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Use the health plan dashboard to view or compare health plan information. The health plan dashboard features health plan contact information, enrollment data, complaint and IMR data, enforcement actions, and financial data.

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View the DMHC Dashboard for a comprehensive look at DMHC health plan data.

What's New

DMHC COVID-19 Testing Emergency Regulation, APLs, FAQs and Fact Sheet

The DMHC emergency regulation regarding COVID-19 diagnostic testing took effect on July 17, 2020. The regulation classifies COVID-19 testing as medically necessary urgent care for essential workers. The regulation specifies, during the relevant state of emergency, COVID-19 diagnostic testing is a medically necessary basic health care services for all essential workers, as defined, and prevents delays in testing and claims payment related to such individuals.

Additionally, the DMHC has issued All Plan Letters on the implementation of the emergency regulation, a Frequently Asked Questions (FAQs) document, and a Fact Sheet to help clarify what individuals should do if they need a COVID-19 test.

DMHC COVID-19 Testing Emergency Regulation

DMHC APL 20-028 - Emergency Regulation Regarding COVID-19 Diagnostic Testing

DMHC APL 20-033 - Implementation of Emergency Regulation Regarding COVID-19 Diagnostic Testing

DMHC COVID-19 Testing Fact Sheet

DMHC FAQ on COVID-19 Testing

DHCS COVID-19 Virus and Antibody Testing Guidance

DMHC Seeks Members for Financial Solvency Standards Board

The Department of Managed Health Care (DMHC) is seeking five (5) dynamic and solution-oriented professional to serve on the Financial Solvency Standards Board (FSSB).

For more information, please read the Board Member Solicitation and Job Description. Interested candidates must submit required documents by October 9, 2020.

DMHC Orders Aetna to Stop Wrongfully Denying Payment for Emergency Medical Services

The California Department of Managed Health Care (DMHC) has ordered Aetna Health of California, Inc. (Aetna) to stop using the plan’s national standard to deny payment for emergency room claims. This practice has resulted in Aetna wrongfully denying members’ emergency room claims as the plan should be applying California’s broader standard to approve emergency room services.

The Department has also fined Aetna $500,000 for repeatedly failing to apply California law and failing to implement corrective actions to correct this problem. Aetna has repeatedly agreed to follow California’s standard for reimbursing emergency room claims but has continued to use its national standard, resulting in many wrongful denials of emergency room claims.

Press Release

Assistance for Health Plan Enrollees Impacted by Wildfires

The California Department of Managed Health Care (DMHC) requires California health plans to help victims of Natural Disasters, including wildfires, who are experiencing problems obtaining health care services. This could include speeding up approvals for care, replacing lost prescriptions and ID cards, or quickly arranging health care at other facilities if a hospital or doctor’s office is not available due to the disaster. You should first contact your health plan for assistance. If you have problems obtaining services or assistance from your health plan, you can contact DMHC’s Help Center at 1-888-466-2219 or visit www.HealthHelp.ca.gov.

DMHC APL 20-030 - State of Emergency due to Extreme Weather and Wildfires

DMHC 2019 Annual Report & Infographic

The Department of Managed Health Care 2019 annual report and infographic are now available online. Both of these documents highlight the DMHC’s activities during 2019 and include key statistics about the Department. 

2019 DMHC Annual Report2019 DMHC Infographic

DMHC Reminds Health Plans to Comply with California Nondiscrimination Requirements

The DMHC remains committed to protecting the health care rights of all Californians, regardless of their gender identity, sexual orientation, or English proficiency. The Department issued an All Plan Letter (APL) reminding health plans licensed in California that they must continue to comply with California law, which protects all Californians from discrimination based on, among other things, gender identity and sexual orientation. Likewise, California-licensed health plans must continue to comply with California’s requirements to provide enrollees with notice of the availability of free language assistance services in English and the top 15 languages spoken by Limited English Proficiency individuals in California.

DMHC APL 20-022 - Compliance with California nondiscrimination requirements

Chief Medical Officer Job Announcement

The Department of Managed Health Care (DMHC) is seeking a dynamic, creative, collaborative and consumer-oriented contracted Clinical Consultant to serve as the DMHC’s Chief Medical Officer (CMO). CMO will assist with ensuring health plan medical, behavioral health and administrative compliance with statutory and regulatory requirements in order to drive improvement in clinical outcomes for health plan enrollees and to improve the DMHC’s effectiveness.

For more information, please read this CMO Job Announcement. Interested candidates must submit required documents by December 31, 2020.

DMHC Directs Health Plans to Ensure Californians Can Access Necessary Medical Care Through Telehealth

The DMHC issued an All Plan Letter (APL) in March directing health plans to ensure Californians can access necessary medical care through telehealth when medically appropriate. This includes directing health plans to reimburse providers for care provided through telehealth at the same rate as in-person care and ensuring enrollee cost-sharing is not changed for telehealth services. Following several questions from plans and providers, the DMHC issued All Plan Letter (APL)  20-013 - Billing for Telehealth Services; Telehealth for the Delivery of Services with a Frequently Asked Questions (FAQ) document. This includes information on provider billing during the COVID-19 State of Emergency to decrease administrative burdens on providers and plans.

DMHC APL 20-013 – Billing for Telehealth Services; Telehealth for the Delivery of Services

DMHC FAQ – Telehealth During the COVID-19 State of Emergency

DMHC APL 20-009 – Reimbursement for Telehealth Services

DMHC APL 20-032 – Continuation of Telehealth All Plan Letters

Assistance for Patients Impacted by the AKF Leaving California

The American Kidney Fund (AKF) has announced it is ending financial assistance funds for Californians in need. The following fact sheet includes information on alternative options patients can explore and how to get help with these other health coverage options.

English Fact Sheet

Spanish Fact Sheet

2018 Annual Report and Infographic

The Department of Managed Health Care 2018 annual report and infographic are now available online. Both of these documents highlight the DMHC’s activities during 2018 and include key statistics about the Department.

2018 DMHC Annual Report2018 DMHC  Infographic

CDPH COVID-19 Updates

DMHC COVID-19 Updates

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