This program is administered
by the Department of
Health Care Services (DHCS).
HCO Frequently Asked Questions
Find answers to questions you may have about the Medi-Cal Managed Care HCO program.
A Medi-Cal Health Plan is a group of doctors, clinics, specialists, pharmacies, and hospitals. Medi-Cal beneficiaries can choose one plan for the entire family or choose a different plan for each family member. When choosing a Medi-Cal Health Plan, Medi-Cal beneficiaries are required to choose one primary physician for the entire family or choose a different primary physician for each family member. Medi-Cal Health Plans offer 24 hour member services information lines and cover emergencies/urgent care while Medi-Cal beneficiaries are temporarily outside the State of California.
Medi-Cal beneficiaries who are aged, blind, disabled, and receiving Supplemental Security Income (SSI) or State Supplementary Payments (SSP), or receive CalWORKS benefits and/or Medi-Cal only with no share of cost are considered to be mandatory and therefore must join a Medi-Cal Health Plan.
Medi-Cal beneficiaries who are a child in a foster care or adoptive aid program are considered to be voluntary and therefore not required to join a Medi-Cal Health Plan. Voluntary beneficiaries can choose to join a Medi-Cal Health Plan or continue to receive their Medi-Cal benefits through Fee-for-Service also known as “Regular Medi-Cal“.
If you are enrolled in a Medi-Cal Health Plan and want to choose another health plan for any reason, you may leave the health plan and join a different health plan. You can call a Health Care Options (HCO) Representative, toll free, at 1-800-430-4263, between 8:00 a.m. to 5:00 p.m., Monday-Friday, or visit a HCO Presentation Site for assistance in making a health plan change. You may also complete and mail an Enrollment Choice Form to Health Care Options. Additional Enrollment Information is available on the Enrollment page.
If you are not satisfied with the services being provided by your Medi-Cal Health Plan, you have the right to do any or all of the following:
- Change your health plan
- File a complaint or grievance with your health plan
- Report the problem to the California Department of Health Care Services’ State Ombudsman
- Report the problem to the California Department of Managed Health Care’s Office of Patient Advocacy
- Ask for a State Fair Hearing with an administrative law judge
Please call your health plan’s Member Services Department first. A member services worker may be able to help you with your complaint.
Your choice of Medi-Cal Health Plans is determined by your county of residence. For a list of Medi-Cal Health Plans available in your county please visit the Provider and Plans page of this website and choose the Find a Medical Plan or Doctor option. You may also call a Health Care Options (HCO) Representative, toll free, at 1-800-430-4263, between 8:00 a.m. to 5:00 p.m., Monday-Friday, or visit a HCO Presentation Site for assistance in making a health plan choice. Visit the Presentation Sites page for a schedule for your county.
- Benefits Identification Card or BIC
The plastic card sent to everyone who is eligible for Medi-Cal. All Medi-Cal providers use the BIC to check eligibility. Also called "Medi-Cal Card".
Immediate need for medical attention for an injury or illness that is life-threatening or disabling.
Your written or verbal feeling of your dissatisfaction with your health plan provider, or medical care service.
- Health Care Options
The company that works for the Medi-Cal Program to help you choose or change health plans.
The California government program that pays providers who give health care services to eligible beneficiaries.
- Medi-Cal Choice Form
The form you fill out to choose or change health plans.
- Medi-Cal Managed Care Health Plan
Organizations with doctors, specialists, clinics, pharmacies, and hospitals that provide health care services to their members.
- Member Services Department
The office in a Medi-Cal Managed Care Health Plan that can answer your questions and help you use your health plan's services.
- Primary Care Provider
The doctor, nurse practitioner, nurse midwife, or physician's services.
- Provider Directory
A list of doctors, clinics, pharmacies, and hospitals you can choose from when you join a health plan.
- Specialist or Specialty Care Doctor
A doctor who only treats certain kinds of health problems like broken bones, asthma, or heart problems. To get this special care, your primary care provider must send you to the specialist or specialty care doctor. OB/GYN(Obstertrics and Gynecology) services may be contacted directly.