Welcome to the Medi-Cal Managed Care Health Care Options

Enrollment

In this section you will find information to help you understand the materials (known as informing materials) you have received in the mail, decide on a health care plan and enroll in the Medi-Cal Managed Care HCO program.

Informational sessions on making a Medi-Cal Managed Care Plan choice are held in various locations near your home. You can come to one of these sessions if you want to hear about your choices and ask questions in person. To find out when and where meetings are held, please visit the Presentation Sites page or call the HCO Call Center using the toll-free numbers listed on the right.

General Informing Materials
Choice Enrollment Forms
Exception to Plan Enrollment Forms
Plan Comparison Charts
Contact HCO

Questions about Enrollment

Medical

Dental

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Answers to Health Plan Enrollment Questions

How to choose a health plan

Think about what is important to you when you get health care. Talk to your family, friends, and doctor. Look at the Health Plan Comparison Chart(s) to help you decide which health plan you want. Look at the provider directories to help you decide which doctor you want.

Here are some things to think about before you make your choice:

Doctor

  • Am I happy with the doctor I have right now?
  • Does my doctor belong to a health plan?
  • Which health plan?
  • Do I have to wait long to get an appointment?
  • Are they open when I can go?
  • Does the doctor have experience with my child's or my medical problem?

Language

  • Does the doctor speak my language or provide interpreters who do?

Location

  • Is the doctor's office or clinic near by?
  • Is it easy to get to?
  • Does the health plan or doctor provide transportation?

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How to join or change a health plan

Join a Health Plan

  • You must be eligible for Medi-Cal to join a health plan.
  • You can use your Medi-Cal Benefits Identification Card (BIC) for services through Regular Medi-Cal (Fee-For-Service) until you are a health plan member.
  • Health Care Options will send you a letter within 15 to 45 days telling you that the health plan change has taken place.
  • Your health plan will send you information about its services and a health plan member card.
  • Take your health plan member card and BIC card with you what you get all medical services, including pharmacy, x-rays, and office visits.

Change a Health Plan

  • If you are not happy with your health plan, you can choose another health plan, if available.
  • Call Health Care Options at 1-800-430-4263 and ask for a Medi-Cal Choice Form.
  • Mail the completed choice form.
  • Health Care Options will send you a letter within 15 to 45 days telling you that the health plan change has taken place.
  • You must see your present doctor until you get the letter from Health Care Options.

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Working with your health plan

It is very important for you to know how to use your health plan as soon as you become a member. Read all the information your health plan sends you. Call your health plan's Member Services Department and ask any questions you have about your health plan. Member services staff will be glad to help you

What if:

  • I am no longer happy with the doctor I am going to?
  • I disagree with my doctor about what is best for my family or me?
  • My doctor denies or delays my request to see a specialist, to have more visits, or to get certain medicines?
  • My doctor or health plan denies or limits medical services?
  • My health plan reduces or stops a service that I was getting before I changed plans?

You have a right to do any or all of these:

Change Your Health Plan

  • Call Health Care Options at 1-800-430-4263 and ask for an informing packet.
  • Complete the choice form and follow the mailing instructions.

File A Complaint Or Grievance With Your Health Plan

  • Call the health plan's Member Services Department. A member services worker may be able to help you with your complaint.
  • If member services staff cannot assist you with your complaint, ask them to mail a grievance form to you at your home address. Your doctor will also have grievance forms or you can send a letter to your health plan.
  • Complete the grievance form and mail the original to the health plan's Member Services Department (keep a copy for your records).
  • Your health plan will review its decision based on your grievance and you will get an answer within 30 days. If you think that waiting 30 days will harm your health, be sure to say why when you ask for your grievance. Then you might be able to get an answer within 3 days.

Report The Problem To The California Department Of Health Services’ State Ombudsman

  • Call 1-888-452-8609, Monday through Friday, from 8:00 a.m. to 5:00 p.m.

Report The Problem To The California Department Of Managed Health Care's Office Of Patient Advocacy

  • Call 1-888-466-2219, 24 hours a day, seven days a week.

Ask For A State Fair Hearing With An Administrative Law Judge

  • If you want a State Fair Hearing, you must ask for it within 90 days from the date of the "Notice of Action" or "Grievance Resolution" letter that you receive from your health plan, or from the date of the order or action you are complaining of.
  • If the “Notice of Action” letter states that your requested treatment is terminated or reduced and you want to keep your treatment going, you must ask for a State Fair Hearing within 10 days from the date the letter was postmarked or personally delivered to you, or before the effective date of the action you're disputing, whichever is earlier.
  • You can also send a personal letter to ask for a State Fair Hearing. Be sure to include your name, address, phone number, Social Security Number, and the reason you want a State Fair Hearing. If someone is helping you ask for a State Fair Hearing, add his/her name, address, and phone number to the letter.
  • If you want to keep your treatment going during the hearing process, be sure to state that in the "Form To File A State Fair Hearing" or in your personal letter.
  • If you need a free interpreter, state that in the "Form To File A State Fair Hearing"or in your personal letter. Include the language that you speak.
  • It takes up to 90 days after you ask for a hearing to get an answer. If you think waiting that long will threaten your health, ask your doctor or health plan for a letter. Make sure the letter explains how waiting will threaten your health. Then, ask for an expedited hearing and include the letter with the "Form To File A State Fair Hearing" or with your own personal letter.

