Medi-Cal Managed Care - Cov lus nug nquag
1. Qhov txawv ntawm Tus Nqi-rau-Service (Regular) Medi-Cal thiab Medi-Cal tswj kev saib xyuas yog dab tsi?
Fee-for-Service (FFS) Medi-Cal is also called “Regular” Medi-Cal.
Yog tias koj muaj FFS Medi-Cal, koj tuaj yeem mus rau ib tus kws kho mob Medi-Cal uas lees txais. Koj cov nyiaj pab Medi-Cal feem ntau tsis muaj kev sib koom tes rau koj.
Nrog Medi-Cal Managed Care, koj txoj kev npaj khomob Medi-Cal tswj xyuas koj cov txiaj ntsig thiab muaj ib lub network ntawm cov kws kho mob uas koj tuaj yeem pom. Tsis tas li ntawd, koj txoj kev npaj khomob Medi-Cal muaj cov kev pabcuam hu ua Community Supports uas tsis muaj nyob rau hauv FFS Medi-Cal.
2. Txoj kev npaj kho mob Medi-Cal yog dab tsi?
Medi-Cal txoj kev npaj khomob yog ib txoj hauv kev los pab koj tau txais kev saib xyuas zoo thiab noj qab nyob zoo. Ib txoj kev npaj khomob Medi-Cal yog ib txoj kev npaj khomob uas:
- Ua haujlwm nrog kws kho mob, tsev kho mob, thiab lwm tus kws kho mob hauv koj cheeb tsam muab kev pab kho mob rau koj.
- Muab Medi-Cal cov kev kho mob uas koj xav tau.
- Ua haujlwm nrog koj thiab koj tus kws kho mob los koom tes thiab tswj xyuas koj qhov kev saib xyuas.
Thaum koj nyob hauv Medi-Cal txoj kev pab them nqi kho mob, koj tseem yuav tau txais qee qhov kev pab cuam los ntawm FFS Medi-Cal es tsis yog los ntawm koj qhov kev pab them nqi kho mob Medi-Cal. Hauv ntau lub nroog, cov no suav nrog:
- Tej yam kev pab hauv tsev thiab hauv zej zog
- Feem ntau cov kev pabcuam Medi-Cal
- Cov kev pab kho mob siv tshuaj tsis zoo (SUD).
- Kev kho hniav
Yog tias koj muaj Medicare, koj txoj kev npaj khomob Medi-Cal tseem tuaj yeem muab cov txiaj ntsig ntxiv rau koj uas Medicare yuav tsis them thiab tuaj yeem pab koj nkag mus rau Medicare cov kev pabcuam xws li:
- Kev thauj mus los rau kev teem caij kho mob
- Cov khoom siv kho mob ntev
- Cov khoom siv kho mob
- Kev txhawb zej zog
For more information about Medi-Cal health benefits, go to: Medi-Cal Health Benefits.
3. Medi-Cal Cov Kev Xaiv Kho Mob yog dab tsi?
Medi-Cal Health Care Options (HCO) is a service that helps members learn about Medi-Cal health and dental plans. It helps members make informed choices about their Medi-Cal health and dental plans. You can find more information on the Medi-Cal HCO website.
Yog xav paub ntxiv, hu rau Medi-Cal HCO Hnub Monday-Friday, 8 teev sawv ntxov txog 6 teev tsaus ntuj ntawm (800) 430-4263 (TTY: (800) 430-7077).
Yog tias koj xav kom HCO hu rau koj, ua daim foos hu rau HCO.
Koj tuaj yeem sau rau HCO. HCO chaw nyob xa ntawv yog:
CA Department of Health Care Services
Kev xaiv kho mob
PO ib 989009
West Sacramento, CA 95798-9850
To learn how to contact other DHCS organizations, go to the Contact us page.
4. Leej twg yuav tsum koom nrog Medi-Cal txoj kev npaj kho mob?
Medi-Cal members are “mandatory” if they get CalWORKs benefits (cash aid, CalFresh), Medi-Cal only with no share of cost*, have both Medi-Cal and Medicare, and/or have Other Health Coverage (OHC). This means they must join a Medi-Cal health plan.
* Cov tswv cuab uas tau txais cov kev pab cuam mus sij hawm ntev thiab muaj feem ntawm cov nqi yuav tsum rau npe rau hauv Medi-Cal txoj kev npaj kho mob.
Rau cov npe ntawm Medi-Cal cov phiaj xwm kev noj qab haus huv hauv koj lub nroog, mus rau nplooj ntawv Health Plan Directory .
