Medi-Cal Kev Tsim Nyog & Covered California - FAQ's
Rov qab mus rau Medi-Cal FAQs
Hauv qab no koj yuav pom cov lus nug uas nquag nug tshaj rau cov neeg tau txais kev pab Medi-Cal tam sim no thiab muaj peev xwm. Yog tias koj tsis pom cov lus teb rau koj cov lus nug, thov hu rau koj lub chaw lis haujlwm hauv nroog los ntawm peb lub County Listings nplooj ntawv lossis email rau peb ntawm Medi-Cal Hu rau peb.
Kev pab them nqi kho mob Medi-Cal
Medi-Cal yog dab tsi?
Medi-Cal muab kev pab them nqi kho mob dawb lossis nqi qis rau cov neeg nyob hauv California uas ua tau raws li qhov yuav tsum tau muaj. Cov neeg thov feem ntau uas thov los ntawm Covered California thiab rau npe hauv Medi-Cal yuav tau txais kev saib xyuas los ntawm cov phiaj xwm kev noj qab haus huv.
Medi-Cal yeej ib txwm them rau cov menyuam tau nyiaj tsawg, cov poj niam cev xeeb tub thiab tsev neeg. Thaum Lub Ib Hlis 1, 2014, California tau nthuav dav
Medi-Cal kev tsim nyog suav nrog cov neeg laus tau nyiaj tsawg. Thaum koj ua tiav daim ntawv thov Covered California, koj qhov kev tsim nyog rau Medi-Cal yuav raug txiav txim siab. Koj tuaj yeem thov rau Medi-Cal cov kev pab cuam txawm hais tias koj yog poj niam txiv neej, haiv neeg, kev ntseeg, xim, haiv neeg twg, kev nyiam poj niam txiv neej, kev txij nkawm, hnub nyoog, kev tsis taus, lossis qub tub rog.
Medi-Cal nqi npaum li cas?
Rau ntau tus neeg uas tso npe rau hauv Medi-Cal, tsis muaj nqi them, tsis them nyiaj, thiab tsis muaj nqi hauv hnab tshos. Pib txij Lub Xya Hli 1, 2022, tag nrho cov nqi them txhua hli raug txo rau $0.00. Feem ntau, cov tib neeg hauv Medi-Cal yuav tau txais cov txiaj ntsig kev noj qab haus huv tib yam muaj nyob hauv Covered California ntawm tus nqi qis dua.
Qhov txawv ntawm Medi-Cal thiab Covered California yog dab tsi?
Medi-Cal yog kev pab them nqi kho mob, ib yam li cov kev pab them nqi kho mob uas muaj los ntawm Covered California. Medi-Cal muab cov txiaj ntsig zoo ib yam li cov kev xaiv muaj nyob hauv Covered California, tab sis feem ntau qis dua lossis tsis muaj nqi rau koj lossis koj tsev neeg. Tag nrho cov phiaj xwm kev noj qab haus huv tau muab los ntawm Covered California lossis los ntawm Medi-Cal suav nrog tib cov txiaj ntsig zoo uas hu ua "cov txiaj ntsig kev noj qab haus huv tseem ceeb." Cov txiaj ntsig kev noj qab haus huv tseem ceeb muaj xws li:
Kev pab kho mob sab nraud (Ambulatory).
Kev pabcuam xwm txheej ceev
Kev kho mob hauv tsev kho mob
Maternity and Newborn care
Kev Noj Qab Haus Huv Kev Noj Qab Haus Huv thiab Kev Siv Tshuaj Siv Tshuaj, suav nrog Kev Kho Tus Cwj Pwm
Tshuaj
Cov kev pab cuam xws li kev kho lub cev thiab kev ua haujlwm (lub npe hu ua Rehabilitative & Habilitative Services) thiab cov khoom siv
Cov kev pabcuam kuaj mob
Kev tiv thaiv thiab kev noj qab haus huv & kev tswj kab mob ntev
Cov Kev Pab Cuam Me Nyuam (Pediatric), suav nrog kev saib xyuas qhov ncauj thiab qhov muag.
