Benefits & services
With Santa Clara Family Health Plan's Medi-Cal Plan, your covered benefits and services include*:
- Chiropractic services
- Dental services provided by Medi-Cal Dental; call Medi-Cal Dental at 1-800-322-6384 (TTY: 711) or visit their website at denti-cal.ca.gov/
- Durable medical equipment (DME)
- Early and periodic screening, diagnosis, and treatment (EPSDT) services for infants, children, and youth under the age of 21
- Emergency services, including ambulance
- Hearing services
- Hospice and palliative care
- Hospital stay
- Incontinence creams and washes
- Laboratory and radiology services, such as x-rays
- Long-term services and supports (LTSS): long-term care, Community-Based Adult Services (CBAS), and Multipurpose Senior Services Program (MSSP)
- Maternity and newborn care
- Mental health services
- Outpatient (ambulatory) services
- Pediatric services
- Podiatry services
- Prescription drugs
- Preventive and wellness services, including chronic disease management
- Speech therapy
- Substance use disorder treatment services
- Transportation to medical appointments
- Non-emergency medical transportation (NEMT)
- Non-medical transportation (NMT)
- Vision services: routine eye exam and eyeglasses once every 24 months
*Restrictions and limitations may apply.
New for 2020
As of January 1, Medi-Cal has expanded to cover undocumented adults between 19 and 25 years of age. This means young adults can now sign up for Medi-Cal, regardless of their immigration status.
As of January 1, Medi-Cal has restored the following benefits for all adults. Prior authorization may be required.
- Acupuncture to prevent, modify, or alleviate the perception of severe, persistent chronic pain resulting from a generally recognized medical condition. Outpatient acupuncture services (with or without electric stimulation of needles) are limited to two services per month, in combination with audiology, chiropractic, occupational therapy and speech therapy services.
- Audiology (hearing) services. Outpatient audiology is limited to two services per month, in combination with acupuncture, chiropractic, occupational therapy and speech therapy services.
- Chiropractic services, limited to the treatment of the spine by manual manipulation. Chiropractic services are limited to two services per month in combination with acupuncture, audiology, occupational therapy and speech therapy services. The following members are eligible for chiropractic services:
- Children under age 21
- Pregnant women through the end of the month that includes 60-days following the end of a pregnancy
- Residents in a skilled nursing facility, intermediate care facility, or subacute care facility, or
- All members when services are provided at hospital outpatient departments, FQHC, or RHC
- Podiatry (foot) services, as medically necessary for diagnosis, and medical, surgical, mechanical, manipulative, and electrical treatment of the human foot, including the ankle and tendons that insert into the foot and the nonsurgical treatment of the muscles and tendons of the leg governing the functions of the foot.
- Occupational therapy services, including occupational therapy evaluation, treatment planning, treatment, instruction and consultative services. Occupational therapy services are limited to two services per month in combination with acupuncture, audiology, chiropractic and speech therapy services.
- Speech therapy that is medically necessary. Speech therapy services are limited to two services per month, in combination with acupuncture, audiology, chiropractic and occupational therapy.
- Vision services. The plan covers:
- Routine eye exam once every 24 months
- Eyeglasses (frames and lens) once every 24 months; contact lens when required for medical conditions such as aphakia, aniridia and keratoconus
See the Member Handbook in Forms & Documents for a complete list of covered services.
Unsure about what is covered? Call Customer Service at 1-800-260-2055 (TTY: 711).
Evaluation of New Technology
Each year, SCFHP looks for changes and advances in health care that may improve your care. We study new treatments, medicines, procedures, and devices. We refer to this as “new technology.”
To consider the use of any new technology, we look at related scientific reports and other information from the government and medical specialists. We also consider value, how well it works, and safety standards. After careful review, we then decide if the new technology should be covered as a health benefit. Members and providers may submit requests directly to SCFHP to review new technology. You can call Customer Service at 1-800-260-2055 (TTY: 711), Monday through Friday, 8:30 a.m. to 5 p.m.