5. Leej twg tsis tas yuav koom nrog Medi-Cal kev noj qab haus huv?
Tej zaum koj yuav tsis tau koom nrog Medi-Cal txoj kev pab them nqi kho mob yog tias koj:
- Yog ib tug neeg Amelikas Indian/Alaska Native,
- Yog ib tug tswvcuab uas tau txais kev pabcuam hauv kev saib xyuas menyuam yaus, Txoj Haujlwm Pabcuam Adoption Assistance, lossis Kev Pabcuam Tiv Thaiv Menyuam Yaus,
- Nyob hauv California Veteran's Home,
- Twb tau txais kev zam kev kho mob los ntawm qhov yuav tsum tau koom nrog Medi-Cal txoj kev npaj kho mob, lossis
- Tau txais kev zam kev kho mob los ntawm qhov yuav tsum tau koom nrog Medi-Cal txoj kev npaj kho mob.
Yog xav paub ntxiv txog kev zam los ntawm kev koom nrog Medi-Cal txoj kev npaj khomob, hu rau Medi-Cal HCO, Monday – Friday, 8 teev sawv ntxov txog 6 teev tsaus ntuj, ntawm (800) 430-4263 (TTY: (800) 430-7077).
Yog tias koj yog ib tug tswvcuab uas tau txais kev pabcuam hauv kev saib xyuas menyuam yaus, Txoj Haujlwm Pabcuam Adoption Assistance, lossis Cov Kev Pabcuam Tiv Thaiv Menyuam Yaus, thiab koj nyob hauv COHS lossis Ib Lub Nroog Plan, koj yuav raug tso npe rau hauv Medi-Cal txoj kev npaj khomob.
If you live in a non-COHS or non-Single plan county, you are “voluntary” and can choose to join a Medi-Cal health plan or get Medi-Cal through Regular Medi-Cal (FFS). To find out if you live in a COHS, Single Plan, or non-COHS, non-Single Plan county, go to the Medi-Cal HCO Quality Reporting webpage.
6. Yuav ua li cas yog kuv yog ib tug Neeg Qhab Asmeskas lossis Alaska Native Member?
If you are an American Indian or Alaska Native member enrolled in a Medi-Cal health plan, you may get services from an Indian Health Care Provider of your choice. If you have questions about your benefits, call your Medi-Cal health plan or the Medi-Cal Ombudsman at (888) 452-8609. To learn more and to find an Indian Health Care Provider near you, go to Indian Health Care Programs (IHCP) locator.
7. Kuv puas muaj kev xaiv nyob rau hauv kuv txoj kev npaj khomob Medi-Cal?
Yog xav paub seb koj puas muaj ntau tshaj ib qho Medi-Cal txoj kev npaj kho mob xaiv hauv koj lub nroog, mus rau ntawm nplooj ntawv Health Plan Directory.
8. Kuv yuav xaiv Medi-Cal li cas?
Koj txoj kev npaj kho mob Medi-Cal xaiv nyob ntawm ob yam:
- Lub nroog koj nyob, thiab
- Yog tias koj nyob hauv Medicare Advantage (MA) txoj kev npaj
Thaum koj thawj zaug tsim nyog rau Medi-Cal, koj raug them raws li Medi-Cal FFS. Nyob ntawm lub nroog koj nyob, tej zaum koj yuav tau xaiv Medi-Cal txoj kev npaj khomob hauv 30 hnub. Yog tias koj tsis xaiv Medi-Cal txoj kev npaj khomob hauv 30 hnub, Medi-Cal yuav xaiv Medi-Cal txoj kev npaj khomob rau koj.
Yog tias koj yog ib tug tswv cuab ntawm Medicare Advantage txoj kev npaj uas muaj qhov sib npaug Medi-Cal txoj kev npaj khomob hauv koj lub nroog, koj yuav raug rau npe rau hauv Medi-Cal txoj kev npaj khomob.
In some counties, you will be automatically enrolled in a Medi-Cal health plan without having to select one. Please wait for your Medi-Cal health plan “welcome packet” in the mail.
If you find multiple Medi-Cal health plans listed in your My Medi-Cal Managed Care Choice Packet, please explore each Medi-Cal health plan and choose the one that suits you and your family’s needs. You can enroll in a Medi-Cal health plan by phone. Call Medi-Cal HCO Monday– Friday, 8 a.m. to 6 p.m. at (800) 430-4263 (TTY: (800) 430-7077). Or enroll online on the Medi-Cal Health Care Options (HCO) website.
9. Kuv tuaj yeem nrhiav tau cov ntaub ntawv ntxiv txog Medi-Medi Plans rau cov neeg uas muaj Medicare thiab Medi-Cal nyob qhov twg?
