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How to Use Medi-Cal as Secondary Insurance

How to Use Medi-Cal as Secondary Insurance

Published: Jul. 15, 2022Updated: Aug. 29, 2023

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Families who already have health insurance coverage for their child can still benefit from Medi-Cal (California’s Medicaid program), which may be used as secondary insurance to pay for certain expenses that primary health insurance doesn’t cover. Medi-Cal may also fund medical supplies, such as diapers and G-tube formula, and durable medical equipment (DME). You can see a list of commonly covered services in our Medi-Cal glossary.

Whether your child qualifies for Medi-Cal based on the waiver program or based on your household income, here’s what you need to know about Medi-Cal as secondary coverage.

Medi-Cal Enrollment

Most new enrollees are required to select a Medi-Cal managed care plan regardless of whether or not they have private primary insurance.. In Los Angeles County, these include HealthNet or LA Care and its contracted programs, including Anthem Blue Cross and Blue Shield of California Promise Health Plan. Kaiser may be available on a limited basis, generally only to current and recent Kaiser patients. Available plans vary depending on your county. If you do not select a plan, you will be assigned to one.

There are some great online resources to help you choose the right managed care plan as your child’s sole insurance coverage. You can use the California Department of Health Care Services (DHCS) to:

  • Compare up to three health care or dental plans.
  • Find information on standard benefits, pharmacies, urgent care centers, and more.
  • Search for a specific provider or hospital to see if they accept a Medi-Cal managed care plan.
  • Get contact information for each provider.

You can also see our article on how to prepare and choose a plan.

Note: Very few recipients will remain on fee-for-service, aka “straight,” Medi-Cal. Such limited exceptions include recipients with a Share of Cost, recipients on a limited-scope Medi-Cal plan, people who receive medical exemptions (not available for those with private health coverage), and some children in the state’s foster child program, depending on their county.

How to use Medi-Cal to cover copays and deductibles

If a child has multiple insurance plans, Medi-Cal is always the payer of last resort — in other words, the last provider to be billed. The child’s private insurance bears the primary responsibility for health care coverage. Any other secondary private insurance must be billed before Medi-Cal will cover the service. The provider must contract with both the private insurance and the Medi-Cal managed care plan.

If there are remaining costs or copayments after the primary insurance pays its share, Medi-Cal can be billed for the amount not covered by the primary insurance, up to the Medi-Cal reimbursable rate, as long as the provider is contracted with the specific form of Medi-Cal that the child receives. In practice, this will look like presenting your primary insurance card along with your Medi-Cal card to a provider and asking them to bill Medi-Cal after the private insurance pays its portion.

Note that “balance billing” — the practice of charging a patient for the difference between the Medi-Cal reimbursement rate and the customary charge for a service — is prohibited for Medi-Cal-covered treatments. For example, if a provider charges a certain rate for a therapy, and the private insurance pays its portion and then Medi-Cal pays the remainder of the bill up to the contracted Medi-Cal rate, the provider cannot bill the patient for any amount left over after Medi-Cal pays its share. However, the patient will still be responsible for any services and procedures that are not covered by Medi-Cal.

Because Medi-Cal supports your primary insurance (including vision and dental insurance) and does not override it, you should first make sure your physician, facility, or service accepts your primary insurance. Then, you can ask if they contract with your Medi-Cal managed care plan. If they do, they can bill your primary insurance before billing the amount not covered to Medi-Cal.

By following these instructions, you may be able to get a service like occupational, physical, speech, or ABA therapy entirely covered by first using your primary insurance and then using Medi-Cal to pay for the rest. As always, there are some exceptions, as Director of Health Plan Advocacy Leslie Lobel explains in this clip.

If a provider doesn’t accept Medi-Cal, Regional Center clients who qualify may be able to get copayment assistance through Regional Center.

How to handle treatment authorization requests

Some medical services provided by Medi-Cal require a treatment authorization request (TAR) beforehand. Ask your provider whether a service will need a TAR and how long the authorization process could take. (If you have a TAR number from your provider, you can find the status on the state website). This can save you time and frustration in the future.

Your provider can use a TAR form to request authorization and receive payment for services like physical therapy, DME, and speech therapy. If your service provider accepts your Medi-Cal plan, they should already know when and how to submit a TAR. Although a provider will typically request a TAR before providing the service, there are some exceptions, such as for acute hospital stays. In these cases, a TAR will need to be submitted and approved retroactively.

Using Medi-Cal to cover services and supplies denied by private insurance

For services or supplies that aren’t completely covered by your primary insurance, you will need a written denial of coverage from your primary insurance as well as a prescription or order from your doctor showing that the service, medication, or supplies are medically necessary.

Example: A child requires a medically necessary piece of durable medical equipment that is excluded by the primary insurer. The parents should request a written denial. Once the written denial is received, parents can approach a DME company contracted with the Medi-Cal managed care plan and present the doctor’s prescription, a copy of the written denial, and their benefits ID card (BIC).

To get Medi-Cal to pay for consumables like incontinence supplies for children over the age of 3, you’ll follow the same process: obtain a written denial from your primary insurer and a prescription from your physician. In this clip, Leslie Lobel and Public Benefits Specialist Lisa Concoff Kronbeck explain what should be in a prescription from your doctor to get the supplies covered by Medi-Cal:

Check out our guide to insurance claim denials and appeals for more information.



Medi-Cal Enrollment

How to use Medi-Cal to cover copays and deductibles

How to handle treatment authorization requests

Using Medi-Cal to cover services and supplies denied by private insurance

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Related Parent Questions

Do I need a Medi-Cal managed care plan?
On January 1, 2022, a program called CalAIM went into effect. Among other things, the program is designed to streamline the delivery of Medi-Cal services in the community. Going forward, only those with medical exemptions will be eligible to remain under fee-for-service Medi-Cal.
Is my child eligible for the Medi-Cal institutional deeming waiver?
To be eligible for the HCBS-DD waiver, a Regional Center client under the age of 18 must live at home with their family, be ineligible for Medi-Cal due to family income, be diagnosed with a developmental disability, and receive at least one funded Regional Center service each year.
What does Medi-Cal cover?
Medi-Cal can pay for health care costs, In-Home Supportive Services (IHSS), vision and dental care, and a number of Regional Center services, including respite, behavioral supports, and other therapies and programs.


Brittany OlsenUndivided Editor

An editor and cartoonist who loves using words and images to simplify and share ideas. She has ten years of experience as a copy editor and lives near Portland, Oregon. She often spends her free time going on nature walks with her dog or trying new bread recipes.

Reviewed by

Jennifer Drew, Undivided Senior Editor


Lisa Concoff Kronbeck, Undivided Public Benfits Specialist
Lisa Concoff Kronbeck, Undivided Public Benefits Specialist

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