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  California Medicaid (Medi-Cal)

email: reimburse@cochlear.org




Medi-Cal is the name for the California Medicaid program, the largest in the nation with well over 6 million Medicaid beneficiaries.

Prior to the Federal coverage directive obtained by Mark Hobratschk of Cochlear Corporation in 1994, Medi-Cal did not provide cochlear implant benefits for either adults or children.

However, both Mr. Hobratschk and Joanne Syrja, his counterpart at Advanced Bionics Corporation successfully engaged in an unprecedented cooperative advocacy effort between the two companies. After a series of meetings during 1995 with the Medi-Cal Advisory Committee on Cochlear Implants, a Medi-Cal coverage policy was implemented for both postlingual adults and children (pre and perilingual candidates remain non-covered).

Medi-Cal uses a "centers of excellence" concept to limit the number of providers in both northern and southern regions of California that can be reimbursed by Medicaid for cochlear implant services.

Medi-Cal payment is fairly good in comparison to Medicare and other State Medicaid programs. The agency reimburses providers for the full acquisition cost of the device system from the manufacturer, or currently roughly $22,000-$25,000. In addition, it covers the related surgical costs.

Speech processor programming and aural rehabilitation is covered in six-month increments. Payment is "by report" or on a case-by-case basis. Unlike Medicare, the Medi-Cal program defines programming and aural rehabilitation as an audiological service.

Inpatient cochlear implant surgeries are rarely approved by Medi-Cal. Implantantation of a second cochlear implant device in the contralateral ear is not reimbursable.