Welcome to the Medi-Cal Managed Care Health Care Options

Informing Materials

County Specific Informing Materials

General Informing Materials

General Informing Materials

Emergencies and Family Planning

Emergencies

If you or a family member are very sick and think it might be an emergency:
  • Call 911 or go to the nearest emergency room in an emergency.
  • An emergency is when someone reasonably believes that she or he needs immediate medical attention. Examples are:
    • Bleeding heavily
    • Trouble breathing
    • In a lot of pain
    • Looks like the person might die or be disabled
  • If you go to any emergency room for an emergency, your health plan will authorize services.
  • If you go to an emergency room and it is not for an emergency, the emergency room staff will send you to your health plan's doctor or clinic.
If you are not sure it is an emergency:
  • Call your doctor or your health plan's after hours phone number.
  • The health plan will see that you get to the emergency room if you need to. Or, they will schedule an appointment for you with your doctor or clinic.

Family Planning

You can get family planning services from:
  • The doctors, nurse practitioners, nurse midwives, physician assistants, and clinics in your health plan.
  • Any family planning practitioner or clinic outside of your health plan that takes Medi-Cal. You do not need to ask your health plan first.
    (Family planning services do not include the services you need after you become pregnant.)

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How To Get An Exception Waiver

You or a member of your family must choose a health plan if:

  • You receive CalWorks benefits (cash aid, food stamps)
  • You receive Medi-Cal only and you do not have a share of cost

You or a member of your family cannot choose a health plan if:

  • You are a member of a commercial health plan through private insurance
  • You receive share of cost Medi-Cal

You or a member of your family may not have to choose a health plan if:

  • You receive health services from an Indian Health Provider
  • You are a member of a Medicare Health Plan
  • You are being treated for a complex medical condition, such as:
    • Pregnancy
    • Cancer
    • Organ transplant (or are scheduled for one)
    • Renal disease and have dialysis at least two times a week
    • A disease that affects more than one organ system (such as diabetes)
    • You are HIV positive
    • Other conditions may qualify

How To Get An Exception Waiver

  • You and your doctor must complete and sign the Medical or Non-Medical Exception Form. Your doctor may not authorize your medical exception, if he or she is part of a Medi-Cal Managed Care Health Plan in your area.
  • You must return the form no later than 30 days after you become eligible to enroll in a Managed Care Plan.
  • If you do not return the form within 30 days, the State will choose a health plan for you.
  • The State will review your request to change you to Regular Medi-Cal (Fee-For-Service).
  • The State will send you a letter to let you know if your request has been approved or denied.
  • If denied, you can call the State's Ombudsman at 1-888-452-8609. The call is free.

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Health Plan Benefits

Medi-Cal Managed Care Health Plan: NO cost to you, NO co-payment

  • Choose a Doctor and Clinic
    You choose a primary care doctor or clinic from a list that belongs to the health plan. You must go to that doctor or clinic first for your health care. The doctor or clinic you go to now may be part of the health plan.
  • Specialty Care
    Your primary care doctor will send you to specialty doctors who are part of your health plan, when necessary.
  • Pharmacy and Other Providers
    Each health plan has pharmacies and other providers as part of the health plan.Your primary care doctor will send you to other providers, when necessary.
  • Medical Advice
    Medi-Cal Managed Care Health Plans have a 24-hour toll free number you can call with questions about your care.
  • Health Education
    All health plans offer special classes to keep you healthy.
  • Change Your Doctor or Clinic
    If you are not happy with your primary care doctor or clinic, you can call the health plan Member Services Department and choose a different primary care doctor or clinic.
  • Change Your Health Plan
    If you want to choose another health plan for any reason, you may leave the health plan and join a different health plan.
  • Family Planning
    If you are not happy with your primary care doctor or clinic, you can call the health plan Member Services Department and choose a different primary care doctor or clinic.
  • Health Plan Information
    The health plan you choose will send you information about their services and a member identification card.

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