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California Department of Healthcare Services

MMCD Office of the Ombudsman 

The Medi-Cal Managed Care Office of the Ombudsman helps solve problems from a neutral standpoint to ensure that our members receive all medically necessary covered services for which plans are contractually responsible.

The Ombudsman will not automatically take sides in a complaint. We consider all sides in an impartial and objective way.  It is our job to help develop fair solutions to health care access problems.

The Office of the Ombudsman:

  • Serves as an objective resource to resolve issues between Medi-Cal managed care members and managed care health plans.
  • Conducts impartial investigations of member complaints about managed care health plans.
  • Helps members with urgent enrollment and disenrollment problems.
  • Offers information and referrals.
  • Identifies ways to improve the effectiveness of the Medi-Cal managed care program.
  • Educates members on how to effectively navigate through the Medi-Cal managed care system.

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How can I remove a hold or change the plan I am enrolled in?

Request For Change - Online Fillable Form (COUNTY STAFF USE ONLY)

This form should be utilized for urgent expedited matters only; all standard changes need to be processed through Health Care Options (HCO) at 800-430-4263.  The online fillable form should be used when requesting expedited:

  • Plan changes
  • Expedited Plan Enrollments
  • Expedited Plan Disenrollments
  • Removal of 59 holds

 

Completion of this form does not guarantee that the request will be processed.  If the Medi-Cal beneficiary does not meet the required criteria or a valid county email address is not used, the request will not be processed. 

Medi-Cal members must contact their local County Eligibility Worker to submit a request using the online fillable form located on the link above.

What can you expect from us?

  • We will treat you with courtesy and respect.
  • We will respond to you in a timely manner.
  • We will keep you informed of our progress.
  • We have policies and procedures in place that protect the privacy of your health information.

How can I contact the Office of the Ombudsman?

 

*Please note: E-mail provides no mechanism for ensuring the confidentiality or privacy of information contained within a message in transit. Therefore the sender of an email message assumes responsibility for including confidential or private data when utilizing this communication medium. The sender should exercise caution when composing a message to exclude confidential or private information such as names, street addresses, phone numbers, social security numbers, license numbers, other personal identification numbers, etc.  If the sender wishes to contact the California Department of Health Care Services (DHCS) Office of the Ombudsman to discuss any issues that may require the inclusion of private or confidential data, DHCS recommends calling the Ombudsman at (1-888) 452-8609.

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