Kev tshawb fawb tsis ntev los no ntawm Medi-Cal cov tswv cuab los ntawm California Healthcare Foundation (CHCF) pom tias 90% ntawm cov neeg teb cov lus teb Medi-Cal yog ib qho kev pabcuam zoo lossis zoo heev. Medi-Cal qhia txog kev tiv thaiv kev noj qab haus huv uas txhawb nqa kev noj qab haus huv thiab kev noj qab haus huv thiab ua haujlwm kom ntseeg tau tias cov tswv cuab tau txais kev saib xyuas raug raws sijhawm.
Lub xeev thiab/lossis lub nroog twg mus cuag cov neeg tsis muaj tsev nyob li cas thiaj li kos npe rau kev kho mob?
Kev nthuav qhia thiab kev tso npe rau npe rau cov neeg raug tsim txom:
Cov tib neeg uas tsis muaj tsev nyob yog ib lub hom phiaj ntawm cov pej xeem rau $ 25 lab ($ 12.5 lab hauv California Endowment cov nyiaj ntxiv rau $ 12.5 lab hauv tsoomfwv cov peev nyiaj) rau cov nyiaj pab rau cov nroog hauv qab AB 82, cov lus sau nqi lus tau tsim los ua ib feem ntawm 2013-14 pob nyiaj siv ( saib excerpt txuas). Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) tau tshaj tawm cov lus qhia rau lub nroog txog cov nyiaj no (nrog) thiab tuav lub vev xaib (nrog) rau hnub tim, nrog lub hom phiaj ntawm kev faib nyiaj pab rau cov nroog los ntawm Lub Ob Hlis 1, 2014.
California Txoj Cai Kawm Txuj Ci los txo Cov Neeg Tsis Muaj Tsev Nyob Ntev Ntev:
Kalifonias yog ib qho ntawm plaub lub xeev uas nyuam qhuav tau koom nrog tsoomfwv Txoj Cai Tiv Thaiv Tshuaj Tiv Thaiv thiab Kev Pabcuam Kev Puas Siab Puas Ntsws (SAMHSA) Txoj Cai Lij Choj los txo Kev Tsis Muaj Tsev Nyob. Nrog rau kev nthuav dav ntawm kev tsim nyog tau txais Medi-Cal, ntau tus neeg uas tab tom ntsib kev tsis muaj tsev nyob ntev yuav tuaj yeem tso npe rau hauv Medi-Cal. Pab Pawg Policy Academy lub xeev thiab tus kws pab tswv yim tam sim no koom nrog cov kws tshaj lij txog kev tsis muaj tsev nyob hauv Medi-Cal Kev Tshaj Tawm thiab Kev Sau Npe Ua Haujlwm los tshawb nrhiav kev npaj cov cuab yeej ntawm cov kev coj ua zoo tshaj plaws rau kev nthuav qhia thiab kev tso npe ntawm cov neeg tsis muaj tsev nyob ntev uas DHCS tuaj yeem sib koom nrog Kev Tshaj Tawm thiab Kev Sau Npe. . Qhov no yuav ua raws li cov kev coj ua zoo tshaj plaws los ntawm Txoj Haujlwm Pabcuam Nyiaj Tau Los Tsawg (LIHP) nrog rau cov kev pabcuam nyiaj txiag tsis ntev los no los rau npe rau cov neeg tsis muaj tsev nyob ntev.
Cov kev pab them nqi kho mob twg muaj los ntawm Medi-Cal?
