Medi-Cal covers a wide range of health care: doctor visits, hospital stays, emergency care, prescriptions, dental, vision, hearing aids, mental health and substance use treatment, maternity care, family planning and abortion, long-term nursing care, in-home personal care, rides to appointments, and even nonmedical supports like medically tailored meals and short-term housing assistance for members who qualify. For most people, there’s no copay and no premium. The specifics depend on your age, your medical needs, and the managed care plan you’re enrolled in, but California runs one of the most expansive Medicaid benefit packages in the country.
Doctor Visits, Hospital Care, and Preventive Services
The core of Medi-Cal is the kind of care most people associate with health insurance. Covered services include primary care visits, specialist care, urgent care, emergency room visits, inpatient and outpatient hospital stays, surgeries, lab work, X-rays, and vaccinations.1Health Net. Health Net Medi-Cal Members Hospital coverage reaches inpatient surgical procedures including bariatric and reconstructive surgery, organ transplantation, and anesthesia.2California Department of Health Care Services. Medi-Cal Benefits Chart
Preventive care comes without cost-sharing. Adults get preventive evaluation visits and cancer screenings for breast, cervical, colorectal, and lung cancer. Depression screening is covered for adults and for children 12 and older, and substance use screening is covered for anyone 11 and older. Prenatal screenings include gestational diabetes, hepatitis B, HIV, syphilis, and Rh incompatibility. Children and adolescents under 21 are screened on the Bright Futures schedule, which includes developmental and autism screenings at recommended ages.3California Department of Health Care Services. Preventive Services Provider Manual
Prescription Drugs
Prescriptions are handled through a statewide program called Medi-Cal Rx rather than through individual managed care plans. Most members pay nothing.4The Alliance. Medi-Cal Prescriptions Medi-Cal Rx keeps a Contract Drugs List of approved medications; drugs that aren’t on the list can still be covered with prior authorization.5California Department of Health Care Services. Medi-Cal Rx Contract Drugs List You’ll need to use a pharmacy enrolled in Medi-Cal Rx.
Some categories have special rules. Controlled substances are generally limited to a 35-day supply, and new opioid prescriptions are capped at a 7-day supply or 30 dosage units. GLP-1 weight-loss medications are not covered as of January 2026, except for members under 21 through the EPSDT benefit or for other FDA-approved uses with prior authorization. HIV medications for post-exposure prophylaxis don’t require prior authorization.5California Department of Health Care Services. Medi-Cal Rx Contract Drugs List Erectile dysfunction medications have not been covered since 2006.
Dental Care
Dental benefits are included for most members. Adults 21 and older get a free checkup every 12 months; members under 21 get one every six months. Young children ages zero to six can receive cleanings, fluoride, and exams up to four times a year. Sealants are covered for children and teens. Pregnant members have coverage during pregnancy and for 12 months after.6California Department of Health Care Services. Medi-Cal Dental Member Handbook
There’s an annual cap of $1,800 on covered dental services, but it doesn’t apply to pregnant members, members under 21, or anyone receiving medically necessary care. Teledentistry is available statewide. Starting July 1, 2026, dental benefits will no longer be available to undocumented adult members 19 and up, though emergency dental services for severe pain, infections, and extractions will still be covered. Children, foster youth, and pregnant individuals keep full dental coverage regardless of immigration status.7Health Consumer Alliance. Medi-Cal Changes and What You Need to Know
Vision and Hearing
Eye exams and eyeglasses are covered for both adults and children.1Health Net. Health Net Medi-Cal Members Protective, cosmetic, or job-related glasses aren’t covered, and neither are progressive lenses, multifocal contact lenses, or vision therapy.8Health Net Provider Library. Principal Exclusions and Limitations
For hearing care, most adults have an annual cap of $1,510 per fiscal year that covers hearing aids, molds and supplies, repairs, an initial set of batteries, and up to six fitting and adjustment visits with the same provider. Members under 21 with full-scope Medi-Cal aren’t subject to the cap. Cochlear implants and bone-anchored hearing devices are classified separately and don’t count against it.9UCSF EARS. Medicaid Coverage for Hearing Devices
Mental Health and Substance Use Treatment
