Providers FAQs

All Medi-Cal MCPs will become responsible for covering institutional LTC services in an adult and pediatric Subacute Care Facilities​. ​

Will changes to Medi-Cal health plans impact Medi-Cal coverage? 

No. Members’ Medi-Cal coverage and benefits will stay the same even if their Medi-Cal health plan changes.

​​​What must members in counties with health plan changes do?

Health plan is changing

If Medi-Cal health plans are changing in their county, members may have to choose a new Medi-Cal health plan.

Automatic enrollment

In some counties, members will be automatically enrolled in a health plan without having to select one. 

Find out if Medi-Cal health plans for members in your county will change.

​​How will Medi-Cal inform members about these health plans changes?

MCP Choice Counties (Geographic Managed Care (GMC), Two-Plan, and Regional Medi-Cal managed care counties 

Alpine, Amador, Calaveras, El Dorado, Fresno, Inyo, Kern, Kings, Los Angeles, Madera, Mono, Riverside, Sacramento, San Bernadino, San Diego, San Francisco, San Joaquin, Santa Clara, Stanislaus, Tulare, and Tuolumne 

If a member’s health plan is changing: 

• October 2023 – Members who are currently enrolled in a Managed Care Plan that will be exiting the county at the end of 2023, will be mailed a letter from their current Medi-Cal health plan letting them know about the health plan changes. 
• November and December 2023 – Member will be mailed a letter from Medi-Cal with additional information about: 
  • new health plan enrollment 
  • additional options that may be available 
  If they have to choose a new health plan, they will receive a Choice Packet to choose a new Managed Care Plan in their county. The member must select a new Plan by December 22, 2023. If they don’t, they will be automatically enrolled in a new health plan or Medi-Cal Fee-For-Service (i.e., foster care children or youth members).
• ​ December 2023 – After a member selects a new Medi-Cal health plan or is automatically enrolled into a new health plan, they will be mailed a letter with information about their new health plan. 
• January 2024 – Member’s new health plan will mail them a welcome packet. 

Single-Plan or County-Organized Health System (COHS) 

Alameda, Butte, Colusa, Contra Costa, Del Norte, Glenn, Humboldt, Imperial, Lake, Lassen, Marin, Mariposa, Mendocino, Merced, Modoc, Monterey, Napa, Nevada, Orange, Placer, Plumas, San Benito, San Luis Obispo, San Mateo, Santa Barbara, Santa Cruz, Shasta, Sierra, Siskiyou, Solano, Sonoma, Sutter, Tehama, Trinity, Ventura, Yolo, and Yuba 

In some counties, members will be automatically enrolled in a health plan without having to select one. 

If the member lives in a county that is changing to a Single Plan Model county or a county that is changing to a County-Organized Health System (COHS) model, they will be enrolled in the COHS plan, Single Plan, or Kaiser Permanente. 

• October 2023 – Members who are currently enrolled in a Managed Care Plan that will be exiting the county at the end of 2023, will be mailed a letter from their current Medi-Cal health plan letting them know about the health plan change. 
• November and December 2023 - Members will be mailed a letter from Medi-Cal with additional information about: 
• New health plan enrollment 
• Additional options that may be available 
• December 2023 - Members will be mailed a letter from Medi-Cal with information about their automatic enrollment into a new health plan or Medi-Cal Fee-for-Service (FFS) (i.e., foster care children or youth members in Single-Plan Counties)
• January 2024 – Member’s new health plan will mail them a welcome packet.

T​ransition information for foster care children and youth members​​

​​Can ​my patients keep seeing me if I am in their new Medi-Cal health plan network?

If you are a network provider in your patient’s previous health plan and their new health plan, your patient can continue to see you. Please work with the new plan and your patient to confirm that you are assigned as the primary care provider​.

​​Can my patients keep seeing me if I am not in their new Medi-Cal health plan network?

• If your patient has seen you in the past 12 months and you are not in their new Medi-Cal health plan network, they might be able to keep seeing you if they, their Authorized Representative, or you ask their new Medi-Cal health plan for “continuity of care (CoC)” and if certain requirements are met. 
• Continuity of care refers to a set of coordination policies that are designed to protect member access to care after the 2024 MCP Transition. Robust CoC policies help members maintain trusted relationships with providers and access to needed services as they transition between MCPs and until the member can transition to a network provider in their new health plan, promoting positive health outcomes. CoC protections are foundational in the Medi-Cal system. These protections are in place today.
  
• Continuity of care means members may be able to keep their Medi-Cal provider for up to 12 months after they join a new Medi-Cal health plan. 
• You can agree to work with your patient’s new Medi-Cal health plan (1) by requesting a Continuity of Care​​ for Providers agreement (a single case agreement) or (2) by requesting to join the Medi-Cal health plan's network. A Continuity of Care for Providers agreement can last up to 12 months or, in some cases, longer. 
• If you will not be working with your patient’s new Medi-Cal health plan, their new Medi-Cal health plan will help them find a new doctor.
  

