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What are essential health benefits?

On Behalf of | Nov 19, 2023 | Medi-Cal and Long Term Care Planning

The Medi-Cal program provides benefits to those who are eligible, focusing on providing low-cost health coverage or free coverage. Essentially, this is a way for those in difficult financial situations – such as those in low-income households or pregnant women who have families they need to support – can get the coverage that they need. It can help to provide essential health benefits for them.

But what are essential health benefits? What exactly is going to be covered? It stands to reason that there could be disagreements between individuals over what is and is not essential, so this is an important distinction to make.

Examples of essential services

Exactly what will be covered in everyone’s case is unique, so the following are just examples of some essential health benefits that may be provided. This helps to show how the Medi-Cal program is set up. These services could include:

  1. Emergency services. 
  2. Outpatient services. 
  3. Hospitalization. 
  4. Ambulatory services. 
  5. Newborn care. 
  6. Maternity services. 
  7. Behavioral health treatment. 
  8. Substance use disorder services. 
  9. Mental health services. 
  10. Access to prescription drugs. 
  11. Pediatric services, which include vision and oral care. 
  12. Wellness services. 
  13. Chronic disease management. 
  14. Preventative services. 
  15. Laboratory services. 
  16. Physical therapy and occupational therapy.

Once again, these are not necessarily all of the services that could be covered, but they do help to show you how the program can provide access to services that may otherwise be out of reach financially – but which can have a very big impact on someone’s life and on their family. Those who are interested in using this program need to be sure that they understand all of the legal steps they need to take and the options they have.