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Medi-Cal Members Questions and Answers

 

 

Does this affect me?

First, you must reside in one of the following counties: Alameda, Contra Costa, Fresno, Kern, Kings, Los Angeles, Madera, Riverside, Sacramento, San Bernardino, San Diego, San Francisco, San Joaquin, Santa Clara, Stanislaus, or Tulare.

Next, if you are a Senior or Person with a Disability (SPD) and you have Medi-Cal only and do NOT have Medicare, this change applies to you. This is NOT for dual-eligibles who also have Medicare; it is for those with Medi-Cal only. You must also have one of the following SPD aid codes to be affected by this change: 20, 24, 26, 2E, 2H, 36, 60, 64, 66, 6A, 6C, 6E, 6G, 6H, 6J, 6N, 6P, 6V, 10,14, 16, 1E, 1H. For a list of other conditions that would exclude you from the change, see Who is excluded from this?

If you are affected and currently do not belong to a managed care health plan, and get your health care through Fee-For-Service (FFS) Medi-Cal, you will be required to join a health plan soon. If you are currently in a health plan, you will no longer have the option to choose FFS Medi-Cal coverage. To get more details, or to choose your health plan or change your health plan at any time go to: Enrollment and Notification Information, or Health Care Options' website.  For information on accessibility and how to see your Medi-Cal provider, go to: Accessibility and How to See Your Medi-Cal Provider.      

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Who is excluded from this?

You will still be considered voluntary, and you will not be mandatorily enrolled into managed care if you belong to one or more of these groups:

  • Dual Eligibles, or those with Medicare   
  • Foster Children
  • Identified as Long Term Care (LTC)   
  • Those with Other Health Insurance   
  • Share of Cost (SOC) Medi-Cal
  • California Children's Services (CCS) - Only CCS members in Alameda, Los Angeles, and San Diego counties will be voluntary; all other CCS members are mandatory for managed care  
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    What is the enrollment process?

    Enrollment of Seniors and Persons with Disabilities will be based on your birth month. You will begin to receive notification approximately 90-days from the month of your birthday. This will begin an informing process that will include notification letters, choice packets, informational materials, and phone calls from people who can help with your enrollment. People with a May birth month will be the first to go through this process and will be enrolled on June 1, 2011.  To get more details, or to choose your health plan or change your health plan at any time, see How do I choose a Health Plan?How do I change health plan? or visit Health Care Options' website.     

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    How will I be notified?

    As a Medi-Cal only Senior or Person with a Disability, you will be notified on a schedule that is based off of the month of your birthday. You will receive letters in the mail and phone calls, the details of which can be found here: Enrollment and Notification Information. These notifications will both educate you on the process of this change to your Medi-Cal coverage, as well as give you an opportunity to select a health plan for your health coverage.

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    How do I choose a health plan?

    You may choose your health plan or change your health plan at any time, and in a number of ways. You can make a choice online by going to Health Care Options' website  or by calling Health Care Options.  You can also choose a health plan by filling out the health plan choice form that will be sent to you in the mail (please see How will I be notified?). You will also have the opportunity to choose a plan over the phone when you are called regarding your health plan enrollment (please see How will I be notified?).

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    How do I change health plans? 

     You may choose your health plan or change your health plan at any time, and in a number of ways. You can make a choice online by going to Health Care Option's website  or call Health Care Options. 

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     Will my health benefits change?

     All of the health care benefits and services that were covered before will stay the same.

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     If I am already in a health plan, do I need to do anything?

    If you are already in a managed care health plan you will not need to do anything, and your services will not change. You can change health plans at any time if you want to. Please note that you will no longer have the choice to have Fee-For-Service Medi-Cal. If you would like to change health plans, you can make a choice online by going to Health Care Options' website  or call Health Care Options. You can also choose a health plan by filling out the health plan choice form that will be sent to you in the mail (please see How will I be notified?). You will also have the opportunity to choose a plan over the phone when you are called regarding your health plan enrollment (please see How will I be notified?). 

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    What about Long Term Care?

    If you receive Long Term Care services, the change in Medi-Cal and the mandatory enrollment of SPDs will affect you in the following way:

  • If you are in Long Term Care today, you will not be mandatorily enrolled into managed care.
  • If you enter Long Term Care while already a member of a managed care plan, the health plan is responsible for the month of admission, plus one more month.  After the first two months, you will be disenrolled out of managed care and into Fee For Service (FFS) Medi-Cal.
  • If you are in Long Term Care and are accidentally enrolled into managed care, the health plan must be notified in order to start the process to immediately disenroll you out of the health plan and into FFS Medi-Cal.
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     If I have more questions, who do I contact?

    If you have more questions regarding the changes in Med-Cal and how they affect you, you can contact Health Care Options by going to Health Care Options' website or call Health Care Options. Any further questions or comments can be sent to mmcdpmb@dhcs.ca.gov.

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     Were you seeing a Medi-Cal doctor before enrolling into a health plan?   

    If your answer is yes, please see Accessibility and How to See Your Medi-Cal Provider

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    Is there a doctor that will meet my accessibility needs?

    Please see Accessibility and How to See Your Medi-Cal Provider

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    Last modified on: 7/5/2012 1:44 PM