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Medi-Cal Coverage & Benefits for Rehab

What is Medi-Cal?

Medi-Cal is the name of Medicaid in California. It is a health insurance program providing crucial health insurance benefits to low-income individuals and families. As of January 2021, 13,635,094 total people were considered certified eligible for Medi-Cal.1

Medi-Cal Eligibility

Eligibility for Medi-Cal is based on the Federal Poverty Level (FPL) limits of the current year. The eligibility for Medi-Cal for adults is up to 138% of the FPL. Other possible qualifications include populations who are2:

  • 65 and older
  • Blind
  • Disabled
  • Under 21
  • Pregnant
  • Residents in skilled nursing or intermediate care homes
  • People with refugee status for a limited time
  • Parents or caretakers of disadvantaged children under 21
  • People who were diagnosed with breast or cervical cancer

Medi-Cal Essential Health Benefits

Medi-Cal covers a core set of services from doctor visits to hospital care. Essential healthcare benefits include mental health and substance use disorder services. The full list is below3:

  • Ambulatory patient services (outpatient care you get without being admitted to a hospital).
  • Emergency services.
  • Hospitalization (like surgery and overnight stays).
  • Pregnancy, maternity, and newborn care (both before and after birth).
  • Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy).
  • Prescription drugs.
  • Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills).
  • Laboratory services.
  • Preventive and wellness services and chronic-disease management.
  • Pediatric services, including oral and vision care (but adult dental and vision coverage aren’t essential health benefits).

Does Medi-Cal Cover Addiction Treatment & Rehab?

Depending on your coverage, Medi-Cal may be able to cover addiction treatment or rehab. This will of course depend on your treatment plan, length of stay, level of coverage, and various other variables that will be determined based on your personalized needs. Call us today at and we can help you determine whether treatment maybe covered. The following are some of the substance use disorder benefits for those enrolled in Medi-Cal3:

If you have a different insurance provider, find out if they may be able to cover all or part of the cost of rehab. Or explore other rehab payment options and plans.

Take Our Substance Abuse Self-Assessment

If you’re still unsure about treatment, take our free, 5-minute substance abuse self-assessment below if you think you or someone you love might be struggling with substance abuse. The evaluation consists of 11 yes or no questions that are intended to be used as an informational tool to assess the severity and probability of a substance use disorder. The test is free, confidential, and no personal information is needed to receive the result.

Sources

  1. Department of Healthcare Services. Medi-Cal Fast Facts.
  2. Department of Healthcare Services. Do You Qualify? | Medi-Cal Eligibility.
  3. Department of Healthcare Services. ​​MEDI-CAL EXPANSION: COVERING MORE CALIFORNIANS.
Last Updated on May 25, 2021
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