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Health & BeautyWhat Does Medi-Cal Cover? Medi-Cal Overview

What Does Medi-Cal Cover? Medi-Cal Overview

The California Medical Assistance Program, Medi-Cal, covers health care costs for low-income individuals and families. Eligible individuals include those who are elderly, pregnant, disabled or have children in foster care. The income limit is 138% of the federal poverty level. Learn more about Medi-Cal’s benefits.

Mental Health Services

Medicaid is a state and federal health insurance program that provides health insurance coverage to low-income individuals. The program was created in 1965 and has since expanded to cover behavioral health care, including mental health services. It has drawn criticism, meanwhile, for not including coverage for inpatient psychiatric hospitalizations. It has led many mental health professionals to push for changes in the program. Recently, the program began to allow states to apply for waivers so that mental health services are covered.

Medi-Cal has several providers who specialize in treating various mental health conditions. The program’s provider directory includes names, phone numbers, and addresses. However, you must meet specific diagnostic criteria to receive the services and to know what does Medi-Cal cover. Once you know which provider you should see, you can begin getting help.

Some private insurance plans do not cover mental health services. In some cases, Medi-Cal may cover the services of a county mental health agency. Patients should file a grievance with the health plan or contact the department help center to ask for an independent medical review. Furthermore, some private plans do not cover wrap-around services or case management.

Behavioral Health Therapy

Medi-Cal has made behavioral health therapy available to its fee-for-service members. To qualify for behavioral health therapy, Medi-Cal members must produce a written diagnosis from their physician and a referral from a qualified mental health care professional. The treatment is provided by a Board Certified Behavior Analyst who develops an individualized treatment plan. The insurance provider will coordinate the treatment and communicate with the member’s physician. As part of the process, members can access a caseworker, care navigator, and 24-hour nurse support line.

Before Managed Care was implemented, Medi-Cal mental health services were administered through two separate programs: state-run Fee-for-Service and county-run Short-Doyle programs. Managed Care was designed to integrate the services and coordinate them more efficiently. It also allowed for increased access with the same funding level and ensured consistency across the state.

Medicaid offers more coverage than Medicare does and covers various behavioral health services. However, some Medicaid plans require you to pay a co-pay or contribute a portion of the cost. Additionally, they often limit the number of therapy sessions you can receive each year and may require a referral from a physician.

Behavioral Health Therapy for People with Autism

In response to recent Centers for Medicare and Medicaid Services (CMS) rules, California has begun covering behavioral health therapy for children and adults with autism. It includes applied behavior analysis (ABA) and other evidence-based behavior intervention programs. To be covered, behavioral health therapy must be recommended by a licensed doctor and provided as part of a treatment plan. It is also covered when provided under the supervision of Board Certified Behavior Analysts. The new coverage does not have age limits or dollar caps.

Behavioral health therapy for people with autism requires prior authorization by a licensed provider and follows a treatment plan approved by the member. This therapy aims to help people with autism with their daily functioning and reduce the adverse effects of their autism. Treatment for autism requires a comprehensive evaluation by a qualified provider and must follow a treatment plan approved by the member’s physician.

However, it is essential to remember that this coverage is unavailable to all Medi-Cal plans. Some of them may limit visits to specific behavioral health service providers. While DHCS has issued updated guidelines clarifying Medi-Cal’s compliance with the MHPAEA, these new guidelines can help ensure that people with autism receive the necessary treatment.

Dental Care

If you need dental treatment, the Medi-Cal program is a great option. Medi-Cal covers dental care as part of a health insurance plan. Routine dental checkups are essential to good oral health and are protected by Medi-Cal. Children should visit the dentist regularly to prevent oral disease. Additionally, 20 percent of child health care expenses are related to dental costs, making it essential to keep the teeth and gums healthy.

If you’re a Medi-Cal member, you might have questions about dental care. Most dental insurance policies include standard cleanings, which is fantastic news. However, you will have to pay a significant portion of the costs of more complex dental issues. Additionally, most dental procedures have low annual maximums, making it difficult to pay for more expensive dental treatment. You’ll quickly run out of benefits if you have a complex problem. In this case, billing your medical insurance for dental care provides affordable care to your patients. Medical procedures are different from dental procedures because they’re used to diagnose medical conditions. For example, an abscessed tooth is a medical condition, while diabetes is a dental problem.

The Balanced Budget Act aimed to cover dental care and other medically necessary services. However, a requirement set by the state requires insurers to cut down expenditures. Medically essential services include consultations, x-rays, and medical imaging. Diagnostic procedures include tests to determine the source of pain and diagnose underlying medical conditions. Routine x-rays, however, are not considered medical diagnostic systems.

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