Medi-Cal Members
Understanding Health Data Sharing
This page is here to help Medi-Cal Members like you understand the rules for sharing your health information. Sharing your data with your doctors, your care team, and health plans can improve your care and provide you with timely support.
Your Privacy Matters
Here, you can access information about keeping your health details private. You'll also learn how your health data can be shared, and how your data is protected.
Empowering You with Knowledge
We're sharing resources below to give you the power to make informed choices about your health data. We want to give you the information you need to choose wisely when sharing your health information.
Keeping Your Health Information Safe
Your Privacy Matters
Your health information is protected. Under the Health Insurance Portability and Accountability Act (HIPAA), you have the right to your health data. Sharing your health information with doctors, health plans, and your care team can result in better health outcomes, improve patient safety and coordinated care, and ensure timely access to your services. You can set some limits on who sees information about your health. However, most sharing of information for treatment, payment, and operational needs doesn't need your consent.
Your Choices Matter
When you see your provider for the first time, you might get a consent form. This form lets you pick what information is shared, with whom, for how long, and for what purpose. You can deny sharing information in certain circumstances or change who can see your information. If you change your mind about who you want to see your information, that's okay. Just talk to your provider to learn more about this process.
Your Rights and Access
Your health plan has your claims information and will grant you access to all explanation of benefits information. Your providers have your health records. If you want your records, ask your provider. You can also check out "Your Patient Privacy Rights: A Consumer Guide to Health Information Privacy in California" from the Office of the California Attorney General, and the
Medi-Cal Notice of Privacy Practices.
For more information on HIPAA visit:
State Laws, Regulations, and Guidance
This section provides you with state and federal guidance documents that outline the importance of data sharing.
- AB 133 is a law that was passed in July 2021 and changed California state law to promote data exchange and care coordination for people receiving services under CalAIM (see section 3 that describes AB 133 in the Data Sharing Authorization Guidance 2.0). Specifically, AB 133 allows data sharing even in situations where state privacy laws may not allow data sharing without signed consent. This was done for the purpose of helping people get access to care.
No Wrong Door for Mental Health Services Policy
Data Privacy, Data Sharing, and Interoperability:
CalAIM Population Health Management
CalAIM's Population Health Management program helps members like you access a comprehensive set of services based on your needs and preferences, which leads to improved health outcomes and health equity.
Supporting the Population Health Management roll out, DHCS will be launching a statewide Population Health Management Service for Medi-Cal members. The Population Health Management Service will provide a wide range of Medi-Cal care teams with data access and availability for Medi-Cal members’ health history, needs, and risks, including historical administrative, medical, behavioral, dental, social service data, and other program information from current disparate sources. The Population Health Management Service will improve data accuracy and improve DHCS’ ability to understand population health trends and the efficacy of various Population Health Management interventions and strengthen oversight.
Please see the Population Health Management initiative page for general information on Population Health Management and the Population Health Management Service.Key Policy and Guidance Documents:
Webinars
PHM Service All Comer Webinar - May 23, 2022
Enhanced Care Management (ECM) and Community Supports
Medi-Cal managed care plans provide a new benefit called Enhanced Care Management (ECM). This benefit addresses your clinical and non-clinical needs, if you qualify for the program. The program includes access to a single Lead Care Manager who coordinates all of your health and health-related services.
You may also get access to Community Supports to meet your social needs. Community Supports are services that support your medical needs and that help you stay healthy, including medically tailored meals or support to secure and maintain housing. Medi-Cal managed care plans offer Community Supports services as a cheaper alternative to traditional medical services or settings.
Please see the Enhanced Care Management and Community Support initiative page for general information on the initiative.
Key Policy and Guidance Documents
Webinars
CalAIM Webinar: Data Sharing and Billing for Enhanced Care Management and Community Supports - November 10, 2022
Overview of Data Exchange and Reporting Requirements for Enhanced Care Management and Community Supports - August 4, 2022
Members should contact their provider or their Managed Care Plan for information on how to revoke a Release of Information (ROI) and/or access their health information.
To learn more about information shared with other stakeholders, visit:
