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Medi-Cal logoInformation for Pending Applicants and Newly Enrolled Medi-Cal Members

Due to the large number of Medi-Cal applications received through the Covered California website and county human services agencies, the Department of Health Care Services (DHCS) is providing this information to help ensure you can get the care you need.

PENDING APPLICANTS


For those who applied and are likely eligible, but are waiting for their application to be finalized, there are ways you can get immediate care while you wait:

  • You can go to a hospital for emergencies. Beginning January 1, 2014, the Hospital Presumptive Eligibility (PE) program began providing adults, pregnant women, children, and former foster care enrollees with temporary, no cost Medi-Cal benefits for up to two months.  In order to receive Hospital PE benefits, you must complete a simplified application online during a hospital stay. You will be notified immediately of your eligibility determination.
  • You can visit your local county human services office. You can use your information to confirm your Medi-Cal eligibility and get a temporary identification card.  This will allow you to get services until your enrollment is complete. 
  • Pregnant women can get temporary Medi-Cal coverage from certain Medi-Cal providers and clinics.
  • Children can get temporary Medi-Cal coverage provided by enrolled Medi-Cal providers and clinics that see children.

 

Once your Medi-Cal eligibility is confirmed, the health coverage is effective beginning the first day of the month when you applied. Also, when you enroll in Medi-Cal, even after March 31, you won’t incur a tax penalty if you began your application before March 31.

If you would like more information or to check the status of your application, please contact your county human services agency.

NEWLY ENROLLED MEMBERS


For those who have been found eligible for Medi-Cal and have a Medi-Cal Benefits Identification Card (BIC), but have yet to select a managed care health plan, there are options below to help you find care. While you have this temporary Medi-Cal eligibility, you can get health care services from an enrolled Medi-Cal provider. Those who accept Medi-Cal fee-for-service (FFS) will be able to help you. Make sure you ask if they accept FFS before you make your appointment. If they don’t, you should contact another Medi-Cal provider.

In the event you have a medical emergency before you find a doctor, contact 9-1-1 or go to the emergency room at your nearest hospital. Medi-Cal does cover emergency services for enrolled members, and if you show your BIC to emergency room staff, Medi-Cal will pay for the services you receive.

Here are some ways you can get the care you need while your Medi-Cal application is being finalized:

Community Health Centers & Clinics
Another way you can get care is to go to a clinic called a Federally Qualified Health Center.  Here is a link to find one of these health centers in your area: http://findahealthcenter.hrsa.gov/Search_HCC.aspx(Not DHCS)

County Human Services Offices
Your county human services agency may be able to help you find a doctor or a list of doctors in your area. You can find out how to reach the county offices by clicking this link: http://www.dhcs.ca.gov/services/medi-cal/Pages/CountyOffices.aspx

Dental Providers
To find a dental provider, go to the Denti-Cal website at www.denti-cal.ca.gov and click the “Find a Dentist” link, or call 1-800-322-6384.

Emergency Rooms
As stated above, if you have an emergency and you cannot find a doctor right away, you can go to the emergency room at any hospital. If you show your BIC to staff at the emergency room, Medi-Cal will pay for the services you get.

Find a Doctor on a Managed Care Health Plan
When your Medi-Cal application is finalized, you will be able to join a managed care health plan.  Until then, you can find a doctor on the websites of those Medi-Cal managed care health plans. Click the name of your county to find the plans that serve your area.  When you find a doctor, call and make sure that they accept Medi-Cal FFS.  If they do not, you should contact another doctor on the list found here: http://www.dhcs.ca.gov/individuals/Pages/MMCDHealthPlanDir.aspx

Health Care Options
This DHCS program has information to help you make choices about Medi-Cal benefits and how you can get them. Visit the website for help finding a doctor or dentist, and for more information about Medi-Cal managed care health and dental plans. http://www.healthcareoptions.dhcs.ca.gov/HCOCSP/Home/

Pharmacy Benefits
If you need a prescription filled you can contact your local pharmacies to see if they accept Medi-Cal. For frequently asked questions on Medi-Cal pharmacy benefits please visit this link: http://www.dhcs.ca.gov/services/Pages/PharmacyBenefitsFrequentlyAskedQuestions.aspx

Public Hospitals
Some counties have a public hospital system that lets you get care at a hospital. You can find out which counties and which hospitals are in this program at this site:http://safetynetinstitute.org/californias-public-hospitals-and-clinics/ (Not DHCS)

Yellow Pages (Not DHCS)
The Yellow Pages contain lists of local health care providers.  Only providers who are enrolled as Medi-Cal health care providers will be paid by Medi-Cal for treating you.  Ask the provider if they accept Medi-Cal FFS before you make your appointment.

 

 

Last modified on: 7/18/2014 9:16 AM