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Medi-Cal Managed Care

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.

Your Primary Care Doctor

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

  • If you have a problem, you can contact your Medi-Cal Managed Care Plan and file a complaint.
  • For help with your complaint, you can call the Medi-Cal Managed Care Ombudsman at 1-888-452-8609. Call between 8 AM and 5 PM. Your call is free and help is offered in many languages.
  • For help with your complaint, you can call the Help Center at 1-888-466-2219. They can also help you ask for a free Independent Medical Review (IMR) of the plan’s decision by doctors who are not connected with the plan. You have a 57.5% chance of succeeding in IMR and obtaining the health care you asked for.
  • If you are not satisfied with your plan’s response, you can also ask for a Medi-Cal State Hearing—call 1-800-952-5253. This is a review of your problem by the state. (Note: If you complete the Medi-Cal State Hearing process you cannot get an Independent Medical Review from the Help Center. But if you get an Independent Medical Review from the Help Center and you are not satisfied with the result, you can still get a Medi-Cal State Hearing.)

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

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
www.dhcs.ca.gov/services/medi-cal/Pages/default.aspx

Medi-Cal State 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)