Adult Immunizations
You can get adult immunizations (shots) from an in-network provider without pre-approval (prior authorization).
L.A. Care covers shots recommended by the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC), including shots you need when you travel.
You can also get some adult immunization (shots) services in 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, that 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 two services per month, or combination of 2 services per month from the following services: acupuncture, audiology, occupational therapy, and speech therapy. 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.
Services may include:
- Health education and training, including control and prevention of chronic or infectious diseases; behavioral, perinatal and oral health conditions; and injury prevention
- Health promotion and coaching, including goal setting and creating action plans to address disease prevention and management
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 for members who are pregnant or were pregnant in the past year when recommended by a physician or licensed practitioner. Medi-Cal does not cover all doula services.
Doulas are birth workers who provide health education, advocacy, and physical, emotional, and non-medical support for pregnant and postpartum persons before, during, and after childbirth, including support during miscarriage, stillbirth, and abortion.
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