How do I prove to Regional Center that Medi-Cal won't cover something?

Since Regional Center is the payor of last resort, you will often be asked to prove that Medi-Cal won't fund a service or supply before Regional Center will agree to fund it.

The easiest thing to do is to go to the Medi-Cal website to find details of what is and isn’t covered. If Medi-Cal won’t cover the service at all, you can show that exclusion to your Regional Center service coordinator. However, if it's about wanting to use a specific provider for your child, not an uncovered service, you need to prove that there are no Medi-Cal providers in your area that are appropriate. If you can, you have a chance of getting Regional Center to cover it. "Lack of access to care" is a good phrase when asking Regional Center to fund something Medi-Cal won't. When Regional Center asks to see a denial for diapers specifically, you can tell them, “Your nurse at the Regional Center can verify for you that it is not a covered benefit.”

For more information, see our article 4 Tips for Funding Your Child's Medical and Therapeutic Needs.