Alex, you might have solved your problem by now, but my situation was even more complicated, so let me describe it in the hope that others may be helped. My adult daughter has a disability so she is covered by Medi-CAL and I am covered by Medicare, being over 65 and retired. So my daughter automatically became covered by Medicare when I turned 65. But Medicare only covers 80% of most things, while Medi-CAL pays 100%. Her Medi-CAL “medical” insurance is managed by Molina Healthcare. Both of us are Type 1 diabetics, even though she was adopted at age <1. We didn’t know she was disabled or would develop Type 1 diabetes when adopted, but God obviously knew what He was doing!
Before I was 65, my CIGMA medical insurance was covering my own Omnipod, Dexcom CGM and Freestyle test strips at 80%. Medi-CAL was covering Omnipods and Freestyle for her at 100%. My Omnipod coverage didn’t change post-65, since Medicare doesn’t cover it (yet), but test strips were now a prescription, not part of “durable medical equipment” anymore, therefore didn’t qualify for "out of pocket maximum.
Post-65 Dexcom coverage for me was first done through Liberty Medical, since they were the only supplier dealing with Medicare. Then Dexcom was ready to deal with Medicare. It took about 3 months (Dexcom actually covered me free a couple months), then finally Dexcom covered me through Medicare. PLUS, they billed my CIGNA secondary insurance for the other 20%.
The important thing is that Dexcom is a direct Medicare provider, so they will pay 80% of the cost for anyone that has Medicare. PLUS, they will bill secondary insurance for the remainder.
So my daughter is moving out of the house soon, so we wanted her to use a CGM to get better control, but when I called Dexcom, they at first said that she didn’t qualify, but that’s because Dexcom was trying to use Molina as the primary insurance when it is really the secondary and Medicare is primary. But when I informed Dexcom that she was covered under Medicare as primary, and Molina as secondary, everything was OK – they’ll get the 80% from Medicare and the 20% from Molina/Medi-CAL. Didn’t get her intro kit yet, but it should be soon.
A Molina representative told me that if she didn’t also have Medicare, Molina would have covered her at 100%, just as they are currently covering her Omnipods at 100%. There was also a lapse in her Omnipod coverage when Medicare started, but thankfully I had enough extra pods to get through.
So if you’re having issues getting Medi-CAL to cover something, it might be because Medicare is also involved.