Rau cov neeg uas muaj Medicare thiab Medi-Cal, Medi-Medi Plans muaj nyob rau hauv qee lub nroog rau kev tso npe nkag. Medi-Medi Plans yog hom phiaj xwm Medicare Advantage hauv California uas tsuas yog muaj rau cov tswv cuab ob leeg tsim nyog thiab muab kev saib xyuas ua ke.
Medi-Cal muaj Medi-Cal txoj kev npaj sib koom ua ke hauv qee lub nroog. Qhov no txhais tau hais tias yog tias koj koom nrog Medicare Advantage txoj kev npaj thiab muaj Medi-Cal txoj kev npaj uas sib haum nrog txoj kev npaj ntawd, koj yuav raug tso npe rau hauv qhov kev npaj Medi-Cal uas sib xws. Txoj cai no tsis hloov lossis cuam tshuam rau koj txoj kev xaiv ntawm Medicare txoj kev npaj.
Rau ib daim ntawv teev npe ntawm Medi-Medi Plans nyob rau hauv lub nroog, thiab kom paub seb yuav sau npe li cas, mus saib hauv Medi-Medi Plan cov npe webpage.
10. Kuv puas tuaj yeem tso npe rau hauv Kaiser Permanente?
You may join Kaiser Permanente if you live in one of the counties that has Kaiser Permanente as a Medi-Cal health plan option.
You also have to meet one of these requirements:
- Koj yog tus tswv cuab Kaiser Permanente hauv 12 lub hlis dhau los, lossis
- Koj yog ib tus neeg hauv tsev neeg tam sim no ntawm Kaiser Permanente tus tswv cuab (tsev neeg txuas),
- Koj yog ib tug me nyuam yug los, los yog yav tas los tus me nyuam yug los, los yog
- Koj muaj ob qho Medicare thiab Medi-Cal (tsim nyog tau txais ob npaug).
Txhawm rau kawm paub yuav ua li cas rau npe hauv Kaiser Permanente, hu rau Medi-Cal HCO Hnub Monday - Friday, 8 teev sawv ntxov txog 6 teev tsaus ntuj ntawm (800) 430-4263 (TTY: (800) 430-7077).
11. Kuv puas tuaj yeem tso npe rau hauv Txoj Haujlwm Pabcuam Kev Saib Xyuas Txhua Tus Neeg Laus (PACE)?
Yog tias koj muaj hnub nyoog 55 xyoos lossis laus dua thiab xav tau kev saib xyuas qib siab dua nyob hauv tsev, koj tuaj yeem tsim nyog koom nrog PACE txoj kev npaj hauv koj cheeb tsam.
PACE yuav tswj xyuas koj qhov kev kho mob, kev saib xyuas hauv tsev, kev thauj mus los, thiab kev saib xyuas tshwj xeeb xws li kev kho hniav thiab cov khoom siv hnov lus. PACE kuj muaj cov chaw sib raug zoo thiab cov gyms laus.
Kev tso npe rau hauv PACE yog kev yeem. Koj tuaj yeem tshem tawm txhua lub sijhawm. Muaj cov txheej txheem thov koom nrog PACE. Nws suav nrog kev ntsuas kev noj qab haus huv. Nov yog kawm txog koj qhov kev xav tau kev saib xyuas. Cov txheej txheem tuaj yeem siv li ob peb lub lis piam. Yog tias koj muaj Medi-Cal, tsis muaj lwm yam kev them nyiaj los yog kev txiav tawm los rau npe hauv PACE. Cov kev pabcuam PACE suav nrog, tab sis tsis txwv rau:
- Kev Pabcuam Cwj Pwm Kev Noj Qab Haus Huv
- Tus kws kho mob thiab kws kho mob tuaj ntsib
- Kev kho mob ceev thiab ceev ceev
- Khoom siv thiab khoom siv kho mob
- Kev kho mob hauv tsev
- Kev kho mob hauv tsev kho mob thiab kev phais
- Kev saib xyuas hauv tsev
- Kev sab laj txog zaub mov thiab npaj zaub mov
- Kev kho lub cev, kev ua haujlwm, thiab kev hais lus
- Cov tshuaj noj
- Kev thauj mus los thiab los ntawm PACE cov chaw thiab kev teem caij kho mob sab nraud
- Lub zeem muag thiab kev pab kho hniav
Yog xav paub seb PACE puas muaj nyob hauv koj lub nroog lossis xav paub ntxiv txog PACE, mus rau CalPACE lub vev xaib. Lossis hu rau Medi-Cal HCO ntawm (800) 430-4263 (TTY (800) 430-7077 lossis 711).
12. Kuv puas tuaj yeem tso npe rau hauv Senior Care Action Network (SCAN) txoj kev npaj khomob?
SCAN yog rau cov tswv cuab nrog Medicare. Yog tias koj muaj Medicare thiab Medi-Cal, koj tuaj yeem koom nrog SCAN Connections (HMO SNP). Nws yog ib txoj kev npaj kho mob tshwj xeeb, tsuas yog ib qho zoo li hauv California.