You may already be in your patients’ new Medi-Cal health plans’ network in their county.
To learn whether you are in a Medi-Cal health plan network, contact the health plan.​

​​​​What requirements must be met for my patients to continue to receive care from me? 

1. The provider is classified as eligible for continuity of care.
   
• Providers eligible for Continuity of Care:
• ​Primary care providers (PCPs)
• Specialists
• Enhanced Care Management (ECM) providers
• Community Supports providers
• Skilled Nursing Facilities (SNFs)
• Intermediate Care Facilities for individuals with Developmental Disabilities (ICF/DD)​*​
• Community-Based Adult Services providers
• Select ancillary providers:
• Dialysis centers
• Physical therapists
• ​​Occupational therapists
• Respiratory therapists
• Mental health providers 
• Behavioral health treatment (BHT) providers 
• ​Speech therapy providers 
• ​Doulas 
• ​Community Health Workers
• Providers excluded from Continuity of Care:
  

• ​​A​ll other ancillary providers, such as: ​
• Radiology ​
• Laboratory 
• Non-emergency medical transportation (NEMT) 
• Non-medical transportation (NMT) 
• Other ancillary services 
• ​​ Non-enrolled Medi-Cal Providers​

1. ​The member has a pre-existing relationship with the eligible provider, defined as at least one non-emergency visit during the 12 months preceding January 1, 2024 
2. The provider is willing to accept the new health plan’s contract rates or Medi-Cal FFS rates 
3. The provider meets professional standards and there are no quality-of-care issues 
4. The provider is CA State Plan approved 
5. The request for continuity of care is made prior to the date of service up until December 31, 2024. 
6. If the services were rendered prior to the continuity of care request, the requestor must contact the patient’s new health plan within 30 calendar days after the date of service. 

Will my patients be able to continue an authorized service or active course of treatment if they change Medi-Cal health plans? 

• If your patient was authorized before January 1, 2024, to receive a Medi-Cal covered service, then your patient can continue to receive that service without a new authorization from your patient’s new Medi-Cal health plan until July 1, 2024. 
• If your patient was receiving an active course of treatment before January 1, 2024, then your patient can continue to receive their prescribed course of treatment without an authorization from your patient’s new Medi-Cal health plan until July 1, 2024. 
• Contact your patient’s new Medi-Cal health plan if you have any questions about the new health plan honoring your patient’s authorization or active course of treatment. 
• You may need to submit a prior authorization for your patient to continue a service or treatment beyond July 1, 2024. 
• Your patient may need to switch doctors to continue their service or treatment beyond January 1, 2024, if you are not in their new Medi-Cal health plan’s network or do not have a Continuity of Care for Providers agreement with their new Medi-Cal health plan.​ 
  

If my patient’s current managed care plan is changing, can they still be enrolled in Enhanced Care Management (ECM) and Community Supports between October 2023 and December 31, 2023? 

Members currently enrolled in a managed care plan can still be enrolled in ECM and Community Supports by their exiting health plan until December 31, 2023.

When a member who is already receiving Community Supports transitions to a new managed care plan, they may be eligible to receive the same Community Supports services so long as those services are offered by their new plan.​

​​If my patient is new to Medi-Cal, can they be enrolled in Enhanced Care Management (ECM) and Community Supports between October 2023 and December 31, 2023? 

ECM and Community Supports are only offered by Medi-Cal managed care plans and are not available in Medi-Cal Fee-For-Service (FFS). If your patient enrolls with an MCP that currently operates in their county, they will be enrolled on the first of the following month and can access ECM and Community Supports after their enrollment date. 

In some instances, your patient may enroll with an MCP that is newly operating in their county starting January 1, 2024. In these instances, your patient will remain in Medi-Cal FFS until their enrollment into their MCP effective January 1, 2024 and they will not be able to receive ECM and Community Supports until after their effective enrollment date. 

For more information on current MCPs and MCPs newly operating on January 1, 2024, please refer to the list of Medi-Cal MCPs by county​.

​​Will my patient’s new Medi-Cal health plan contact me if I am not in their new Medi-Cal health plan network? 

• In some limited cases, a patient’s new Medi-Cal health plan may contact their providers to ask if they will continue seeing the patient. 
• Do not assume your patient’s new Medi-Cal health plan will contact you. If your patient wants to continue receiving care from you, then the patient, authorized representative, or you will need to contact your patient’s new Medi-Cal health plan. 

What does the transition mean for members who are foster care children and youth?

If a county is changing to a County Organized Health Systems Model (Butte, Colusa, Glenn, Mariposa, Nevada, Placer, Plumas, San Benito, Sierra, Sutter, Tehama, Yuba), members are required to enroll into the Medi-Cal health plan in their county. 

