What is the difference between Medi-Cal Fee-for-Service and Medi-Cal Managed Care?

If you have Medi-Cal Fee-for-Service, you can go to any Medi-Cal provider who accepts it. Your Medi-Cal benefits are usually not coordinated for you.

With Medi-Cal Managed Care, your Medi-Cal health plan coordinates your benefits and has a network of providers you can see. Also, your Medi-Cal health plan offers services called Community Supports and Enhanced Care Management that are not offered in Medi-Cal Fee-for-Service

How do I find a provider in Medi-Cal Fee-for-Service?

You can see any provider who accepts Medi-Cal Fee-for-Service. If you already have a doctor or clinic, call and ask: “Do you take Medi-Cal Fee-for-Service?”

• If they say yes, you can keep going there.
• If they say no, you will need to choose a new doctor.

Call the Medi-Cal Help Line (1-800-541-5555) for help understanding the change or finding Medi-Cal Fee-for-Service providers.

The Find Doctors and Services online tool will be updated in September with more user-friendly features to make it easier for members to find providers, and it will continue to be improved throughout the transition.

What if I already have appointments for January 1, 2027, or later?

Call your provider and ask if they accept Medi-Cal Fee-for-Service.

• If yes, you can keep your appointment.
• If no, make a new appointment with a doctor who accepts Medi-Cal Fee-for-Service.

Can I keep seeing my specialist?

Ask your specialist: “Do you take Medi-Cal Fee-for-Service?”

• If yes, you can keep seeing them.
• If no, find a new specialist who accepts Medi-Cal Fee-for-Service.
• Call the Medi-Cal Help Line (1-800-541-5555) for help understanding the change or finding Medi- Fee-for-Service providers.
• The Find Doctors and Services online tool will be updated in September with more user-friendly features to make it easier for members to find providers, and it will continue to be improved throughout the transition.

Will my prescriptions or pharmacy change?

No. Your Medi-Cal Rx pharmacy benefit will stay the same.

When you see a new Medi-Cal Fee-for-Service doctor, tell them what medicines you take and if you need refills. If you have Medicare, your Medicare Part D drug plan will still work with Medi-Cal Rx.

What about my medical supplies (like catheters or wound care supplies)?

Some medical supplies will now be billed to Medi-Cal Fee-for-Service instead of your old Medi-Cal health plan. If you need help getting supplies, call the Medi-Cal Help Line at 1-800-541-5555 and say what type of supplies you use. They will help you find a provider.

What happens to my wheelchair, walker, or other Durable Medical Equipment?

You can keep using your equipment when you move to Medi-Cal Fee-for-Service.

You may need a doctor who accepts Medi-Cal Fee-for-Service to approve it again, so it stays covered.

For help, call the Medi-Cal Help Line at 1-800-541-5555 and tell them what you use (for example: wheelchair, walker, oxygen). They can help you find a provider.

What about my transportation to medical appointments?

You may still get rides. You might need a form from your new Medi-Cal Fee-for-Service doctor.

This includes Non-Emergency Medical Transportation (like wheelchair vans or ambulances) and Non-Medical Transportation (rides to appointments).

For help, call the Medi-Cal Help Line at 1-800-541-5555 or learn more online.

Will I need new approvals (authorizations) for services?

Maybe. Some services will need a new authorization from your Medi-Cal Fee-for-Service provider. Ask your provider if you have questions.

Can I keep my current doctor or clinic?

Ask your doctor or provider: “Do you take Medi-Cal Fee-for-Service?”

• If yes, you can stay with them.
• If no, you will need to find a new provider.

If you need help finding Medi-Cal Fee-for-Service providers or understanding this change, call the Medi-Cal Help Line at 1-800-541-5555.

Will my county mental health care change?

No. If you get specialty mental health or substance use services through your County Behavioral Health Plan, your care will stay the same. Non-specialty mental health services such as therapy, counseling, medication follow-up, and psychological testing, will continue in Medi-Cal Fee-for-Service. You can get these services from any Medi-Cal Fee-for-Service provider who offers them.

What dental services do I get through Medi-Cal Fee-for-Service?

Dental care is not changing for most members:

• San Mateo County: Moving to Dental Fee-for-Service on January 1, 2027.
• Los Angeles and Sacramento counties: Staying in Dental Managed Care.
• All other counties: Already using Dental Fee-for-Service.

Starting July 1, 2027, some adults will only get emergency dental care.

Visit www.smilecalifornia.org to learn more.

To find a dentist, call 1-800-322-6384 or visit the Medi-Cal Dentist Provider Directory.

My health plan gives me extra help, like support finding services or housing. Will I still get that after I move to Medi-Cal Fee-for-Service?

No. Medi-Cal Fee-for-Service does not include Enhanced Care Management (care management for people with complex needs) or Community Supports (non-medical services like medically tailored meals and help finding housing). These services are only offered in managed care.

You may still get other kinds of help in Fee-for-Service, like:

• Support from Community Health Workers, promotoras, and Tribal representatives
• Chronic care management
• Doula services
• County mental health and substance use treatment
• Programs that help people stay at home or in their community Call the Medi-Cal Help Line at 1-800-541-5555 for help finding services.

Will I get help during this change?

Yes. DHCS will offer new support to help members. This includes:

• The Medi-Cal Fee-for-Service Nurse Advice Line, beginning in January, with trained staff who can answer questions and help you find care
• Clinic and community-based helpers to help you find services and get support in your own language

Will my child keep the same benefits they have in the Whole Child Model (WCM) California Children’s Services (CCS) Program?

Yes. Children who are in the CCS Program will keep the same CCS services they get today.

Your child will not get Enhanced Care Management or Community Supports anymore, because those services are only in Medi-Cal health plans.

For questions about your child’s CCS services, contact your County CCS Office.

What if I get a medical bill?

If the bill is for care you got before January 1, 2027, call your Medi-Cal health plan using the number on your plan card.

If the bill is for care you got on or after January 1, 2027, call the Medi-Cal Help Line at 1-800-541-5555.

If you think the bill is wrong, you can file a complaint with DHCS by calling (916) 345-8980, emailing Medi-Cal.Benefits@dhcs.ca.gov or visiting dhcs.ca.gov/File-a-Complaint.

What if I am in a Medi-Medi Plan?

A Medi-Medi Plan is for people who have both Medicare and Medi-Cal.

Because you will no longer be in a Medi-Cal health plan, you will leave your Medi-Medi Plan on January 1, 2027.

If you still have Medicare, you can use Original Medicare or choose another Medicare plan.

Call 1-800-MEDICARE or the Health Insurance Counseling and Advocacy Program at 1-800-434-0222.

What if I need to file a complaint?

If you think something is wrong with your Medi-Cal benefits or services, you can tell DHCS.

Call (916) 345-8980, email Medi-Cal.Benefits@dhcs.ca.gov, or go to dhcs.ca.gov/File-a-Complaint.

Where can I get help or learn more?

• Medi-Cal Help Line: 1-800-541-5555
• Dental: 1-800-322-6384 or SmileCalifornia.org
• Medi-Cal rights/help: 1-888-452-8609 (TTY 711)
• Help for members with both Medicare and Medi-Cal: 1-855-501-3077
• Other formats (large print, audio, braille): 1-800-430-4263
• More information: Medi-Cal Changes