With SCAN Connections, you get all Medicare and Medi-Cal benefits. Plus, you get extra benefits to help you stay healthy. SCAN Connections offers a Personal Assistance Line to help answer benefits or health care questions. Your personal assistant can also help you make providers’ appointments. You may also qualify for even more senior services such as in-home and personal care.
Txhawm rau koom nrog SCAN Connections, koj yuav tsum:
- Yuav muaj hnub nyoog 65 xyoos lossis laus dua,
- Nyob hauv Los Angeles, Riverside, San Bernardino, lossis San Diego County, thiab
- Khaws koj li Medicare Tshooj A thiab B thiab Medi-Cal
To learn more, call SCAN at (800) 675-4439 (TTY 711). Or go to the SCAN Health Place website.
13. Kuv puas tuaj yeem tau txais kev zam kev kho mob los ntawm kev koom nrog Medi-Cal txoj kev npaj khomob?
Nyob ntawm lub nroog koj nyob thiab yog tias koj nyob hauv FFS Medi-Cal, koj tuaj yeem tsim nyog tau txais kev zam kev kho mob kom khaws koj tus kws kho mob ntev txog 12 lub hlis yog tias koj muaj mob hnyav thiab koj tus kws kho mob lossis tsev kho mob Medi-Cal yog FFS Medi-Cal tus kws kho mob uas tsis nyob hauv Medi-Cal cov phiaj xwm kev noj qab haus huv hauv koj lub nroog.
Yog tias koj xav nyob hauv FFS Medi-Cal, thov kom zam kev kho mob sai li sai tau. Feem ntau, koj tsis tuaj yeem tau txais kev zam los ntawm kev tso npe saib xyuas kev tswj hwm tom qab koj tau nyob hauv Medi-Cal txoj kev npaj kho mob rau 90 hnub. Koj tus kws kho mob, chaw kho mob, lossis tus kws kho mob tuaj yeem pab koj ua daim foos. Koj tus kws kho mob tseem yuav tau sau ib feem ntawm daim ntawv. Xa daim foos ua tiav rau Medi-Cal HCO. Yog tias koj tau txais kev kho mob tam sim no los ntawm FFS Medi-Cal tus kws kho mob, koj tuaj yeem tsim nyog tau txais kev zam ib ntus los ntawm qhov yuav tsum tau tso npe rau hauv Medi-Cal txoj kev npaj kho mob. Tus kws kho mob FFS tsis tuaj yeem yog ib feem ntawm Medi-Cal txoj kev npaj khomob hauv koj lub nroog. Tus kws kho mob yuav tsum tau kho koj rau ib qho kev mob nyuaj uas tuaj yeem mob hnyav dua yog tias koj yuav tsum hloov cov kws kho mob.
Koj tsis tas yuav muaj kev zam kho mob los khaws koj cov kws kho mob Medicare. Koj tuaj yeem pom koj cov kws kho mob Medicare txuas ntxiv txawm tias tau tso npe rau hauv Medi-Cal txoj kev npaj khomob.
Muaj ob txoj hauv kev uas koj tuaj yeem thov kom zam kev kho mob:
- Hu rau Medi-Cal HCO Hnub Monday - Friday, 8 teev sawv ntxov txog 6 teev tsaus ntuj ntawm (800) 430-4263 (TTY: (800) 430-7077).
- Go to Medi-Cal HCO website
Yog tias koj qhov kev zam kev kho mob raug pom zoo, koj tuaj yeem nyob hauv FFS Medi-Cal thiab khaws koj tus kws kho mob mus txog thaum qhov kev zam kev kho mob xaus.
If you have certain health conditions and want to keep your FFS Medi-Cal provider for more than 12 months, you may be able to ask for a medical exemption extension. You must wait until at least 11 months from your existing medical exemption’s start date to ask for an extension. Medi-Cal HCO will tell you when it is 45 days before your medical exemption ends. They will tell you how to ask for an extension.
If your exemption is denied, you may be able to keep your doctor if you ask your Medi-Cal health for “continuity of care.” This includes your primary care doctor, specialists, and most therapists. Your Provider and Medi-Cal health plan must come to a mutual agreement to allow you to continue to see your Provider. To find out if you qualify for continuity of care you will need to contact your Medi-Cal health plan. You can find out more information on the continuity of care website.
To learn more about exemptions from joining a Medi-Cal health plan, call Medi-Cal HCO Monday – Friday, 8 a.m. to 6 p.m. at (800) 430-4623 (TTY: (800) 430-7077). Or go to the Medi-Cal HCO website.