    State Fair Hearing


    Write to:
    California Department of Social Services
    State Fair Hearing Division
    P.O. Box 944243, MS 19-37
    Sacramento, CA 94244-2430

    Call: 1-800-952-5253
    TDD: 1-800-952-8349

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Answers to Dental Plan Enrollment Questions

How to choose a dental plan

Think about what is important to you when you get dental care. Talk to your family, friends, and dentist. Look at the Dental Plan Comparison Charts on this site to help you decide which dental plan you want. Look at the provider directories on this site to help you decide which dentist you want.

Here are some things to think about before you make your choice:

Dentist

  • Am I happy with the dentist I have right now?
  • Does my dentist belong to a dental plan?
  • Which dental plan?
  • Do I have to wait long to get an appointment?
  • Is my dentist's office open when I can go?
  • Does the dentist have experience with my child's or my dental problem?

Language

  • Does the dentist speak my language or provide interpreters who do?

Location

  • Is the dentist's office nearby?
  • Is it easy to get to?
  • Does the dental plan or dentist provide transportation?

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How to join or change a dental plan

Join a Dental Plan

  • You must be eligible for Medi-Cal to join a dental plan.
  • You can use your Medi-Cal Benefits Identification Card (BIC) for services through Regular Medi-Cal (Fee-For-Service) until you are a dental plan member.
  • Health Care Options will send you a letter within 15 to 45 days telling you that the dental plan change has taken place.
  • Your dental plan will send you information about its services and a dental plan member card.
  • Take your dental plan member card and BIC card with you when you visit your dentist.

Change a Dental Plan

  • You must be eligible for Medi-Cal to join a dental plan.
  • If you are not happy with your dental plan, you can choose another dental plan or return to Regular Medi-Cal (Fee-For-Service) if you live in Los Angeles county. If you live in Sacramento County, you may be required to be enrolled in a dental but you may change dental plans at any time.
  • Call Health Care Options at 1-800-430-4263 and ask for a Medi-Cal Dental Choice Form.
  • Call Denti-Cal at 1-800-322-6384 to find a dentist who takes Medi-Cal.
  • Mail the completed choice form.
  • Health Care Options will send you a letter within 15 to 45 days telling you that the dental plan change has taken place.
  • You must see your present dentist until you get the letter from Health Care Options.

Change Your Dentist

  • If you would like to change your dentist, you can call the dental plan’s Member Services Department and choose a different dentist. You must be eligible for Medi-Cal to join a dental plan.

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Working with your dental plan

It is very important for you to know how to use your dental plan as soon as you become a member. Read all the information your dental plan sends you. Call your dental plan's Member Services Department and ask any questions you have about your dental plan. Member services staff will be glad to help you.

What if:

  • I am no longer happy with the dentist I am going to?
  • I disagree with my dentist about what is best for my family or me?
  • My dentist denies or delays my request to see a specialist, to have more visits, or to get certain medicines?
  • My dentist or dental plan denies or limits dental services?
  • My dental plan reduces or stops a service that I was getting before I changed plans?
  • I received a “Notice of Action” that denied, delayed, modified, or reduced my treatment request, or terminated treatment I have been receiving.

You have a right to do any or all of these:

Change Your Dental Plan
  • Call Health Care Options at 1-800-430-4263 and ask for an informing packet.
  • Complete the choice form and follow the mailing instructions.
File A Complaint Or Grievance With Your Dental Plan
  • Call the dental plan's Member Services Department. A member services worker may be able to help you with your complaint.
  • If member services staff cannot assist you with your complaint, ask them to mail a grievance form to you at your home address. Your dentist will also have grievance forms or you can send a letter to your dental plan.
  • Complete the grievance form and mail the original to the dental plan's Member Services Department (keep a copy for your records).
  • Within 5 days, you should hear from your dental plan that it has received your grievance.
  • Your dental plan will review its decision based on your grievance and you will get an answer within 30 days. If you think that waiting 30 days will harm your health, be sure to say why when you ask for your grievance. Then you might be able to get an answer within 3 days.
Ask For A State Fair Hearing With An Administrative Law Judge
  • If you want a State Fair Hearing, you must ask for it within 90 days from the date of the “Notice of Action” or “Grievance Resolution” letter that you receive from your dental plan, or from the date of the order or action you are complaining of.
  • If the “Notice of Action” letter states that your requested treatment is terminated or reduced and you want to keep your treatment going, you must ask for a State Fair Hearing within 10 days from the date the letter was postmarked or personally delivered to you, or before the effective date of the action you are disputing, whichever is earlier.
  • Complete the “Form To File A State Fair Hearing” that is included with your “Notice of Action” letter.
  • You can also send a personal letter to ask for a State Fair Hearing. Be sure to include your name, address, phone number, Social Security Number, and the reason you want a State Fair Hearing. If someone is helping you ask for a State Fair Hearing, add his/her name, address, and phone number to the letter.
  • If you want to keep your treatment going during the hearing process, be sure to state that in the “Form To File A State Fair Hearing” or in your personal letter.
  • If you need a free interpreter, state that in the “Form To File A State Fair Hearing” or in your personal letter. Include the language that you speak.
  • It takes up to 90 days after you ask for a hearing to get an answer. If you think waiting that long will threaten your health, ask your dentist or dental plan for a letter. Make sure the letter explains how waiting will threaten your health. Then, ask for an expedited hearing and include the letter with the “Form To File A State Fair Hearing”" or with your own personal letter.

    State Fair Hearing


    Write to:
    California Department of Social Services
    State Fair Hearing Division
    P.O. Box 944243, MS 19-37
    Sacramento, CA 94244-2430

    Call: 1-800-952-5253
    TDD: 1-800-952-8349

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