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Frequently asked questions (FAQs)

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We're here to help you understand your health care choices!

These Frequently Asked Questions (FAQs) answer some questions you may have.

If you have other questions, call HCO Medi-Cal Managed Care at 1-800-430-4263 or HCO Coordinated Care Initiative at 1-844-580-7272 (TTY 1-800-430-7077).

What is a Medi-Cal medical plan?

A Medi-Cal medical plan is a group of doctors, clinics, specialists, pharmacies, and hospitals. Medi-Cal beneficiaries can choose one plan for the family or choose a different plan for each family member. When choosing a Medi-Cal medical plan, Medi-Cal beneficiaries must choose one primary care provider (PCP) for the family or a different PCP for each family member. Medi-Cal medical plans offer 24-hour member services information lines. They cover emergencies and urgent care while Medi-Cal beneficiaries are temporarily outside the State of California.

Who must join a Medi-Cal medical plan?

Medi-Cal beneficiaries are “mandatory” if they are aged, blind, disabled, and getting Supplemental Security Income (SSI) or State Supplementary Payments (SSP), or if they get CalWORKS benefits and/or Medi-Cal only with no share of cost. This means they must join a Medi-Cal medical plan.

Who may join a Medi-Cal medical plan?

Medi-Cal beneficiaries who are a child in a foster care or adoptive aid program are “voluntary.” This means they do not have to join a Medi-Cal medical plan. Voluntary beneficiaries can choose to join a Medi-Cal medical plan. Or they can keep getting their Medi-Cal benefits through Regular (Fee-for-Service) Medi-Cal.

Can I change my Medi-Cal health plan?

Yes. If you are 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 Health Care Options (HCO), toll free, at 1-800-430-4263 (TTY 1-800-430-7077), 8 a.m. to 6 p.m. PT, Monday through Friday, except holidays. Or visit a HCO presentation site for help changing your health plan. You may also complete and mail an Enrollment Choice Form to Health Care Options. You can get an enrollment form on the Download forms page. Read more about enrollment on the Enroll page.

What if I am not happy with my Medi-Cal health plan?

If you are not satisfied with your Medi-Cal health plan services, you have the right to:

  • 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 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. They may be able to help you with your complaint. To learn more about these options, go to the Rights page.

How do I make a complaint to my health plan?

You can file a complaint or grievance with your health plan if you think they made a mistake or made a decision you don’t agree with. To learn more, go to the Rights page.

What Medi-Cal health plans are available?

Your choice of Medi-Cal health plans is determined by the county you live in. For a list of Medi-Cal health plans in your county, go to the Compare medical plans and dental plans page. You may also call Health Care Options (HCO) toll free at 1-800-430-4263 (TTY 1-800-430-7077), from 8 a.m. to 6 p.m. PT, Monday through Friday, except holidays. Or visit an HCO presentation site for help choosing a health plan. For a list of presentation sites in your county, go to the Download forms page.

How can I enroll?

You can enroll by mail, by phone, or in person. To learn more, go to the Enroll page.

How do I choose a medical or dental plan?

For help choosing a medical plan, go to the Tips to help you choose a medical plan page. For help choosing a dental plan, go to the Tips to help you choose a dental plan page.

To compare medical or dental plans, go to the Compare medical plans and dental plans page.

Where can I find forms to help me enroll?

You can find forms to help you enroll on the Download forms page.

How do I ask for a copy of personal health information for myself or someone I represent?

Complete one of the Request for access to protected health information forms. There are two forms. One form helps you ask for your own information. The other form helps you ask for the information of someone you represent. You can find both forms on the Download forms page.

What should I do if I think I don’t have to join a plan?

Most people who get Medi-Cal have to join a plan, but some do not. If you think you don’t have to join a plan, you can ask for an exemption (release) from joining. Use one of the exemption forms on the Download forms page. Or call Health Care Options (HCO) Medi-Cal Managed Care at 1-800-430-4263 (TTY 1-800-430-7077) or HCO Coordinated Care Initiative at 1-844-580-7272 (TTY 1-800-430-7077). The call is free.

How do I work with my medical or dental plan?

To learn about working with your medical plan, go to the Tips to help you choose a medical plan page. To learn about working with your dental plan, go to the Tips to help you choose a dental plan page. 

How do I contact HCO?

You can call HCO Medi-Cal Managed Care at 1-800-430-4263 (TTY 1-800-430-7077) or HCO Coordinated Care Initiative at 1-844-580-7272 (TTY 1-800-430-7077). The call is free. We are open Monday through Friday, 8 a.m. to 6 p.m. PT, except holidays.

If you want HCO to contact you, fill out the HCO Contact Form.

You can write to HCO. Our mailing address is:

CA Department of Health Care Services
Health Care Options
P.O. Box 989009
West Sacramento, CA 95798-9850

To learn how to contact other DHCS organizations, go to the Contact us page.

How can I get in-person help?

We have information sessions near you. The sessions are about choosing Medi-Cal managed care plans. You can go to any session to hear about your choices and ask questions in person.

To find meeting places and times near you, go to the Download forms page.

Where can I find reports about Medi-Cal and health plans?

Medi-Cal and every health plan must offer quality (good) health care to help you stay healthy. There are reports that tell you how we’re doing. You can view quality reports about Medi-Cal and health plans on the Quality reporting page.

Where can I find consumer guides to learn how Medi-Cal plans compare on quality of care?

You can find consumer guides for every Medi-Cal plan on the Health plan materials page.

Words to know

  • Benefits Identification Card (BIC)
    This is the plastic card sent to everyone who qualifies for Medi-Cal. All Medi-Cal providers use the BIC to check eligibility. Also called the Medi-Cal card.
     
  • County Organized Health System (COHS)
    A non-profit, independent public agency that contracts with the State to administer Medi-Cal benefits through local care providers and/or Health Maintenance Organizations. Medi-Cal eligible beneficiaries are mandatorily enrolled in the single COHS plan in the county. To learn more, go to Managed Care Operations Division (MCOD).
     
  • Emergency
    Immediate need for medical attention for an injury or illness that is life-threatening or disabling.
     
  • Grievance
    Your written or verbal statement of dissatisfaction with your health plan provider or medical care service.
     
  • Health Care Options (HCO)
    The company that works for Medi-Cal to help you choose or change health plans.
     
  • Medi-Cal
    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, dentists, 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 (PCP)
    The doctor, nurse practitioner, nurse midwife, or physician assistant who gives you most of your 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 (PCP) must send you to the specialist or specialty care doctor. You may contact OB/GYN (Obstetrics and Gynecology) services directly.