• The member will receive a notice in November and in December letting them know of this change. In January, the member will receive a Welcome Packet from their new health plan. 
• It is important for them to choose a primary care provider and their new health plan can help them choose one. 
•  If the member has a primary care provider today, they should call their new health plan to make sure that doctor works with them. 

If a county is changing to a Two Plan Model and members are currently in Fee-For-Service (FFS) Medi-Cal (Alpine, El Dorado), they are still voluntary to be in a managed care plan. 

• Members currently enrolled in FFS will not receive transition notices in late 2023. 
• If the member is voluntarily enrolled in a managed care plan today that will no longer be available in the county on January 1, 2024, the member will receive a notice from their current plan in October letting them know they will no longer be the member’s plan beginning in January. 
• The member will also receive a notice in November and December letting them know about this change. 
• The member will receive a voluntary enrollment packet to choose a plan in their county if they want to be in managed care. 
  
•  If the member does not choose a plan, they will go to FFS Medi-Cal effective January 1, 2024. 

If a county is changing to a Single Plan Model (Alameda, Contra Costa, Imperial) and members are currently in Fee-For-Service (FFS) Medi-Cal, they are still voluntary to be in a managed care plan. 

• Members currently enrolled in FFS will not receive transition notices in late 2023.
• If they are voluntarily enrolled in a managed care plan today that will no longer be available in the county on January 1, 2024, they will receive a notice from their current plan in October letting them know they will no longer be the member’s plan beginning in January. 
• The member will also receive a notice in November and December letting them know about this change. • To enroll in a new Medi-Cal health plan, call Medi‑Cal Health Care Options (HCO) Monday – Friday, 8 a.m. to 6 p.m. at (800) 430-4263 (TTY: (800) 430-7077). Or go to www.healthcareoptions.dhcs.ca.gov. 
• If the member does not choose a new plan, they will remain enrolled into FFS Medi-Cal. 
• Foster care children and youth members in a Single Plan county will not be mandatory to be enrolled in a managed care plan until 2025. [Assembly Bill (AB) 118​]

Will Medicare change when Medi-Cal health plan changes for dual eligible members (who have both Medi-Cal and Medicare)?

If your patient is also enrolled in Medicare, their Medicare benefits and providers will not change when their Medi-Cal health plan changes.

Medicare providers:​

• Do not have to be in a patient’s Medi-Cal health plan network to keep providing care. 
• Cannot charge co-pays, co-insurance, and deductibles if patients have Medi-Cal. 
• Must be registered as an active Medi-Cal provider or submit an application to receive reimbursement as a “Crossover Only” provider via the DHCS PAVE Provider Portal to receive reimbursement for a crossover claim from a Medi-Cal plan.
• Should consult the DHCS Crossover billing toolkit​​ regarding procedures for crossover billing.​

If your patient has questions about their Medicare, or Medicare Advantage plan, they should call (800) MEDICARE, or the number on their Medicare Advantage plan member card. See the Notice of Additional Information​ for more details ​about Medicare.

Will PACE and SCAN health plans change if your patient’s Medi-Cal health plan changes? 

• Program of All-Inclusive Care for the Elderly (PACE) and Senior Care Action Network (SCAN)​ plans will not change.
  
• How to enroll in a PACE or SCAN health plan.​
  

What protections are there for American Indian and Alaska Native Members during this transition?

Member has an Indian healthcare provider 

American Indian/Alaska Native (AI/AN) members can get healthcare services from any Indian Health Care Provider (IHCP) at any time. 

For assistance, contact: 

• Member’s Medi-Cal health plan or 
• Medi-Cal Ombudsman 
• Phone: (888) 452-8609 (Call is free.)
• TTY: 711 for California State Relay 
• Email: MMCDOmbudsmanOffice@dhcs.ca.gov​

Member has a Non-Indian healthcare provider 

AI/AN members getting care from a provider who is not an Indian Health Care provider may be able to get continuity of care to keep the same provider. If they need assistance with continuity of care, they should contact their Medi-Cal health plan.

Managed care opt-out 

• AI/AN members can opt out of managed care in some counties.
• For counties where a member cannot opt out, the member still has a right to be seen by an Indian Health Care Provider (IHCP) even if t​hey are not with the plan.

For more information:​

• Notice of Additional Information
• Managed Care Plan Transition Policy Guide​​
• Contact Health Care Options
• Phone: (800) 430-4263​
• Website: www.healthcareoptions.dhcs.ca.gov​​

​Where can Medi-Cal providers get more information and support?​

• Visit MCP Transition​ 
• Contact your MCP network helpline
  

Where can Medi-Cal members get more information and support?​

• Visit Contact Us​
  

* ​Continuity of Care Policy only applies to members residing in ICF/DD who are in managed care as of December 31, 2023. See the Managed Care Plan Transition Policy Guide​ for more information.