Adult Immunizations
You can get adult immunizations (shots) from an in-network provider without pre-approval (prior authorization) when they are a preventive service.
L.A. Care covers shots recommended by the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) as preventive services, including immunizations (shots) you need when you travel.
You can also get some adult immunization (shots) services from a pharmacy through Medi-Cal Rx.
To learn more about the Medi-Cal Rx program, visit the Outpatient Prescription Drugs page in this handbook.
Allergy care
L.A. Care covers allergy testing and treatment, including allergy desensitization, hypo-sensitization, or immunotherapy.
Anesthesiologist services
L.A. Care covers anesthesia services that are medically necessary when you get outpatient care.
This may include anesthesia for dental procedures when provided by an anesthesiologist who may require pre-approval (prior authorization).
Chiropractic services
L.A. Care covers chiropractic services, limited to the treatment of the spine by manual manipulation.
Chiropractic services are limited to a maximum of 2 services per month. Limits do not apply to children under age 21. L.A. Care may pre-approve other services as medically necessary
These members qualify for chiropractic services:
- Children under age 21
- Pregnant people through the end of the month that includes 60-days after the end of a pregnancy
- Residents in a skilled nursing facility, intermediate care facility, or subacute care facility
- All members when services are provided at county hospital outpatient departments, outpatient clinics, Federally Qualified Health Center (FQHCs), or Rural Health Clinics (RHCs) in the L.A. Care’s network. Not all FQHCs, RHCs, or county hospitals offer outpatient chiropractic services.
Cognitive health assessments
L.A. Care covers a yearly cognitive health assessment for members 65 years old or older who do not otherwise qualify for a similar assessment as part of a yearly wellness visit under the Medicare program. A cognitive health assessment looks for signs of Alzheimer’s disease or dementia.
Community health worker services
L.A. Care covers community health worker (CHW) services for individuals when recommended by a doctor or other licensed practitioner to prevent disease, disability, and other health conditions or their progression; prolong life; and promote physical and mental health and efficiency. CHW services have no service location limits and members can receive services in settings, such as the emergency department.
Services may include:
- Health education and individual support or advocacy, including control and prevention of chronic or infectious diseases; behavioral, perinatal, and oral health conditions; and violence or injury prevention
- Health promotion and coaching, including goal setting and creating action plans to address disease prevention and management
- Health navigation, including providing information, training, and support to help get health care and community resources
- Screening and assessment services that help connect a member to services to improve their health.
CHW violence prevention services are available to members who meet any of the following circumstances as determined by a licensed practitioner:
- The member has been violently injured as a result of community violence.
- The member is at significant risk of experiencing violent injury as a result of community violence.
- The member has experienced chronic exposure to community violence. CHW violence prevention services are specific to community violence (e.g., gang violence).
CHW services can be provided to members for interpersonal/domestic violence through the other pathways with training/ experience specific to those needs.
Dialysis/hemodialysis services
L.A. Care covers dialysis treatments. L.A. Care also covers hemodialysis (chronic dialysis) services if your your doctor submits a request and L.A. Care approves it.
Medi-Cal coverage does not include:
- Comfort, convenience, or luxury equipment, supplies and features
- Non-medical items, such as generators or accessories to make home dialysis equipment portable for travel
Doula services
L.A. Care covers doula services provided by in-network doula providers during a member’s pregnancy; during labor and delivery, including stil birth, miscarriage, and abortion; and within one year of the end of a member’s pregnancy. Medi-Cal does not cover all doula services.
Doula providers are birth workers who provide health education, advocacy, and physical, emotional, and nonmedical support for pregnant and postpartum persons before, during, and after childbirth, including support during, stillbirth, miscarriage, and abortion.
As a preventive benefit, doula services require a written recommendation from a physician or other licensed practitioner of the healing arts within their scope of practice. DHCS issued a standing recommendation for doula services that fulfills the requirement for an initial recommendation. The initial recommendation for doula services includes the following authorizations:
- One initial visit
- Up to 8 additional visits that can be a mix of prenatal and postpartum visits
- Support during labor and delivery (including labor and delivery resulting in a stillbirth), abortion or miscarriage
- Up to 2 extended 3-hour postpartum visits after the end of a pregnancy
Members may receive up to nine additional postpartum visits with an additional written recommendation from a physician or other licensed practitioner.
L.A. Care must coordinate for out-of-network access to doula services for members if an in-network doula provider is not available.
Dyadic care services
L.A. Care covers medically necessary dyadic behavioral health (DBH) care services for members and their caregivers. A dyad is a child and their parents or caregivers. Dyadic care serves parents or caregivers and child together. It targets family well-being to support healthy child development and mental health.
Dyadic care services include:
- DBH well-child visits
- Dyadic comprehensive Community Supports services
- Dyadic psycho-educational services
- Dyadic parent or caregiver services
- Dyadic family training, and
- Counseling for child development, and maternal mental health services
Outpatient surgery
L.A. Care covers outpatient surgical procedures. For some procedures, you will need to get pre-approval (prior authorization) before getting those services. Diagnostic procedures and certain outpatient medical or dental procedures are considered elective. You must get pre-approval (prior authorization).
Physician services
L.A. Care covers physician services that are medically necessary.
Podiatry (foot) services
L.A. Care covers podiatry services as medically necessary for diagnosis and for medical, surgical, mechanical, manipulative, and electrical treatment of the human foot. This includes treatment for the ankle and for tendons connected to the foot. It also includes nonsurgical treatment of the muscles and tendons of the leg that controls the functions of the foot.
Treatment therapies
L.A. Care covers different treatment therapies, including:
- Chemotherapy
- Radiation therapy