Medi-Cal–Vision and Denti-Cal Coverage

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This guide provides an overview of the dental and vision services available for adults enrolled in full-scope Medi-Cal. It also explain show to find a provider for those services. Please note that on May 1, 2014, certain dental services were restored to adults over the age of 21. The information in this guide has been adapted from http://www.denti-cal.ca.gov/ and http://www.dhcs.ca.gov/.

DENTAL SERVICES AVAILABLE TO FULL-SCOPE MEDI-CAL RECIPIENTS

Who can receive dental services?

A person who has been approved for full-scope Medi-Cal is eligible to be enrolled to receive dental services. Individuals with restricted or “emergency” Medi-Cal are not eligible for dental services.

How do I get dental coverage through Medi-Cal?

After you have applied and have been approved for Medi-Cal, you should receive an enrollment packet from Medi-Cal allowing you to choose your health and dental plans. For Dental Services, you can choose Medi-Cal Dental, known as Denti-Cal, or a Managed Care Dental Plan.

What is the difference between Denti-Cal and a Managed Care Dental Plan?

The services covered under the plans should be the same. Individual dentists and providers may vary depending on the plan that you choose. The agency you contact to receive benefit information may also vary depending on the plan that you choose.

What is covered?

Services include:

 Exams and x-rays

 Root canals in front teeth

 Cleanings (Prophylaxis)

 Prefabricated Crowns

 Fluoride treatments

 Full dentures

 Fillings

 Other medically necessary dental services

How do I find a dentist if I choose Denti-Cal as my benefit plan?

You will not receive a separate provider handbook for Denti-Cal. You will need to find a dentist or dental clinic that accepts Medi-Cal and seek an appointment. You can find a Medi-Cal dentist on the Denti-Cal website at http://www.denti-cal.ca.gov by clicking on “Find a Medi-Cal Dentist.” You can also call Denti-Cal at 1-800-322-6384.

How do I find a dentist if I choose a Managed Care Dental Plan?

Your Managed Care Dental Plan should send you a provider handbook. You can then choose the primary dentist for your dental care needs. You can also find a dentist by calling your plan or on the Denti-Cal website. As long as you choose a dentist within your managed care plan, you do not have to ask managed care dentists if they take Medi-Cal patients.

What if I need a specialty dentist?

There is no charge for specialty dentists when your dentist refers you.

What if I have a dental emergency?

Call your dentist or your dental plan’s 24-hour toll-free phone number. The dental plan or dentist will see that you get immediate care, or schedule an appointment if it is not an emergency.

What if I do not choose a Dental Plan?

There is no default dental plan. If you fail to indicate which dental plan you wish to enroll in, you will not be automatically enrolled. Even if you did not chose a dental plan when you were sent your enrollment packet, you can choose one at any time by sending in the “Medi-Cal Dental Choice Form” (this can be found online), by calling Health Care Options at 1-800-430-4263, or by going into your DPSS office.


VISION BENEFITS

Is vision coverage available under Medi-Cal?

Limited vision services may be provided for beneficiaries with full-scope Medi-Cal.

What vision services are covered?

The services covered depend on your age. For adults over the age of 21, a routine eye exam once every 24 months is covered to check the health of the eyes and test for an eyeglass prescription.

Are eyeglasses covered under Medi-Cal?

Medi-Cal does not cover eyeglasses for adults over the age of 21. Eyeglasses are only covered for individuals under 21 years old and residents of a nursing home.

What other services are available?

Other services may be available under special circumstances, including contact lens testing if a disease or condition makes the use of glasses not possible, low vision testing for those that have an impairment that is not correctable by standard measures, or artificial eye services for those that have lost an eye or eyes to disease or injury.

How do I obtain care?

Vision services are provided through your managed care health plan. You should contact your managed care health plan to determine your vision services provider.

What if I do not know which managed care health plan I am enrolled in?

When you were approved for Medi-Cal you should have received an enrollment packet to choose a managed care health plan. If you did not return this enrollment packet then you were placed into a managed care health plan by default. You can call Health Care Options at 1-800-430-4263 to determine your managed care health plan and obtain the phone number to contact your plan.

Can I go to the Medi-Cal website to find a vision provider?

Only those enrolled in Medi-Cal, but not a managed care health plan, should use the Medi-Cal website to find a vision provider. If you receive vision services from a Medi-Cal vision provider while you are enrolled in a managed care health plan, then those services may not be covered. You should verify whether you are enrolled in Medi-Cal or a managed care health plan before obtaining services from a vision provider by calling Health Care Options at 1-800-430-4263.