14. Yuav ua li cas yog tias kuv tsis txaus siab rau kuv txoj kev npaj kho mob Medi-Cal?
Yog tias koj tsis txaus siab rau koj cov kev pabcuam Medi-Cal, koj muaj cai:
- Hloov koj txoj kev npaj khomob Medi-Cal
- Ua ntawv tsis txaus siab lossis tsis txaus siab nrog koj qhov kev npaj khomob Medi-Cal
- Qhia qhov teeb meem no mus rau California Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv Hauv Lub Xeev Ombudsman
- Qhia qhov teeb meem no mus rau California Department of Managed Health Care Office of Patient Advocacy
- Nug lub Xeev Lub Rooj Sib Hais nrog Tus Kws Txiav Txim Plaub Ntug
Please call your Medi-Cal health plan’s member services department first. They may be able to help you with your complaint. To learn more about these options, go to the Medi-Cal HCO Rights page.
15. Kuv tuaj yeem ua ntawv tsis txaus siab lossis tsis txaus siab rau kuv qhov kev npaj khomob Medi-Cal li cas?
A complaint is also called a grievance. To file a complaint or grievance with your Medi-Cal health plan, call the Medi-Cal health plan’s member services. They can help you with your complaint.
You can:
- Sau koj qhov kev tsis txaus siab hauv xov tooj
- Thov kom muaj daim ntawv tsis txaus siab xa mus rau koj qhov chaw nyob
- Tau txais daim ntawv tsis txaus siab los ntawm koj tus kws kho mob
- Xa ib tsab ntawv mus rau koj qhov kev npaj khomob Medi-Cal
- Submit a grievance online through your plan’s website
Yog tias koj sau thiab xa daim foos, khaws ib daim qauv rau koj cov ntaub ntawv.
Your Medi-Cal health plan will review your grievance and answer within 30 days. If you think waiting 30 days will harm your health or you believe your health is in danger, ask for an “expedited” (fast) grievance. Explain why when you submit the form.
Koj qhov kev npaj khomob Medi-Cal yuav lees paub yog tias koj qhov teeb meem ceev thiab pom zoo rau koj qhov kev tsis txaus siab raws li kev nrawm. Yog tias koj qhov kev tsis txaus siab sai sai lossis kev thov rov hais dua tau tso cai, koj qhov kev npaj khomob Medi-Cal yuav tsum ua kom tiav koj qhov kev tsis txaus siab sai sai hauv 3 hnub.
Yog tias koj qhov kev npaj khomob Medi-Cal tsis pom zoo rau koj qhov kev tsis txaus siab sai, lawv yuav teb tsis pub dhau 30 hnub.
You may be able to get free legal help from your county’s Legal Aid Office by calling (888) 804-3536.
16. Yuav ua li cas yog tias kuv tau rau npe rau hauv Medi-Cal txoj kev npaj kho mob tab sis poob kuv qhov kev pab cuam Medi-Cal?
Yog tias koj qhov Medi-Cal xaus, koj yuav muaj sijhawm 3 lub hlis kom rov sau npe rau hauv Medi-Cal. Lub sij hawm txais txiaj ntsig pib hnub kawg uas koj tsim nyog. Hnub ntawd yog nyob rau ntawm Koj Daim Ntawv Ceeb Toom Ua Haujlwm.
Yog tias koj tsis rov sau npe dua thaum kawg ntawm lub sijhawm muaj txiaj ntsig, koj yuav tsum thov Medi-Cal dua.
Yog tias koj hu rau koj lub nroog Medi-Cal lub chaw ua haujlwm hauv lub sijhawm 3-hli tom qab Medi-Cal xaus, thiab koj tsim nyog tau txais Medi-Cal, koj yuav rov rau npe dua. Koj yuav nyob hauv koj li Medi-Cal txoj kev npaj khomob.
Yog tias koj Medi-Cal xaus, hu rau koj lub nroog Medi-Cal chaw ua haujlwm sai li sai tau. Tus neeg ua haujlwm tsim nyog hauv lub nroog yuav qhia koj yuav ua li cas thiaj li rov pib koj qhov Medi-Cal. Nco ntsoov teb txhua qhov kev thov hauv nroog kom koj Medi-Cal rov pib dua thiab txuas ntxiv mus yam tsis muaj kev cuam tshuam. Yog tias koj tsis rov sau npe dua thaum kawg ntawm lub sijhawm muaj txiaj ntsig, koj yuav tsum rov thov rau Medi-Cal.
