This program is administered
by the Department of Health Care Services (DHCS).
Welcome to MCAP
To have a healthy baby — One of the best things you can do is see a doctor early and often.
What is MCAP?
MCAP provides pregnant women with comprehensive coverage for a low cost with no copayments or deductibles for its covered services. Their newborns may be covered by the Medi-Cal Access Infant Program. MCAP is for middle-income families who do not have health insurance and whose income is too high for no-cost Medi-Cal. MCAP is also available to women who have other health insurance plans that doesn't cover maternity services or with a maternity-only deductible or copayment greater than $500. You can read more about Coordination of Benefits between your other health insurance plan and the MCAP health plan in the Glossary of Terms. If you are enrolled in MCAP, your baby has eligibility for coverage in the Medi-Cal Access Infant Program for up to two years, unless your baby is enrolled in employer sponsored insurance or no-cost Medi-Cal or your income no longer qualifies on your infant’s first birthday.
Services available for your baby through the DHCS Medi-Cal Managed Care Delivery System
Medi-Cal currently provides a core set of health benefits, including doctor visits, hospital care, immunization, pregnancy-related services and nursing home care, if medically necessary. For a majority of enrollees, Medi-Cal provides covered services through the managed care delivery system in all 58 counties, although services may be accessed on a fee-for-service basis.
The Affordable Care Act (ACA) ensures all Medi-Cal health plans offer a comprehensive package of services, known as Essential Health Benefits (EHB). The ten EHBs include the following categories of services: Ambulatory Patient Services; Emergency Services; Hospitalization; Maternity and Newborn Care; Mental Health and Substance Use Disorder Services including Behavioral Health Treatment, Prescription Drugs; Rehabilitative and Habilitative Services and Devices; Laboratory Services; Preventive and Wellness Services & Chronic Disease Management and Pediatric Services (including oral and vision care). Medi-Cal currently meets the requirements to cover all of the ten EHBs.
Beginning in 2014, all enrolled individuals, those already on Medi-Cal as well as newly eligible adults, may receive an expanded array of mental health and substance use disorder services. The following mental health benefits will be available through Medi-Cal managed care plans or the fee-for-service delivery system: Individual and group mental health evaluation and treatment (psychotherapy); Psychological testing when clinically indicated to evaluate a mental health condition; Outpatient services for the purposes of monitoring drug therapy; Outpatient laboratory, drugs, supplies and supplements; Psychiatric consultation; Specialty mental health services currently provided by County Mental Health Plans will continue to be available.
The following substance use disorder services will also be made available to eligible Medi-Cal beneficiaries: Voluntary Inpatient Detoxification; Intensive Outpatient Treatment Services; Residential Treatment Services; Outpatient Drug Free Services and Narcotic Treatment Services. Dental care and vision services are available with some limitation. Dental services will become available to all adults starting May, 2014.