I qualified for medi-cal last month and the lowest level on income. Basically I won't have a copay, from my understanding.

I have not had any kind of health insurance for at least 15 years. I have been self medicating for three years. I have my first appointment next month at a Los Angeles transgender care center.

My question is..   do you know what kind of care is covered under medi-cal? Is HRT prescriptions covered? What about "cosmetic" things, like electrolysis?

Really, I am just going in to get checked out and to get under a doctor's supervision for my HRT, but I have no idea how medi-cal works. For instance, they sent me a package and said I have to choose a provider???  I though medi-cal was the insurance provider?

Anyone with ANY experience with medi-cal who is willing to educate me would be greatly appreciated!

Well I did figure out a few things.

First of all there are three choices I have for Medi-Cal in Los Angeles county. I can choose to be on straight Med-Cal, OR choose between two "group" managed plans under Medi-Cal. The two pans are Health Net and L.A. Care. I chose L.A. Care.

All of the plans cover prescription medication either free or for one dollar per prescription.

Generally, if you choose one of the managed plans you'll have to pick a primary physician listed by that plan, but they will manage your care. Straight Med-Cal means you have to find your own doctors who accept Medi-Cal.

All of the Medi-Cal options will cover SRS (is that term politically incorrect these days?) if it is deemed a medical necessity. They are required to give an answer within 30 days and you can despite any ruling before a panel/judge.
HRT will most certainly be easily covered. SRS will more than likely be covered, though they will try to not pay it initially I think.

Coverage for cosmetic surgeries are iffy. Things like electrolysy and FFS may be tough to get, but not out of the realm of possibilities.

One problem I've read about is finding a surgeon who is well qualified and experienced that will take what Medi-Cal is willing to pay. I've also read that that issue has changed recently with the addition of the managed health care plans under Medi-Cal.

I would still LOVE any advice from anyone who had ANY experience in dealing with ANY transsexual care through Medi-Cal. I'll also update this thread as I move forward and I'll use it to relate my experiences in the hope that it might be of some benefit to others.

Like I said, right now my primary focus will be to just get basic care and a legitimate HRT prescription, as well as being tested for hormone levels, etc. I figure once I start to see and interact with doctors, I'll be able to learn a lot more about what other options I have for related issues, like electrolysis.

I'm on Medi-Cal in LA too and they are making great strides to get things covered. As of now I got my bottom electrolysis covered and have 5 sessions under my belt. (Pain numbing injections though are out of pocket)
I talked with a case manager and she is sending the letters to hopefully get my facial electrolysis covered very soon too.

I have a surgeon here in LA who accepts Medi-Cal who will do my SRS. Dr. Sinclair in Beverley hills.

My hormones are free and Medi-Cal is getting better as time goes on. Two years ago they wouldn't cover SRS or hair removal, but right now my therapists, case managers and doctors are working with the insurers to get more things covered. hopefully that will include FFS too. A lot of it is letter writing, saying the right things, waiting, and more painful waiting.

But trans care here in LA is getting a lot better IMO.

Quote from: Trini on October 30, 2017, 09:11:36 PM
I'm on Medi-Cal in LA too and they are making great strides to get things covered. As of now I got my bottom electrolysis covered and have 5 sessions under my belt. (Pain numbing injections though are out of pocket)
I talked with a case manager and she is sending the letters to hopefully get my facial electrolysis covered very soon too.

I have a surgeon here in LA who accepts Medi-Cal who will do my SRS. Dr. Sinclair in Beverley hills.

My hormones are free and Medi-Cal is getting better as time goes on. Two years ago they wouldn't cover SRS or hair removal, but right now my therapists, case managers and doctors are working with the insurers to get more things covered. hopefully that will include FFS too. A lot of it is letter writing, saying the right things, waiting, and more painful waiting.

But trans care here in LA is getting a lot better IMO.

Wow! Thank you SO much for responding, Trini!

I am completely new to all of this and only have me first doctor appointment in two weeks. I have so many questions... and I would be ever so grateful if you would answer a few.

I guess I'll find out from my doctor, since he's a trans care specialist, but I was wondering if I'll be required to go to therapists in order to get anything covered? I've been on full HRT for three years, and my immediate goal is just to get my bloodwork done and to get a legit prescription for the HRT.

I guess after that I'd like to see about getting facial electrolysis. I've been very lucky in that I don't have any hair on my body, except for my head, face and normal female-type arm fuzz.I don't even have hair on my legs, lol.

Then FFS. That's the biggest thing holding me back. I could even live without anything else...  my body developed very well. My damn face is the deal breaker in my mind.

To get any kind of surgery, you have to get two letters of recommendation from two therapists and your primary care doctor dealing with your HRT. You also need to attend two therapy sessions to get those surgery therapist letters.

I got mine for SRS two years ago and atm they are revamping the letters to include FFS.

Getting HRT isn't a problem as long as you're in some good health. More waiting tho.

FFS is tricky since it's new ground to get it covered. I'm getting mine in Spain where insurance won't cover it and i need to save for it, but as far as getting SRS and hair removal taken care of, you're in a good spot living in California. Just a lot of waiting.

So the therapy letters can be given after one therapy session for each letter? That's good to know! I thought I was going to have to be in constant therapy.

Thank you so much, Trini!

I attended two two hour sessions in consecutive Thursdays to get the letters.
You cannot miss any of the two meetings. You have to go to both.

Sorry if I have too many basic questions. I hope I'm not bugging too much.

In the therapy sessions, do you feel like you have to go in prepared to give the "standard" answers in order to get those letters? What's it like? I realize they're all going to be different. What was it like for you?
I'm wondering if it helps at all that I'm been on full HRT for 3 years. The bad part is that I'm not living full time. So they want to make you live full time for a year still?

I dunno about living fulltime. I think you do need to when having the surgery consult.

As far as therapist letter sessions go, you just show up and they teach you about risks, what you're getting yourself into, after care etc. It's not a quiz or test