Medi-Cal Managed Care in California
Medi-Cal is health care for people with low or no incomes. Some people who have Medi-Cal are in a Medi-Cal managed care plan. These plans have networks of providers, including doctors, pharmacies, clinics, labs, and hospitals. You must use the providers in your network when you need health care. These Medi-Cal plans also have interpreter services for members with limited English-speaking skills.
You will have one doctor or clinic that you go to first for most of your health care. The health plan may choose a doctor or clinic for you when you join the plan. You can change your doctor or clinic if you want. Call your plan and ask for a list of doctors and clinics.
Medi-Cal Benefits
Medi-Cal covers the Basic Benefits that all health plans cover. Medi-Cal also covers prescription drugs, vision care, and hearing care.
If You Have a Complaint
- You can call the Medi-Cal Managed Care Ombudsman at 1-888-452-8609.
- You can also file a complaint with your health plan.
- You can ask for a Medi-Cal Fair Hearing by calling 1-800-952-5253. However, if you start the Medi-Cal Fair Hearing process, you cannot get an Independent Medical Review from the HMO Help Center.
- If your health plan still says you cannot get the services you want:
- You can contact the HMO Help Center. You may be able to get an Independent Medical Review.
Questions and Answers
How do I get Medi-Cal?
There are many ways to qualify for Medi-Cal. Medi-Cal considers both your income and your medical problems. For information, call your county Social Services office.
Can I get Medi-Cal if I am pregnant?
If you are pregnant and have a low income, you can apply for Emergency Medi-Cal. If you get Emergency Medi-Cal, services start right away. This means that you can get prenatal care. Call or visit a local clinic or hospital to apply. If you do not qualify for Medi-Cal, you may be able to get AIM. AIM stands for Access for Infants and Mothers. It is low-cost health care for pregnant women and their infants. To apply for AIM, call 1-800-433-2611.
Can I get mental health care if I have Medi-Cal?
Yes. If you need mental health care, call your County Mental Health Agency. You can also call the Medi-Cal Mental Health Care Ombudsman at 1-800-896-4042.
Resources
Centers for Medicare and Medicaid Services (CMS)
Federal government agency with information on Medi-Cal (California's name for Medicaid)
www.cms.hhs.gov
California Health Care Options
Help with enrolling in or leaving a Medi-Cal managed care plan
1-800-430-4263 (many languages)
1-800-430-7077 (TTY)
Medi-Cal
State program with health care for people who qualify because of low or no incomes and/or costly disabilities
1-800-541-5555 (Spanish)
1-916-636-1980 (many languages)
1-866-784-2595 (TTY)
www.medi-cal.ca.gov
Medi-Cal Fair Hearing
File an appeal if your health plan denies you the services you need
1-800-952-5253 (Spanish)
Medi-Cal Managed Care Ombudsman
Help if you have a problem you cannot solve with your health plan
1-888-452-8609 (many languages)
Medi-Cal Mental Health Care Ombudsman
Help with Medi-Cal mental health care services
1-800-896-4042 (many languages)
UNDERSTAND
