Medi-Cal acupuncture coverage: no copay, 12 visits per year, and how to use your benefit

Medi-Cal covers acupuncture with no copay for most eligible members -- a benefit that was restored in 2020 and has been in effect ever since. If you have Medi-Cal in California, you can receive acupuncture treatment at Nature Acupuncture & Herbs at all three of our Los Angeles locations without paying anything out of pocket at the time of service.

Here is a plain-language breakdown of how the Medi-Cal acupuncture benefit works, who qualifies, and what the visit limits look like.

When did Medi-Cal start covering acupuncture?

Acupuncture was cut from Medi-Cal as a covered benefit in 2009 during state budget cuts. In 2020, SB 1246 was signed into law, restoring acupuncture coverage for Medi-Cal beneficiaries across California. The benefit has been active since January 1, 2021 and applies to both fee-for-service Medi-Cal and Medi-Cal managed care plans.

The restoration was part of a broader effort to expand access to alternative and integrative medicine for Medi-Cal members, particularly for pain management as an alternative to opioid prescribing.

Who qualifies for Medi-Cal acupuncture coverage?

Any California resident enrolled in Medi-Cal with an active Medi-Cal ID is eligible for the acupuncture benefit. Medi-Cal eligibility is primarily income-based -- adults earning up to 138% of the federal poverty level qualify for full-scope Medi-Cal in California.

Since 2024, Medi-Cal for All has extended full-scope Medi-Cal to all income-eligible California residents regardless of immigration status. Acupuncture is included as a covered benefit under Medi-Cal for All on the same terms as standard Medi-Cal.

How many acupuncture visits does Medi-Cal cover?

Medi-Cal covers up to 12 acupuncture visits per calendar year as a baseline benefit. Additional visits beyond 12 are available with a documented medical necessity authorization. If your condition requires ongoing treatment, your acupuncturist can request extended visits through the standard Medi-Cal prior authorization process.

Visits reset annually on January 1. There is no cost-sharing requirement -- no copay, no deductible, no coinsurance -- for Medi-Cal acupuncture visits at participating in-network providers.

Medi-Cal managed care and acupuncture in Los Angeles

Most Medi-Cal beneficiaries in Los Angeles County are enrolled in a Medi-Cal managed care plan rather than fee-for-service Medi-Cal. The major managed care plans in LA County -- LA Care Health Plan, Blue Shield Promise Health Plan, Health Net Community Solutions, Molina Healthcare of California, and Anthem Blue Cross -- all cover acupuncture under the Medi-Cal benefit guidelines.

If you are enrolled in a Medi-Cal managed care plan, acupuncture coverage is included and administered through your plan. Some managed care plans may require that you see a provider within their specific network, so it is worth confirming that Nature Acupuncture & Herbs participates in your specific managed care plan when you call to schedule.

What conditions does Medi-Cal cover?

The Medi-Cal acupuncture benefit is available for a broad range of medically indicated conditions. Chronic pain -- including back and neck pain, headaches, arthritis, and joint pain -- is the most commonly treated category. The benefit is not limited to pain conditions; acupuncture for nausea, insomnia, anxiety, and fertility-related conditions is also covered when medically indicated under your provider's clinical judgment.

Cosmetic acupuncture is not a covered Medi-Cal benefit. Herbal medicine is also excluded from Medi-Cal coverage and is billed separately.

How to use your Medi-Cal acupuncture benefit

Bring your Medi-Cal ID card or Benefits Identification Card (BIC) to your appointment. If you are enrolled in a managed care plan, bring that card as well. Our billing team handles Medi-Cal billing directly -- there is no paperwork for you to complete beyond standard intake forms.

We accept Medi-Cal at our West LA clinic (11901 Santa Monica Blvd, STE 209), our Hawthorne clinic (11633 Hawthorne Blvd, STE 402), and our Lynwood clinic (3680 E Imperial Hwy, STE 460). To confirm coverage and schedule an appointment, call (424) 317-0014 or submit your information through the insurance form at natureac.com.