Medi-Cal and Medi-Cal Managed Care (MCP) Updates
Doula Services Now Covered
Beginning January 1, 2023, doula services are covered by MCPs. 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. Doulas are not licensed and they do not require supervision.
To learn more about eligibility requirements and covered doula services, refer to the Department of Health Care Services (DHCS) All Plan Letter (APL) 22-031.
Biomarker Testing for Stage 3 or 4 Cancer
Effective July 1, 2022, MCPs are required to cover medically necessary biomarker testing for members with:
• Advanced or metastatic stage 3 or 4 cancer.
• Cancer progression or recurrence in the member with advanced or metastatic stage 3 or 4 cancer.
MCPs cannot require prior authorization for biomarker testing that is associated with a federal Food and Drug Administration (FDA)-approved therapy for advanced or metastatic stage 3 or 4 cancer. If the biomarker test is not associated with an FDA-approved cancer therapy for advanced or metastatic stage 3 or 4 cancer, MCPs may still require prior authorization for such testing. For more details, refer to DHCS, All Plan Letter (APL) 22-010.
Home COVID Testing Kits Are Covered
Effective February 1, 2022, health plans are required to provide self-administered (at-home) COVID testing kits at no cost to its members. Up to 8 kits per month (every 30 days) per member. In general, these kits are provided through the member's pharmacy benefits (dispensed at a pharmacy) and not purchased at a store. To learn more, refer to DHCS document titled, Medi-Cal Rx Coverage of Over-the-Counter COVID-19 Antigen Test Kits.