Additional Medi-Cal Section
Covered Services
In general, Medi-Cal covers services that are medically necessary, that is services needed to prevent death or serious injury. DHCS defines services that Medi-Cal covers. If the service is not defined by DHCS as Medi-Cal covered, you can argue it must be covered because it is necessary to prevent death or serious injury.
All Medi-Cal beneficiaries get medications through the state’s centralized “Medi-Cal Rx” system now. Pharmacies are no longer controlled by managed care.
For an appeal about decisions made by managed care plans, the recipient must exhaust the managed care plan grievance process before requesting a state administrative hearing with the California Department of Social Services