Medi-Cal Managed Care and Mental Health Office of the Ombudsman
The Medi-Cal Managed Care and Mental Health Office of the Ombudsman helps solve problems from a neutral standpoint to ensure that our members receive all medically necessary covered services for which plans are contractually responsible.
The Mental Health Ombudsman is designed to create a bridge between the Mental Health Plan system and individuals, family members and friends of individuals, in need of mental health services by providing information and assistance in navigating through the system.
The Ombudsman will listen, answer your questions, analyze your situation, explain DHCS policies and procedures, provide information, advice, and options, and suggest appropriate referrals. It is our job to help develop fair solutions to health care access problems.
The Office of the Ombudsman does not conduct formal investigations; does not change rules, policies, or procedures, nor does it participate in any formal hearing or grievance process.
The Office of the Ombudsman:
- Helps solve problems between Medi-Cal managed care members and managed care plans
- Helps solve problems between Medi-Cal members and county mental health plans
- Helps members with urgent enrollment and disenrollment problems
- Helps Medi-Cal members access Medi-Cal specialty mental health services
- Offers information and referrals
- Identifies ways to make the Medi-Cal managed care program more effective
- Educates members on how to navigate the Medi-Cal managed care and specialty mental health system
- Connect you with the right person or department to help solve a problem
- Connect you with local resources in your county who can help you
- Connect you with patients' rights services
Contact Us
*Please note: Email provides no mechanism for ensuring the confidentiality or privacy of information contained within a message in transit. Therefore, the sender of an email message assumes responsibility for including confidential or private data when utilizing this communication medium. The sender should exercise caution when composing a message to exclude confidential or private information such as names, street addresses, phone numbers, social security numbers, license numbers, other personal identification numbers, etc. If the sender wishes to contact the California Department of Health Care Services (DHCS) Office of the Ombudsman to discuss any issues that may require the inclusion of private or confidential data, DHCS recommends calling the Ombudsman at (888) 452-8609.
How can I remove a hold or change the Medi-Cal Managed Care Plan I am enrolled in?
Request For Change - Online Fillable Form (COUNTY STAFF USE ONLY)
This form should be utilized for urgent expedited matters only; all standard changes need to be processed through Health Care Options (HCO) at (800) 430-4263. The online fillable form should be used when requesting:
- Plan changes
- Expedited Plan Enrollments
- Expedited Plan Disenrollments
- Removal of 59 holds
Completion of this form does not guarantee that the request will be processed. If the Medi-Cal beneficiary does not meet the required criteria or a valid county email address is not used, the request will not be processed.
Medi-Cal members must contact their local County Eligibility Worker to submit a request using the online fillable form located on the link above.
Helpful Resources and Links
Outside Resources
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NATIONAL SUICIDE PREVENTION LIFELINE ARE YOU IN CRISIS? PLEASE CALL (800) 273-8255 (TALK)
- The California DEPARTMENT OF AGING, LONG-TERM CARE OMBUDSMAN PROGRAM (LTCOP) The primary responsibility of the LTCOP is to investigate and endeavor to resolve complaints made by, or on behalf of, individual residents in long-term care facilities.
- The California DEPARTMENT OF DEVELOPMENTAL SERVICES (CDDS) is the agency through which the State of California provides services and supports to individuals with developmental disabilities.
- The California DEPARTMENT OF HEALTH CARE SERVICES (DHCS - MEDI-CAL INFORMATION) To assist an individual in finding out if he/she qualifies as a Medi-Cal beneficiary, how to enroll and learn about available programs for children with special medical conditions and seniors needing personal care.
- The California DEPARTMENT OF SOCIAL SERVICES OMBUDSMAN FOR FOSTER CARE Information on the rights of children and youth who are placed in foster care. The program provides advocacy services to foster children and youth and those who reach out on their behalf. Toll-free telephone (877) 846-1602 e-mail address:
fosteryouthhelp@dss.ca.gov. For complaints, please visit: Department of Social Services: File a Complaint
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DISABILITY RIGHTS CALIFORNIA (PATIENT'S RIGHTS ADVOCATE) We envision a world where all people with disabilities have equality, dignity and power. Advocacy, information on disability rights, resources for persons with disabilities in California whose rights have been violated, and list of advocacy contacts throughout California. (800) 776-5746 (Voice) (800) 719-5798 (TTY) Handbook of Patient's Rights Advocates contact information listed by county.
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NATIONAL LONG-TERM CARE OMBUDSMAN RESOURCE CENTER Long-term care ombudsmen are advocates for residents of nursing homes, board and care homes and assisted living facilities. Ombudsmen provide information about how to find a facility and what to do to get quality care.
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U.S. DEPARTMENT OF JUSTICE, AMERICANS WITH DISABILITIES ACT Information about the Americans with Disabilities Act (ADA) for individuals with disabilities, businesses, State and local governments, or others inquiring about general or specific ADA requirements, laws, regulations, reports and publications regarding the ADA.
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DEPARTMENT OF REHABILITATION
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DEPARTMENT OF EDUCATION
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DEPARTMENT OF CORRECTIONS