Nco tseg:
- Yog tias koj tau txais kev pom zoo rau Medi-Cal thiab nyob hauv ib lub nroog uas muaj ntau tshaj ib qho kev xaiv Medi-Cal, koj yuav tsum xaiv Medi-Cal txoj kev npaj khomob hauv 30 hnub. Medi-Cal Health Care Options yuav xa ib daim ntawv Medi-Cal Choice tshiab rau koj. Yog tias koj tsis xaiv Medi-Cal txoj kev npaj khomob hauv 30 hnub, Medi-Cal yuav xaiv ib qho rau koj.
- Yog tias koj tau txais kev pom zoo rau Medi-Cal thiab nyob hauv ib lub nroog uas tsuas muaj ib qho kev xaiv Medi-Cal txoj kev npaj khomob xwb, koj yuav raug tso npe rau hauv Medi-Cal txoj kev npaj khomob ntawd.
17. Muaj kev hloov pauv dab tsi tshwm sim txij li Lub Ib Hlis 1, 2024?Qhov kawg ntawm cov ntsiab lus ntxiv
Thaum Lub Ib Hlis Ntuj hnub tim 1, 2024, California tau hloov Medi-Cal kom koj thiaj li tau txais kev kho mob uas koj xav tau kom ua neej noj qab nyob zoo. Raws li ib feem ntawm 2024 MCP Kev Hloov Pauv, cov phiaj xwm kev noj qab haus huv Medi-Cal yuav tsum ua raws li cov cai tshiab rau qhov zoo, kev nkag mus tau, kev lav ris, thiab kev pob tshab. Cov kev hloov pauv no ua kom ntseeg tau tias peb cov tswv cuab thoob plaws lub xeev tau txais kev kho mob zoo thiab raws sijhawm los ntawm txhua txoj kev npaj kho mob. Txawm hais tias qee tus tswv cuab ntawm Medi-Cal yuav tsum tau hloov cov phiaj xwm kho mob ntawm Medi-Cal, kev pab them nqi thiab cov txiaj ntsig ntawm Medi-Cal tseem zoo li qub.
- Yog xav paub ntxiv txog kev hloov pauv ntawm txoj kev npaj kho mob Medi-Cal los ntawm lub nroog, mus saib lub rooj ntawm lub nroog no: Cov Phiaj Xwm Kev Kho Mob Tswj Xyuas los ntawm Lub Nroog (Txij li xyoo 2023 thiab 2024)
- Yog xav paub ntxiv txog kev hloov pauv ntawm MCP xyoo 2024, mus saib Phau Ntawv Qhia Txoj Cai: 2024 MEDI-CAL MANAGED CARE PLAN TRANSITTION POLICY GUIDE
18. Kuv tuaj yeem tau txais lwm yam kev pabcuam dab tsi los ntawm Medi-Cal?
California Children's Services (CCS) Program
Koj lossis koj tus menyuam tuaj yeem tsim nyog rau CCS Program. CCS yog lub xeev txoj haujlwm rau cov menyuam yaus thiab cov hluas uas muaj qee yam mob, kev txwv lub cev, lossis teeb meem kev noj qab haus huv. Cov menyuam yaus thiab cov tub ntxhais hluas hnub nyoog txog 21 xyoos tuaj yeem tau txais kev kho mob thiab kev pabcuam uas lawv xav tau. CCS yuav txuas tus menyuam lossis cov hluas nrog cov kws kho mob thiab cov neeg saib xyuas kev noj qab haus huv uas paub txog kev saib xyuas lawv cov kev xav tau kev kho mob li cas.
Tus menyuam lossis cov hluas tuaj yeem tsim nyog rau CCS Program yog tias tus menyuam lossis cov hluas:
- Muaj hnub nyoog qis dua 21 xyoos,
- Muaj CCS tsim nyog kho mob
- Nws yog neeg nyob hauv California, thiab
- Muaj tsev neeg cov nyiaj tau los qis dua $40,000
Yog xav paub ntxiv, nrhiav CCS Program hauv koj lub nroog tus lej chaw ua haujlwm.
Kev kho hniav
- Koj tuaj yeem tau txais kev pabcuam kho hniav los ntawm Medi-Cal. Koj cov txiaj ntsig kho hniav tsis hloov pauv thaum koj tso npe rau hauv Medi-Cal txoj kev npaj kho mob.
- For most counties, you get FFS Medi-Cal dental services through the Medi-Cal Dental Program. You need to go to a dental provider who takes Medi-Cal Dental. To find a dental provider, you can call the Medi-Cal Dental Customer Service Center at (800) 322-6384 (TTY: (800) 735-2922), Monday – Friday, 8 a.m. to 5 p.m. You can also find a dental provider and more about Medi-Cal dental services on the “Smile, California” website.