Medi-Cal tswj kev saib xyuas muaj kev xaiv ntawm 21 txoj kev npaj kho mob. Koj txoj kev npaj kho mob yuav txawv nyob ntawm lub nroog koj nyob. Feem ntau lub nroog muaj cov phiaj xwm kev lag luam, uas tseem ua haujlwm hauv Covered California suav nrog Anthem Blue Cross, Kaiser, Health Net, thiab Molina. Lwm cov phiaj xwm yog pej xeem cov phiaj xwm tswj hwm los ntawm zej zog. Txhua lub nroog cov phiaj xwm Medi-Cal muab kev saib xyuas zoo tib yam ntawm tus nqi qis lossis tsis muaj nqi rau cov neeg California, txawm koj nyob qhov twg. Daim ntawv teev npe ntawm cov phiaj xwm kev noj qab haus huv muaj los ntawm Medi-Cal kev saib xyuas muaj nyob hauv online ntawm: Medi-Cal Managed Care: Health Plan Directory. Kuv puas tuaj yeem nyob nrog kuv tus kws kho mob?
Ntau tshaj 400 lub tsev kho mob thiab kwv yees li 130,000 tus kws kho mob, kws muag tshuaj, kws kho hniav, thiab lwm tus kws kho mob koom nrog hauv Medi-Cal qhov kev pab cuam los muab kev kho mob tsim nyog rau cov tswv cuab. Feem ntau Medi-Cal cov tswv cuab uas koom nrog hauv CHCF txoj kev tshawb fawb tau hais tias nws yooj yim mus nrhiav ib tus kws kho mob thawj zaug nyob ze. Koj tuaj yeem tshawb nrhiav tus kws saib xyuas kev tswj hwm ntawm Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv lub vev xaib ntawm Health Care Options. Puas yog cov tswv cuab ntawm tib tsev neeg tsim nyog tau txais kev pab them nqi sib txawv tib lub sijhawm?
Daim ntawv thov Covered California yog ib daim ntawv thov rau ntau yam kev pab them nqi kho mob. Nws yog ib qho uas cov tswv cuab ntawm tib tsev neeg lossis tsev neeg se tau txais kev pab cuam sib txawv. Piv txwv li, ob leeg niam txiv tuaj yeem tsim nyog tau txais cov qhab nia se los ntawm Covered California, thaum cov me nyuam tsim nyog tau txais Medi-Cal. Qhov no yog vim tias txoj cai tsim nyog rau Medi-Cal cov me nyuam txawv dua li cov neeg laus, uas ua kom ntseeg tau tias tsis muaj tus me nyuam tsis muaj peev xwm them taus. Hauv lwm qhov xwm txheej, ib tus niam txiv tuaj yeem tsim nyog tau txais Covered California yam tsis muaj nyiaj pab vim lawv tau txais kev pab them nqi pheej yig los ntawm lawv txoj haujlwm, thaum lawv tus txij nkawm tsim nyog tau txais kev pab them nqi se los ntawm Covered California thiab cov me nyuam tsim nyog tau Medi-Cal.
Kuv yuav ua li cas yog tias kuv muaj lus nug txog tshuaj, mus ntsib kws kho mob, lossis kws kho mob tshwj xeeb?
Yog tias koj muaj lus nug txog koj qhov kev pab cuam nyob rau hauv Medi-Cal kev saib xyuas, koj tuaj yeem hu rau koj lub phiaj xwm kev noj qab haus huv cov neeg sawv cev pabcuam cov neeg siv khoom ncaj qha, ib yam li koj xav tau los ntawm lwm qhov kev pab them nqi kho mob. Txhawm rau nkag mus rau Medi-Cal daim ntawv qhia txog kev npaj kho mob, thov nkag mus rau: Medi-Cal Managed Care: Health Plan Directory.
Kuv puas tuaj yeem tsis lees txais Medi-Cal thiab tso npe rau hauv Covered California txoj kev pab them nqi kho mob thiab tau txais kev pab them nqi kho mob ntawm tsoom fwv?
