Home Medi-Cal Updates Fee-for-Service Transition Member Letter

Member Letter

Fee-for-Service Transition

Medi-Cal

A new federal rule requires California to change how some immigrants get Medi-Cal. You will still have Medi-Cal. This means you will keep your Medi-Cal benefits and have access to almost all the same health services as before. All medically necessary services will still be covered by your Medi-Cal. But the way you get benefits will change and you may have to change where you get services. Some benefits may also change.

What is changing?

Starting January 1, 2027, you will no longer get your care through a Medi-Cal health plan. You will still have Medi-Cal coverage, but you will get your care through Medi-Cal Fee-for-Service instead. Fee-for-Service is a way Medi-Cal pays doctors and other care providers. With Medi-Cal Fee-for-Service, you can go to any doctor, clinic, and other providers that accept Medi-Cal Fee-for-Service.

The members listed below will be moved from the Medi-Cal health plan to Medi-Cal Fee-for-Service starting on January 1, 2027:

See your member notice

Starting January 1, 2027:

  • Your Medi-Cal health plan will no longer provide or coordinate your Medi-Cal covered services.
  • You will not use your Medi-Cal plan network to find providers.
  • You will be enrolled in Medi-Cal Fee-for-Service.
  • You will still have Medi-Cal coverage, but you will get your care through Medi-Cal Fee-for-Service.
  • You can only see a provider such as a doctor or clinic who accepts Medi-Cal Fee-for-Service.
  • You can keep your current doctor if they accept Medi-Cal Fee-for-Service.
  • You can keep using your Medi-Cal Benefits Identification Card (BIC).

Certain services from your current Medi-Cal health plan will no longer be available in Medi-Cal Fee-for-Service. Medi-Cal Fee-for-Service does not offer Enhanced Care

Management (ECM) or Community Supports. If you have a Lead Care Manager through ECM that provides you with extra support, or if you get medically tailored meals, housing-related supports, or similar services, these services will no longer be available. Other services may still be available to help you. Contact your current Medi-Cal health plan or your ECM or Community Supports provider to prepare for this change.

You will need to go to providers who take Medi-Cal Fee-for-Service, starting January 1, 2027

What you should do now:

Keep using your Benefits Identification Card (BIC)

Always take your Medi-Cal BIC to medical, dental, and pharmacy visits. Your BIC is a plastic card. It has a “poppy flower” or blue and white design. “State of California” is on the card. If you need a new BIC, call your county Medi-Cal office. You can find a list of county Medi-Cal offices online.

If you have both Medicare and Medi-Cal and are enrolled in a Medi-Medi plan

  • You will be moved from your Medi-Medi plan starting January 1, 2027. This is because you will no longer qualify to be in a Medi-Cal health plan.
  • For questions about changes to your Medicare coverage, call 1-800-MEDICARE or (800) 633-4227.
  • You can also call the Health Insurance Counseling and Advocacy Program (HICAP) at (800) 434-0222. Or call the Medicare and Medi-Cal Ombudsperson Program (MMOP) at (855) 501-3077.

Where to learn more

You can read more about this change in the Notice of Additional Information About Your Rights and Benefits (NOAI). The NOAI has more information about Medi-Cal Fee-for-Service. It has resources on who to call with questions. The resources are also listed at the end of this letter. Or use your smartphone to scan the Quick Response (QR) code at the end of this letter to read the NOAI.

If you want a printed NOAI mailed to you, call Medi-Cal Health Care Options (HCO) Monday – Friday, 8 a.m. to 6 p.m., at (800) 430-4263 (TTY: (800) 430-7077).

If you want this notice in another language or format like large print, audio, or Braille, call Medi-Cal HCO Monday – Friday, 8 a.m. to 6 p.m., at (800) 430-4263 (TTY: (800) 430-7077).

Questions?

If you have general Medi-Cal questions, call the Medi-Cal Helpline Monday – Friday, 8 a.m. to 5 p.m., at (800) 541-5555. The call is free. They will help you learn more about what services you can get through Medi-Cal.

If you have questions about dental care, call the Medi-Cal Dental Telephone Service Center Monday – Friday, 8 a.m. to 5 p.m., at (800) 322-6384. The call is free. Or visit www.smilecalifornia.org.

If you need help using your Medi-Cal benefits or understanding your rights, call the Medi-Cal Ombudsman Office Monday – Friday, 8 a.m. to 5 p.m., at

(888) 452-8609 (TTY: 711 for California State Relay). The call is free. Or email MMCDOmbudsmanOffice@dhcs.ca.gov.

If you have both Medicare and Medi-Cal, call the Medicare and Medi-Cal Ombudsperson Program (MMOP) at (855) 501-3077. The call is free. The MMOP can help dual eligible members with questions about coverage, enrollment, and getting care.

To learn more about Medi-Cal Medi‑Medi plans, view the Medi‑Medi Provider Factsheet or the Medi‑Medi Outreach page.

If you want a printed copy of the NOAI mailed to you, or you want a copy of this notice in another format like large print, audio, or Braille, call Medi-Cal HCO Monday – Friday, 8 a.m. to 6 p.m., at (800) 430-4263 (TTY: (800) 430-7077). The call is free. Or go to Medi-Cal HCO at www.healthcareoptions.dhcs.ca.gov. HCO is a service that helps members learn about Medi-Cal health and dental plans.

Learn more about Medi-Cal program changes.

For questions about changes to the scope of Medi-Cal coverage based on immigration status call the Medi-Cal Helpline Monday – Friday, 8 a.m. to 5 p.m., at (800) 541-5555. The call is free.

Find your local county Medi-Cal office.

For questions about your Medi-Cal health plan, contact your Medi-Cal health plan. To find your Medi-Cal health plan, use the Medi-Cal Managed Care Health Plan Directory.

Thank you,

Medi-Cal

Department of Health Care Services