Who must enroll

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Who must enroll

Most people who have Medi-Cal must enroll in a medical plan. You or a member of your family must choose a medical plan if:

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

To find out if you must enroll, call Health Care Options (HCO) Medi-Cal Managed Care at 1-800-430-4263 (TTY 1-800-430-7077). The call is free.

Who may not have to enroll

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

  • You get health services from an Indian Health Provider
  • You are in the third trimester of pregnancy
  • You are being treated for a complex medical condition such as:
    • Pregnancy
    • Cancer
    • Organ transplant, or are scheduled for a transplant
    • 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 that may qualify

How to get a medical or non-medical exemption from plan enrollment

  • You and your doctor must complete and sign a medical exemption from plan enrollment form. Or your doctor may complete and sign a non-medical exemption from plan enrollment form. You can find the forms on the Download forms page. Your doctor may not authorize your exemption if he or she is part of a Medi-Cal managed care medical plan in your area.
  • If you do not return the form within 30 days, the State will choose a medical plan for you.
  • If you have been enrolled in a Medi-Cal Managed Care Plan for more than 90 days you cannot get a medical exemption
  • The State will review your request to change you to Regular (Fee-for-Service) Medi-Cal.
  • 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 or Medi-Cal State Fair Hearing at 1-800-952-5253 (TTY 1-800-952-8349). The call is free. Or visit the Medi-Cal State Fair Hearing website at http://www.dhcs.ca.gov/services/medi-cal/Pages/Medi-CalFairHearing.aspx.