- Yog tias koj nyob hauv Lub Nroog Sacramento, koj yuav tau txais kev pabcuam los ntawm Medi-Cal txoj kev npaj kho hniav. Yog xav paub ntxiv txog cov phiaj xwm no, hu rau Medi-Cal HCO Hnub Monday - Friday, 8 teev sawv ntxov txog 6 teev tsaus ntuj ntawm (800) 430-4263 (TTY: (800) 430-7077).
- Yog tias koj nyob hauv Los Angeles County, koj tuaj yeem tau txais kev pabcuam los ntawm Medi-Cal Dental Program nrog FFS kho hniav lossis Medi-Cal kev npaj kho hniav. Yog xav paub ntxiv txog kev koom nrog Medi-Cal txoj kev npaj kho hniav, hu rau Medi-Cal HCO Hnub Monday - Friday, 8 teev sawv ntxov txog 6 teev tsaus ntuj ntawm (800) 430-4263 (TTY: (800) 430-7077).
- Yog tias koj nyob hauv Nroog San Mateo, koj yuav tau txais kev pabcuam kho hniav los ntawm Txoj Kev Npaj Khomob ntawm San Mateo (HPSM) lossis FFS kho hniav.
- Yog tias koj tau cuv npe hauv HPSM, koj yuav tau txais kev pabcuam kho hniav los ntawm HPSM. Yog xav paub ntxiv txog HPSM, hu rau cov kev pab tswv cuab hnub Monday - Friday, 8 teev sawv ntxov txog 6 teev tsaus ntuj ntawm (800) 750-4776 (TTY: (800) 735-2929).
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- Yog tias koj tau cuv npe hauv Kaiser Permanente, koj yuav tau txais kev pabcuam kho hniav los ntawm FFS kho hniav. Txhawm rau nrhiav tus kws kho hniav, koj tuaj yeem hu rau Medi-Cal Dental Customer Service Center ntawm (800) 322-6384 (TTY: (800) 735-2922), Hnub Monday - Friday, 8 teev sawv ntxov txog 5 teev tsaus ntuj
Kev Pabcuam Hauv Tsev Hauv Tsev (IHSS).
Qhov kev pabcuam IHSS pab them rau cov kev pabcuam uas pab koj nyob nyab xeeb hauv koj lub tsev. IHSS yog lwm txoj hauv kev saib xyuas sab nraud xws li tsev laus lossis pawg thawj coj saib xyuas thiab chaw saib xyuas. IHSS tuaj yeem tso cai rau cov kev pabcuam no:
- Kev tu tsev
- Kev npaj pluas mov
- Khaub ncaws
- Khoom noj khoom haus
- Kev saib xyuas tus kheej, xws li kev saib xyuas plab hnyuv thiab zais zis, da dej, tu cev, thiab kev kho mob
- Nrog rau kev teem caij kho mob
- Kev saib xyuas kev tiv thaiv rau cov neeg puas hlwb
Yog xav thov IHSS, hu rau koj lub nroog lub chaw saib xyuas kev noj qab haus huv. Txhawm rau nrhiav koj lub chaw saib xyuas kev pabcuam hauv nroog mus rau CDSS lub vev xaib. Ib tus neeg saib xyuas kev noj qab haus huv hauv nroog yuav xam phaj koj hauv koj lub tsev kom paub seb koj puas tsim nyog tau txais thiab xav tau IHSS. Raws li koj muaj peev xwm ua tau tej yam hauj lwm zoo rau koj tus kheej, tus neeg ua hauj lwm hauv zej zog yuav ntsuam xyuas cov kev pab cuam uas koj xav tau thiab cov sij hawm uas lub nroog yuav tso cai rau cov kev pab cuam ntawd.
Yog tias koj tau txais kev pom zoo rau IHSS hauv ntau lub nroog, koj yuav tsum ntiav ib tus neeg (koj tus neeg muab kev pabcuam) los ua cov kev pabcuam raug tso cai. Koj lub nroog IHSS Public Authority tuaj yeem pab txuas koj nrog cov kws kho mob uas tsim nyog IHSS.
Cov kev pab cuam puas hlwb
If you need mental health services, talk to your Medi-Cal health plan member services. Or talk to your PCP or your county mental health plan. You may get mental health services through your Medicare or Medi-Cal health plan’s network. You may also qualify for specialty mental health services from your county mental health plan.
Koj txoj kev npaj khomob Medi-Cal thiab koj lub nroog txoj kev kho mob puas hlwb yuav tsum pab koj txog koj cov kev xav tau kev kho mob puas hlwb. Lawv yuav tsum pab koj nrhiav tus kws kho mob. Yog xav paub ntxiv txog koj lub nroog txoj kev npaj kho mob puas hlwb, mus rau ntawm MHP Daim Ntawv Teev Npe lub vev xaib. Txawm koj hu rau tus twg los xij, koj yuav tsum tau txais kev pabcuam tam sim ntawd. Koj tsis tas yuav kuaj mob kom tau txais kev saib xyuas.
