Member FAQ
Doctors and other health care providers who care for Medi-Cal members must be enrolled with Medi-Cal. If a provider is not enrolled or their information is missing or out of date, there may be a delay getting medicine or other health care services. These questions and answers explain what to do if your medicine or care is delayed.
My pharmacist said my doctor is not enrolled with Medi-Cal, so I can’t get my prescription. I’ve been with the same doctor for years. Why is this happening?
All doctors and other health care providers who write prescriptions for Medi-Cal members must be enrolled with Medi-Cal. This is required by federal and state law. If your doctor is not enrolled or needs to update their information, your prescription or service may be delayed.
How can I get my medication if my doctor is not enrolled with Medi-Cal?
If you are enrolled in a Medi-Cal health plan, you can call your plan’s Member Services department for help finding an enrolled provider. If you are in fee-for service (not part of a Medi-Cal health plan), you can call the Medi-Cal Telephone Service Center at 1-800-541-5555 to get help finding an enrolled provider. If you need a new prescription, you may need to make an appointment with an enrolled provider.
What if I have a medical emergency or am almost out of my medicine?
If this is a medical emergency, call 911 or go to the nearest emergency room. If you are almost out of your medicine or have already run out, tell your pharmacist right away you have the right to request two 14-day supplies within a 30-day period, with approval from your pharmacy. If you are experiencing difficulties in getting an emergency fill, call your Medi-Cal health plan or the Medi-Cal Telephone Service Center at 1-800-541-5555.
How long will the delay last?
It may take your doctor or provider up to 180 days to enroll. Call your Medi-Cal health plan or the Medi-Cal helpline as soon as possible so you can find a new provider who is enrolled with Medi-Cal.
Will I still get my medicine?
In most cases, yes. If you need your medicine right away, talk to your pharmacist.
Will I have to pay for my medicine or care? Will I be reimbursed?
Ask your pharmacist or provider before you pay out of pocket. If you have questions about payment or reimbursement, contact your Medi-Cal health plan or the Medi-Cal Member helpline at (1-800-541-5555).
Will I still get my care?
Yes. Most people will still get the care they need. If your provider is not enrolled in Medi-Cal, you may need to see a different provider who is enrolled in Medi-Cal to receive your prescriptions. Please see the Medi-Cal Managed Care Health Plan Directory for plan contact information. Your doctor or provider may need to update their Medi-Cal enrollment or fix missing information before Medi-Cal can pay for your medicine or care.
What care could be affected?
This may affect:
- Prescriptions
- Lab tests
- Behavioral health care
- X-rays or imaging
- Medical equipment
- Medical services
Is this something new?
No. These rules have been in place since 2013. Medi-Cal is now checking them more closely.
How do I find a new Medi-Cal provider if I need one?
A. If you are enrolled in a Medi-Cal health plan, you can:
- Call your health plan’s customer service team.
- Use your plan’s provider directory. You can find your plan’s contact information at: http://www.dhcs.ca.gov/mmchpd.
All members, including fee-for-service members, can also:
- Call the Medi-Cal Telephone Service Center at 1-800-541-5555
- Use the Medi-Cal Fee-for-Service Provider Lookup App to find an enrolled provider.