DHCS issued an All Plan Letter clarifying how Medi-Cal plans should determine medical need for wheelchairs and applicable seating and positioning components. The criteria for medical necessity must include a medical evaluation of the beneficiary and review of the equipment to ensure that the beneficiary has appropriate mobility in or out of the home.
Medi-Cal covers medically necessary equipment when it is appropriate for use in or out of the patient’s home, regardless of whether the needed equipment will be used inside or outside of the home. DHCS APL 15-018 (7/9/15).