Medi-Cal is California’s version of the federal Medicaid program, providing no-cost or low-cost health coverage to eligible low-income residents. Dermatology coverage is strictly limited to services deemed “medically necessary,” focusing on the diagnosis and treatment of diseases, infections, and conditions that negatively impact health. Services performed for purely cosmetic reasons or to improve appearance are not covered.
Medically Necessary Dermatology Coverage
Medi-Cal covers dermatological services necessary to protect health or restore function. This focuses on treating active diseases or conditions that, if left untreated, could compromise overall health. This includes the diagnosis, screening, and treatment of skin cancer, such as Mohs surgery.
Coverage extends to serious inflammatory conditions, including severe psoriasis, chronic eczema, and other blistering skin diseases. For acne, coverage is provided when the condition is severe or requires systemic treatment, such as oral medications, to prevent permanent scarring. Treatment of skin infections and serious rashes also falls under medically necessary care.
The standard for coverage is whether the treatment is required to diagnose or treat a medical condition. Procedures like biopsies, necessary for sample collection and diagnosis confirmation, are covered benefits. Tele-dermatology consultations are also an approved benefit, helping improve access to care.
How to Access Medi-Cal Dermatology Services
Accessing a dermatologist involves specific administrative steps, as dermatology is a specialty service. Most beneficiaries are enrolled in a Medi-Cal managed care plan, which requires the member to first consult their assigned Primary Care Physician (PCP).
The PCP acts as a gatekeeper and must issue a referral before the patient can schedule a specialist appointment. This process ensures specialty visits are medically appropriate and coordinated. A common challenge is finding a dermatologist within the specific Medi-Cal plan’s network who is accepting new patients.
For certain services or medications, Medi-Cal may require a Prior Authorization (PA). This is a request submitted by the provider for approval before rendering the service. The provider must submit clinical documentation demonstrating medical necessity, and approval can take several business days.
Procedures and Treatments Not Covered
Medi-Cal explicitly excludes treatments and procedures that are purely cosmetic or intended solely to improve appearance. These elective services are not considered medically necessary and must be paid for out-of-pocket. Excluded procedures include elective wrinkle removal, non-medical tattoo removal, and treatments for age spots or unwanted facial veins.
Common aesthetic procedures such as Botox injections, chemical peels, microdermabrasion, and laser hair removal are not covered. The program also excludes experimental or unproven treatments. Even the removal of benign, non-cancerous growths, like seborrheic keratoses, may not be covered unless they are bleeding, infected, or interfere with daily bodily function.