While full-scope Medi-Cal provides comprehensive health benefits, restricted scope Medi-Cal does not cover all services, notably excluding medicine and primary care.
Medi-Cal is California's Medicaid program, offering free or low-cost health coverage to eligible low-income individuals and families. The scope of services covered can vary based on an individual's eligibility and the specific Medi-Cal program they are enrolled in.
Restricted Scope Medi-Cal Limitations
For individuals enrolled in restricted scope Medi-Cal, the services covered are limited. This particular scope of Medi-Cal does not include coverage for:
| Service Type | Coverage Status for Restricted Scope Medi-Cal |
|---|---|
| Medicine | Not Covered |
| Primary Care | Not Covered |
Primary care generally refers to routine medical care provided by a general practitioner or family doctor, including regular check-ups, ongoing care for chronic conditions, and initial treatment for common illnesses. Medicine refers to prescription drugs.
Important Exception:
It's crucial to note an important exception: if an individual has pregnancy-related limited scope Medi-Cal, they will receive the full scope of Medi-Cal benefits, provided the service is deemed medically necessary. This ensures comprehensive care during pregnancy.
For information on what is covered by Medi-Cal or to understand the different scopes of coverage, it is advisable to consult official resources from the California Department of Health Care Services (DHCS).