Mental health coverage is split by severity. If you have a mild to moderate condition like anxiety or depression, your managed care plan handles outpatient services, which include individual, group, and family therapy, psychiatric consultations, psychological testing, and medication management. No referral is usually required for an initial assessment.10L.A. Care Health Plan. Medi-Cal Behavioral Health
Members with serious mental illness that affects their ability to work, care for themselves, or stay safe are served through county specialty mental health programs, which offer crisis intervention, outpatient treatment, medication support, and inpatient psychiatric hospitalization.10L.A. Care Health Plan. Medi-Cal Behavioral Health
Substance use treatment for members 11 and up includes screening, outpatient and intensive outpatient treatment, medications for addiction treatment, withdrawal management, residential treatment, case management, and recovery support. For members under 21, behavioral health treatment including Applied Behavior Analysis is covered when a licensed provider finds it medically necessary. An autism diagnosis is not required.11San Francisco Health Plan. Behavioral and Mental Health Services
Pregnancy, Family Planning, and Abortion
Family planning is one of the easiest Medi-Cal benefits to use. You can see any qualified Medi-Cal provider without a referral or prior authorization, even if the provider is outside your plan’s network, and there is no cost-sharing.12Health Net Provider Library. Family Planning Overview
Coverage includes all FDA-approved contraceptive methods: oral contraceptives, patches, rings, injectables, IUDs, implants, condoms, diaphragms, spermicides, and emergency contraception. Members can get up to a 12-month supply of self-administered hormonal contraceptives at once. Vasectomy and tubal ligation are covered for members 21 and older with informed consent given at least 30 days in advance. Testing and treatment for sexually transmitted infections are included when provided in a family planning setting. Medi-Cal also covers abortion services using state funds, with no prior authorization and no cost-sharing.13National Health Law Program. Medi-Cal Services Guide Chapter 6
Physical, Occupational, and Speech Therapy
Therapy services are covered but come with visit limits for adults. Outpatient occupational therapy is generally limited to two visits per month for adults, though that cap doesn’t apply in certified rehabilitation centers or nursing facilities.14California Department of Health Care Services. Occupational Therapy Provider Manual Physical therapy requires a physician’s written order and prior authorization, and prescriptions are valid for up to six months.15California Department of Health Care Services. Physical Therapy Provider Manual For adults, acupuncture, audiology, chiropractic, and podiatry visits are also capped at two per calendar month.8Health Net Provider Library. Principal Exclusions and Limitations
Long-Term Care and In-Home Support
Medi-Cal is the primary payer for long-term care in California. Coverage extends to skilled nursing facilities, intermediate care facilities, and subacute care, including physician visits, medical supplies, prescriptions, and durable medical equipment.16California Advocates for Nursing Home Reform. Overview of Medi-Cal for Long Term Care Nursing facility residents pay a monthly share of cost based on their income, minus a $35 personal needs allowance and any deductible medical premiums.
If you’d rather stay at home, In-Home Supportive Services is the state’s largest home and community-based program, serving nearly 900,000 people. IHSS pays for help with domestic tasks, meal preparation, personal care like bathing and grooming, paramedical services such as medication and wound care, protective supervision for people with cognitive impairments, and accompaniment to medical appointments. Recipients hire and manage their own caregivers. The county assesses how many hours you need, with severely impaired participants eligible for up to 283 hours per month.17Justice in Aging. In-Home Supportive Services for Older Adults and People With Disabilities
Rides to Medical Appointments
Medi-Cal covers two kinds of transportation. Non-Medical Transportation is for members who can travel normally but lack a way to get to covered services. It includes rides by passenger car, taxi, rideshare, paratransit, or public transit, and no physician certification is needed.18California Department of Health Care Services. Non-Medical Transportation Benefit Non-Emergency Medical Transportation is for members whose medical condition prevents ordinary travel, so trips happen by ambulance, wheelchair van, or litter van. This type requires a physician certification statement.19Health Net Provider Library. Transportation Medi-Cal Both are available to all full-scope members, and the benefit covers one accompanying attendant.
