available for those with vision impairment that is not correctable by standard glasses, contact lenses, medicine or surgery and that interferes with a person’s ability to perform everyday activities (e.g., age-related macular degeneration).
  • Artificial-eye services and materials are available for those individuals who have lost an eye or eyes to disease or injury.

Finding a Vision Provider

Contact a Medi-Cal provider directly for an appointment. For a list of vision providers, visit the online directory at the Find a Vision Care Provider page on the California Department of Health Care Services (DHCS) website. For other vision program questions, individuals may contact DHCS’s Vision Services Branch at vision@dhcs.ca.gov.

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