What is the difference between Medi-Cal and Medicare coverage for DME (Durable Medical Equipment)?
Medi-Cal: Eligibility is determined by financial situation. DME is described as equipment prescribed by a physician that preserves bodily functions essential for acts of daily living. It is considered medically necessary for adults if the item protects life, prevents significant illness, or alleviates severe pain. If an item is not on the excluded/included list of DME, then the professional filling out the TAR can refer back to the definition of DME and justify the equipment within the terms of the definition. Medi-Cal is open to this procedure as long as item is not on excluded list. Therefore, Medi-Cal is less restrictive on what it will provide versus Medicare. Also, oftentimes Medi-Cal will miss the date for TAR to be approved/denied. If this occurs, then the equipment is automatically approved, under federal law. Types of AT covered by Medi-Cal include Prosthetics/orthotics, AAC devices, wheelchairs, and hearing aids. There are many limitations on Medi-Cal coverage of AT items. An