Raws li tsoomfwv txoj cai lij choj, yog tias koj tam sim no tso npe rau hauv lossis tsim nyog rau Medi-Cal, koj tsis tsim nyog yuav tau txais kev pab cuam los ntawm Covered California. Yog tias koj tsim nyog tau Medi-Cal, koj tseem tuaj yeem yuav daim phiaj xwm kev noj qab haus huv los ntawm Covered California, tab sis koj tsis tuaj yeem tau txais kev pab them nqi kho mob kom txo nws cov nqi thiab yuav tau them tus nqi them tag nrho ntawm Covered California tus nqi them nqi kho mob.
Puas muaj hnub kawg rau npe rau hauv Medi-Cal?
Tsis muaj. Tsis muaj hnub kawg rau npe rau hauv Medi-Cal. Koj tuaj yeem thov txhua lub sijhawm hauv lub xyoo. Thaum koj raug txiav txim tias tsim nyog rau Medi-Cal, koj qhov kev tsim nyog yuav rov qab mus rau lub hli ntawm koj daim ntawv thov. Qee zaum, koj tuaj yeem tau txais Medi-Cal kev pab them nqi tam sim ntawd. Hu rau koj lub county lub chaw saib xyuas kev pab tib neeg ntawm County Offices yog xav paub ntxiv. Txawm li cas los xij, kev tso npe kawm hauv Covered California tsuas yog tshwm sim thaum qhib daim ntawv sau npe, yog li yog tias koj tab tom sim tso npe rau qee cov neeg hauv tsev neeg hauv Medi-Cal thiab lwm tus hauv Covered California, nco ntsoov sau npe raws sijhawm rau cov tsev neeg nrhiav kev pab los ntawm Covered California. Yog hais tias ib tug neeg qhov kev pab cuam Medi-Cal raug muab tso tseg vim nyiaj tau los nce lossis txo qis hauv tsev neeg, tus neeg ntawd puas tsim nyog tau txais kev tso npe tshwj xeeb rau hauv Covered California?
Yog lawm, poob kev pab them nqi kho mob xws li Medi-Cal yog suav tias yog ib qho kev tsim nyog uas yuav ua rau lub sijhawm tshwj xeeb rau npe. Lwm cov xwm txheej tsim nyog suav nrog:
- Hloov mus tas mus li/hauv California
- Poob lossis yuav poob lawv daim ntawv pov hwm kev noj qab haus huv sai sai, suav nrog kev tsim nyog tau txais Medi-Cal (tseem hu ua qhov poob ntawm Qhov Kev Pabcuam Tsawg Tsawg (MEC)
- Tau ib tug me nyuam los yog saws me nyuam
- Tau sib yuav los yog nkag mus rau hauv kev sib koom tes hauv tsev
- Cov neeg muaj kev kub ntxhov hauv tsev (Yog tias muaj txij nkawm, tus neeg tsim txom cov nyiaj tau los tsis suav yog tias tus neeg muaj sia nyob sib nrug thiab tsis tuaj yeem sau se ua ke.)
- Rov qab los ntawm kev ua tub rog ua haujlwm
- Tso tawm hauv tsev lojcuj lossis tsev lojcuj
- Tau txais neeg xam xaj / raug cai nyob
- Federally Recognized American Indian/Alaska Native
- Lwm cov xwm txheej tsim nyog raws li tau txheeb xyuas ntawm Covered California portal
Yog tias ib qho ntawm cov xwm txheej hauv lub neej no tshwm sim, koj yuav tsim nyog rau npe hauv 60 hnub ntawm qhov xwm txheej ntawd. Lub sijhawm ntawd koj tsis tuaj yeem tsis lees paub qhov kev pab them nqi kho mob hauv Covered California lossis hauv khw muag khoom yog tias koj tsis tsim nyog, thiab koj tuaj yeem tsim nyog tau txais kev pab them nqi kho mob uas tsuas muaj nyob hauv Covered California xwb.
