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California guide · Under 21 with Medi-Cal

Using Medi-Cal for a Child Evaluation in California

Children and teens under 21 with full-scope Medi-Cal are covered for medically necessary screening, diagnostic, and treatment services under EPSDT. Here's how that applies to developmental, autism, and ADHD evaluations.

Written by the ChildEvaluation editorial team. Sources checked October 16, 2026. Editorial policy · Clinical standards

What Medi-Cal covers for children

Medi-Cal's Early and Periodic Screening, Diagnostic, and Treatment benefit (EPSDT, also called Medi-Cal for Kids and Teens) covers children and young adults under 21 with full-scope Medi-Cal. It includes regular screenings, diagnostic services to fully evaluate a condition found through screening, and medically necessary treatment, at no cost to the family.

Medi-Cal also covers medically necessary behavioral health treatment, including applied behavior analysis (ABA), for members under 21. A licensed physician or psychologist has to determine that it's medically necessary, and any health care provider can make the referral for that evaluation.

How to get an evaluation through Medi-Cal

  1. 1

    Start with your child's doctor

    Tell the pediatrician exactly what you're noticing. Developmental and autism screening at well-child visits is part of the benefit, and a positive screen or a parent concern can lead to a referral.

  2. 2

    Call your health plan

    Most Medi-Cal children are in a managed care plan. The member services number on the back of the card can tell you which in-network psychologists or developmental specialists do evaluations, and whether a referral or authorization is needed.

  3. 3

    Ask about the wait and the scope

    Ask whether the provider does a full evaluation or a shorter diagnostic visit, and what the report will include. Our guide to testing versus consultation explains the difference.

  4. 4

    Keep using the free public routes

    Regional center and school assessments don't use your Medi-Cal and can happen at the same time.

Testing for school only

Health plans cover evaluations to diagnose or treat a health condition. Testing that's only about school placement or accommodations is usually the district's responsibility, and the district assesses for free.

If a request is denied

Ask the plan for the denial in writing, including the criteria it used. You can file an appeal with the plan, and after that request a State Hearing. Plans must decide coverage case by case; blanket limits on behavioral health treatment hours aren't allowed.

Sources

  1. California Department of Health Care Services: EPSDT for members under 21
  2. California Department of Health Care Services: Behavioral Health Treatment
General information, not legal or medical advice

Laws and program details change. Check with the agency named on this page, and talk to a qualified professional about your child. Spotted something out of date? Email hello@childevaluation.com.

Related California guides

  • Autism insurance law (SB 946)California requires state-regulated health plans to cover behavioral health treatment for autism, and to cover medically necessary mental health care on the same terms as other medical care. Here's what that means for getting an evaluation covered.
  • Testing vs. consultationSome evaluations are a few hours of interviews and observation; others include a day of standardized testing and a long report. Here's how they differ and which questions each can answer.
  • While you waitPrivate evaluation waitlists in the Bay Area can run for months. Free public routes have legal timelines, and much of what helps a child doesn't require a diagnosis.