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) or HCO Coordinated Care Initiative at 1-844-580-7272 (TTY 1-800-430-7077). The call is free.
Who cannot enroll
You or a member of your family cannot choose a medical plan if:
- You are a member of a commercial medical plan through private insurance
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 a member of a Medicare medical plan
- You are being treated for a complex medical condition such as:
- 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.
- You must return the form no later than 30 days after you qualify to enroll in a managed care plan.
- If you do not return the form within 30 days, the State will choose a medical plan for you.
- 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.