Kuv Medi-Cal tau raug txiav tawm thiab tam sim no kuv tuaj yeem tso npe rau hauv Covered California thaum Lub Sijhawm Teev Npe Tshwj Xeeb (SEP), Kuv yuav ua li cas kom tsis txhob muaj qhov sib txawv ntawm kuv qhov kev pab them nqi kho mob?
Yog tias koj qhov Medi-Cal yuav yog lossis raug txiav tawm, txhawm rau kom tsis txhob muaj qhov sib txawv ntawm koj qhov kev pov hwm kev noj qab haus huv, koj yuav tsum xaiv Covered California txoj kev npaj ua ntej hnub koj Medi-Cal xaus. Yog tias koj tsis xaiv Covered California txoj kev npaj rau tib lub hlis uas koj Medi-Cal xaus, koj yuav tsis muaj kev pab them nqi kho mob tsawg kawg ib hlis. Koj tseem yuav tsum them koj cov nqi them Covered California los ntawm hnub kawg thaum koj tau them nqi thiaj li yuav raug them. Yog tias koj qhov kev thov rau npe kawm tiav hauv 60 hnub ntawm hnub tsim nyog rau lub neej, qhov sai tshaj plaws koj qhov kev npaj khomob hauv Covered California tuaj yeem pib yog hnub tim 1 ntawm lub hlis tom qab koj xaiv txoj kev npaj Covered California. Yog tias koj tos ntau tshaj 60 hnub tom qab koj Medi-Cal xaus rau kev xaiv Covered California txoj kev npaj, koj yuav tsis muaj peev xwm tso npe mus txog rau Covered California lub Sijhawm Qhib Rau Npe Kawm Ntxiv. Koj tuaj yeem tiv tauj Covered California hauv online ntawm CoveredCA.com lossis hu rau (800) 300-1506 lossis tiv tauj koj Tus Neeg Ua Haujlwm Tsim Nyog Lub Nroog kom tau txais kev pab xaiv koj txoj kev npaj Covered California. Koj tuaj yeem mus cuag koj Tus Neeg Ua Haujlwm Tsim Nyog Hauv Lub Nroog ntawm lub chaw saib xyuas kev noj qab haus huv hauv nroog.
Thaum twg kuv yuav tsum tau qhia cov cuab tam rau kuv lub chaw Medi-Cal hauv zos?
Qee tus tswvcuab Medi-Cal thiab cov neeg thov kev pabcuam uas muaj feem tsim nyog raws li hnub nyoog (cov laus laus dua, 65+ xyoo), kev xiam oob qhab (lub cev, hlwb, lossis kev loj hlob), lossis kev saib xyuas mus sij hawm ntev yuav tsum tau tshaj tawm cov khoom muaj nqis yog tias lawv thov Medi-Cal lossis txuas ntxiv lawv qhov kev pabcuam rau lossis tomqab Lub Ib Hlis 1, 2026. Yog tias koj twb yog ib tug tswv cuab Medi-Cal lawm, koj cov cuab tam yuav raug tshuaj xyuas ntawm koj daim ntawv cog lus tshiab txhua xyoo.
Yav dhau los kuv twb tsis kam txais Medi-Cal vim kuv muaj tsheb. Kuv puas tsim nyog tam sim no?
Xyoo 2024, Medi-Cal tau tsim cov cai tsim nyog tau yooj yim dua. Cov khoom vaj khoom tsev zoo li lub tsheb tsis raug suav thaum txiav txim siab tias ib tus neeg tuaj yeem tau txais kev pab them nqi kho mob.
Pib txij Lub Ib Hlis Ntuj 1, 2026, Medi-Cal yuav rov qab txwv cov cuab tam rau qee tus neeg. Yog tias koj muaj ntau tshaj ib lub tsheb, nws tuaj yeem cuam tshuam koj qhov kev tsim nyog dua. Yog xav paub ntxiv, mus saib hauv
Asset Limits lub vev xaib.
Yog kuv sau npe rau Medi-Cal, puas muaj dab tsi tshwm sim rau kuv cov cuab tam?
