Getting a power wheelchair when you have medical conditions that limit your mobility can be life-changing. 

However, wheelchairs are expensive. Most people in need of a wheelchair can't afford one on their own, so they rely on medical insurance to help out. 

In this informational guide, we're covering whether Medi-Cal pays for wheelchairs. 

The short answer is yes. 

The long answer? You'll need to work with a doctor who can show a wheelchair is medically necessary for you to go about your daily life. 

Here's how Medi-Cal wheelchair coverage works in California. 

Does Medi-Cal Cover Wheelchairs in California? 

In California, Medi-Cal (also known as "Medicaid" in other states) covers durable medical equipment, which includes manual wheelchairs and power wheelchairs. (Medicaid coverage for wheelchairs varies by state.)

The majority of the cost of a wheelchair should be covered by Medi-Cal as long as the user has a medical condition causing significant mobility problems, which we explain more in depth below. 

Does Medi-Cal Cover Wheelchairs? 

Yes, Medi-Cal will help cover the cost of a wheelchair if it's medically necessary. 

Each state has different laws and coverage for medical equipment; Medi-Cal is California's version of Medicaid. 

What Makes a Wheelchair Medically Necessary? 

A wheelchair is medically necessary if a person has a medical condition that affects their mobility so severely it's difficult for them to go about their daily life. 

Medi-Cal has two definitions for mobility-related activities: 

  • Activities of Daily Living (ADL) - These activities are related to daily living, such as using the bathroom, getting dressed, bathing, eating, walking, or navigating in or out of the home. 

  • Instrumental Activities of Daily Living (IADL) - These activities refer to anything that helps someone live independently, such as cooking food, cleaning the house, taking medications, using a phone, and accessing transportation.  

If your medical condition affects your ability to perform ADL or IADL, you may be eligible for a wheelchair covered by Medi-Cal.  

Manual Wheelchairs 

You may be eligible for a manual wheelchair covered by Medi-Cal if you have enough upper body strength and function to propel a manual wheelchair. 

The type of manual wheelchair you might qualify for depends on your strength and endurance limitations, range of motion, and the environment you'll be using the wheelchair. There are many different types of manual wheelchairs, from ultra-lightweight to heavy-duty.  

Electric Wheelchairs 

Eligibility for an electric wheelchair depends on whether your medical condition allows you to operate a manual wheelchair and how easily an electric wheelchair would fit into your regular life. 

For example, someone will need to visit your home to determine what type of wheelchair could easily maneuver around your home if the chair would be used frequently. An experienced complex rehab equipment expert will build a custom power wheelchair solution for you, ensuring the chair is comfortable, easy for you to maneuver, and fits your medical needs. 

The Process of Getting a Wheelchair Through Medi-Cal 

Obtaining a wheelchair through Medi-Cal isn't straightforward. You'll need the help of your doctor, a durable medical equipment provider, and Medicaid. 

We've detailed the process for getting a wheelchair covered by insurance, which involves the following: 

  • Finding a medical equipment supplier who can help you through the insurance qualification process 

  • Verifying your insurance eligibility

  • Getting a prescription from your doctor

  • In-home evaluation 

  • Insurance authorization 

How Often Will Medi-Cal Pay for a Wheelchair?

In general, wheelchairs are only approved by Medi-Cal about once every five years. The frequency you need a new wheelchair can sometimes be open to interpretation. 

If any of your medical conditions change enough to warrant a different wheelchair, you might get approved for one sooner. For example, if you have a manual wheelchair but need a power wheelchair due to changes in your medical condition, you might get a replacement chair sooner. 

When Does Medi-Cal NOT Pay for a Wheelchair? 

Medi-Cal won't cover the cost of a wheelchair if: 

  • The wheelchair is not medically necessary 

  • The wheelchair won't be used by the beneficiary (or person who has Medi-Cal) 

  • The wheelchair will be used for convenience

  • The beneficiary wants to use it as a replacement for transportation, such as a car, bus, or taxi 

  • It isn't prescribed by a licensed practitioner 

  • The wheelchair will be used in a facility that is expected to provide these items  

Do You Need Help Getting a Medi-Cal-Approved Wheelchair? 

If you live in the state of California and need assistance obtaining a Medi-Cal-approved wheelchair, we can help! We service the entire state and have a team of complex rehab technology experts ready to get you through the process of obtaining a wheelchair! 

See if you qualify today, or contact us for a consultation!