Housing Help, Meals, and Other Nonmedical Supports
Through an initiative called CalAIM, Medi-Cal pays for services that affect health but don’t happen in a clinic. As of 2025 there are 15 authorized Community Supports that managed care plans can offer, including medically tailored meals, housing deposits, transitional rent of up to six months, housing navigation, asthma remediation, home modifications for accessibility, sobering centers, personal care and homemaker services, recuperative care for people without stable housing who are recovering from illness, and short-term post-hospitalization housing.20California Department of Health Care Services. Community Supports Search Tool By mid-2024 these services had reached over 239,000 members.21California Department of Health Care Services. Community Supports Policy Guide
Enhanced Care Management is a companion program providing intensive care coordination for members with complex needs: people experiencing homelessness who have a physical or behavioral health condition, adults with five or more emergency department visits in six months, people with serious mental illness or substance use disorders compounded by housing insecurity or other social challenges, individuals transitioning out of incarceration with qualifying health conditions, and nursing facility residents who want to move back into the community.22California Department of Health Care Services. Enhanced Care Management Populations of Focus
One caveat: the CalAIM waiver expires at the end of 2026, and the federal Centers for Medicare and Medicaid Services has signaled it may not renew the funding mechanism behind these social-service-oriented benefits. For now, the programs remain operational and funded through 2026.23CalMatters. Medicaid Waiver CalAIM
Extra Benefits for Members Under 21
If you or your child is under 21 and has full-scope Medi-Cal, a federal rule called Early and Periodic Screening, Diagnostic, and Treatment expands what’s covered. Under EPSDT, any service that is medically necessary to “correct or ameliorate” a physical or mental condition must be provided, even if that service would normally be limited or excluded for adults. Managed care plans can’t impose flat caps or hard limits on EPSDT benefits for budget reasons.24Kaiser Permanente. Occupational and Physical Therapy Services EPSDT In practice this is why the adult therapy caps, the dental cap, and the hearing aid cap largely don’t apply to children, and why services must be authorized based on the individual child’s needs.14California Department of Health Care Services. Occupational Therapy Provider Manual
What Medi-Cal Does Not Cover
The exclusions are specific. Cosmetic surgery isn’t covered unless it repairs trauma, congenital defects, or disease-related disfigurement. Experimental procedures, infertility treatments, fertility preservation, and reversal of voluntary sterilization are excluded. Personal comfort items, home or vehicle modifications outside of CalAIM accessibility adaptations, and custodial care fall outside the program. Vaccines that aren’t recommended by the CDC or the Advisory Committee on Immunization Practices are also excluded.8Health Net Provider Library. Principal Exclusions and Limitations
What You’ll Pay
Most Medi-Cal members pay nothing for covered services. There are no copays for dental, family planning, preventive care, or prescriptions for the great majority of beneficiaries.4The Alliance. Medi-Cal Prescriptions The main exception is “share of cost,” which works like a monthly deductible for members whose income exceeds the free-coverage threshold (currently $1,801 per month for an individual). You only owe your share of cost in months when you actually use medical services, and health insurance premiums, unpaid medical bills from prior months, and out-of-pocket medical costs can count toward meeting it.25California Advocates for Nursing Home Reform. Understanding the Share of Cost for Medi-Cal
Two cost changes are on the horizon. Starting July 1, 2027, undocumented adults ages 19 to 59 who kept full-scope coverage will pay a $30 monthly premium to keep it.7Health Consumer Alliance. Medi-Cal Changes and What You Need to Know Starting October 1, 2028, adults in the Medicaid expansion population with incomes above 100% of the federal poverty level will face copays of up to $35 for certain services, with primary care, mental health, and substance use disorder services exempt.26Disability Rights California. Medicaid Policy Changes in California