Medi-Cal tsuas yog sim kom rov qab tau nws cov nqi rau kev pab kho mob tom qab koj tuag thaum tus neeg txais kev pab muaj hnub nyoog tshaj 55 xyoos, lossis thaum tus tswv cuab ntawm txhua lub hnub nyoog raug saib xyuas hauv ib lub tsev kho mob, xws li tsev laus. Medi-Cal tsis nrhiav kev them nyiaj hauv koj lub neej lossis lub neej ntawm koj tus txij nkawm tseem muaj sia nyob, tus tub lossis tus ntxhais uas tsis taus, lossis thaum koj tus menyuam muaj hnub nyoog qis dua 21 xyoos. Yog tias koj muaj hnub nyoog qis dua 55 xyoos, koj tuaj yeem sau npe rau Medi-Cal paub tias yuav tsis muaj dab tsi tshwm sim rau koj cov cuab tam tshwj tsis yog tias koj tsis tau koom nrog. Rau cov neeg muaj hnub nyoog tshaj 55 xyoos lossis nyob hauv ib lub tsev kawm ntawv, Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv tuaj yeem nthuav tawm daim ntawv thov rau tus nqi kho mob. Nws yuav raug them los ntawm koj cov cuab yeej cuab tam thaum koj tuag. Yog xav paub ntxiv, thov mus saib Third Party Liability. Tsev neeg
Kuv tsev neeg thiab kuv puas tsim nyog tau txais kev pab tib yam?
Nyob ntawm koj tsev neeg qhov loj lossis tsev neeg cov nyiaj tau los, koj lossis koj tsev neeg tuaj yeem tsim nyog tau txais kev pabcuam sib txawv. Piv txwv li, koj tuaj yeem tsim nyog tau txais kev pov hwm kho mob ntiag tug pheej yig uas muaj nyob hauv Covered California. Txawm li cas los xij, koj tus menyuam tuaj yeem tsim nyog tau Medi-Cal dawb. Peb yuav qhia koj tias koj thiab lwm cov tswv cuab tsim nyog tau txais kev pov hwm kho mob twg.
Kuv nyuam qhuav paub tias kuv cev xeeb tub. Kuv puas tuaj yeem thov kev pov hwm kev noj qab haus huv uas yuav them rau kuv thaum kuv cev xeeb tub?
Yog lawm. Nco ntsoov teb yog rau daim ntawv thov nug "Koj puas cev xeeb tub?" los yog qhia rau tus neeg pab koj sau koj daim ntawv thov. Koj tuaj yeem thov kev pov hwm kev noj qab haus huv uas tuaj yeem them rau kev saib xyuas ua ntej yug menyuam, kev ua haujlwm thiab kev yug menyuam, thiab kev saib xyuas tom qab yug menyuam. Cov phiaj xwm kev tuav pov hwm kho mob tsis tuaj yeem tsis lees paub kev pov hwm kev noj qab haus huv yog tias koj cev xeeb tub.
Kuv nyuam qhuav muaj menyuam tshiab. Kuv yuav ua li cas txog kev pov hwm kev noj qab haus huv?
Yog tias koj tsis muaj Medi-Cal lossis Medi-Cal Access Program thaum lub sijhawm xa khoom, ua daim ntawv thov no rau koj tus menyuam mos. Yog tias koj muaj Medi-Cal lossis Medi-Cal Access Program thaum koj cev xeeb tub, koj tsis tas yuav ua daim ntawv thov no. Hu rau koj tus neeg ua haujlwm hauv nroog kom paub tseeb tias koj tus menyuam muaj kev tiv thaiv thaum yug los, lossis ua daim foos xa mus rau tus menyuam yug tshiab. Sau daim ntawv MC 330. Yog tias koj muaj kev pab them nqi kho mob raws li Medi-Cal Access Program rub tawm Daim Ntawv Sau Npe Me Nyuam mos, lossis hu rau (800) 433-2611.