Cawv thiab yeeb tshuaj siv cov kev pabcuam kho mob
Yog tias koj xav tau kev pab txog kev haus cawv lossis lwm yam kev siv tshuaj yeeb dawb (SUD) kev kho mob, koj tuaj yeem tau txais kev ntsuam xyuas los ntawm koj qhov kev npaj khomob Medi-Cal. Koj kuj tuaj yeem hu rau koj lub nroog qhov kev pab cuam Drug Medi-Cal rau SUD cov kev pab kho mob. Txhawm rau nrhiav koj lub nroog qhov kev pab cuam Drug Medi-Cal mus rau ntawm SUD Directories lub vev xaib. Lossis hu rau koj qhov kev pab them nqi kho mob Medi-Cal rau kev pab kom tau txais kev kho mob SUD.
Cov chaw muag tshuaj
Medi-Cal Rx suav nrog cov tshuaj uas koj tus kws kho mob tau sau rau koj kom tau txais los ntawm lub tsev muag tshuaj. Koj qhov kev npaj khomob Medi-Cal them rau cov tshuaj uas koj tus kws khomob muab rau koj tus kheej, xws li tom tsev khomob lossis chaw khomob.
To learn more about Medi-Cal Rx prescription drug coverage and pharmacies that take Medi-Cal, go to the Medi-Cal Rx website. Or call the Medi-Cal Rx Customer Service Center at (800) 977-2273 (TTY: State Relay at 711). Have your Medi-Cal Benefits Identification Card (BIC) number ready when you call. You can fill your prescriptions at any Medi-Cal enrolled pharmacy statewide through Medi-Cal Rx. To find one near you, use the Medi-Cal Rx Pharmacy Locator.
Yog tias koj tsim nyog rau Medicare, Medicare Part D yuav them rau feem ntau cov tshuaj. Koj yuav tsum tau them cov nqi sib koom ua ke. Medi-Cal tsuas yog them rau ob peb yam tshuaj uas tsis nyob hauv koj txoj kev npaj Part D.
Kev thauj mus los
Yog tias koj tsis muaj txoj hauv kev mus ntsib kws kho mob, tsev kho mob, kws kho hniav, mob hlwb, lossis kev teem caij kho mob tsis zoo, lossis mus nqa tshuaj lossis lwm yam kev pabcuam Medi-Cal, koj tuaj yeem tsim nyog tau txais kev pabcuam thauj dawb. Koj tuaj yeem tau txais cov kev pabcuam no, hu ua "Non-Medical Transportation (NMT)" los ntawm tsheb, tsheb tavxij, tsheb npav, lossis lwm lub tsheb pej xeem lossis ntiag tug. NMT muaj rau cov kev teem caij uas them los ntawm koj qhov kev npaj khomob Medi-Cal nrog rau cov kev pabcuam uas tau them los ntawm Medi-Cal tab sis tsis yog los ntawm Medi-Cal txoj kev npaj khomob, xws li kev pabcuam kev siv tshuaj yeeb tshuaj.
Yog tias koj tsis tuaj yeem siv lub tsheb, tsheb npav, tsheb tavxij, lossis lwm lub tsheb pej xeem lossis ntiag tug mus rau koj lub sijhawm teem sijhawm vim tias koj muaj kev noj qab haus huv, koj tuaj yeem tau txais kev pabcuam Kev Khomob Tsis Muaj Xwm Ceev (NEMT) rau koj lub sijhawm teem sijhawm los ntawm tsheb thauj neeg mob, lub rooj zaum lub rooj zaum, lossis litter van. NEMT yog rau cov neeg uas tsis tuaj yeem siv kev thauj mus los hauv pej xeem lossis ntiag tug. Koj yuav xav tau daim ntawv tshuaj los ntawm tus kws kho mob uas muaj ntawv tso cai kom tau txais NEMT. Koj tus kws kho mob thawj zaug, kws kho hniav, kws kho hniav, kws kho mob hlwb, lossis tus kws kho mob siv yeeb tshuaj tuaj yeem sau NEMT.
Your Medi-Cal health plan can help you schedule your transportation. To ask for a ride, call the Medi-Cal health plan’s member services.
Thaum thov kev thauj mus los, koj yuav tsum hu rau koj qhov kev npaj khomob Medi-Cal sai li sai tau ua ntej teem sijhawm. Yog tias koj muaj ntau lub sijhawm teem sijhawm, koj tuaj yeem thov kev thauj mus los rau cov sijhawm teem sijhawm ib zaug.