​Continuity of Care

​What is Continuity of Care (Coc)?

CoC means that you may be able to keep a Medi-Cal provider for up to 12 months after you enroll in a new managed care plan. This includes your primary care doctor, specialists, and most therapists. Therapists you may be able to keep include physical, occupational, respiratory, and speech therapists, and behavioral health treatment providers. A Medi-Cal managed care health plan will be referred to as the “Plan."

You may be able to get  CoC protections to keep a Medi-Cal provider for up to 12 months if all of these apply to you:

• You were required to enroll in a managed care plan, and
• You want to keep a Medi-Cal provider who is not in your new plan, and
• You went to that provider at least once in the last 12 months, and
• Your provider is willing to work with your plan by making an agreement with your new plan to get paid.

CoC also means that you can continue receiving the medical services and medicines you need after you have been enrolled in a Plan. If you have received a prescription or authorization for a medicine, service, treatment, procedure, or surgery scheduled to occur after you join a new Plan, you will still be able to receive it. In some cases, you may need to have a different provider deliver the care or perform the procedure you need. Talk to your new Plan doctor about what services and medicines you need.

Be sure to read the Frequently Asked Questions for more detailed information about this or contact your Plan.​

Does this apply to me?

This information applies to you if:

• You had regular (fee-for-service) Medi-Cal, and
• You are a new member in a Medi-Cal managed care plan, and
• You enrolled in your Medi-Cal managed care plan in the last year.

As part of the 2024 MCP transition, some Medi-Cal MCPs are changing on January 1, 2024. The protections in the 2024 MCP transition are different. Visit Continuity of Care | Managed Care Plan Transition | DHCS for additional details about the 2024 MCP transition and how it varies.

CoC applies to you if:

• Your Medi-Cal plan is no longer available in your county as of January 1, 2024, or
• Your Medi-Cal plan in 2023 is Health Net in Los Angeles County and Health Net informs you in mid-November 2023 that you will be re-assigned automatically to their partner Molina Healthcare on January 1, 2024, or
• You are receiving Medi-Cal services from Kaiser Permanente providers and Kaiser informs you that you will be automatically enrolled into Kaiser Permanente Medi-Cal Plan, starting January 1, 2024, or
• You are 25 years old or younger, and are receiving foster care services or used to receive foster care services, and are enrolling in Medi-Cal managed care from regular (fee-for-service) Medi-Cal.​
  

Can I keep my providers in my new Medi-Cal plan?

You will get most of your needed health care services through your new Medi-Cal plan's provider network (group). It has doctors, therapists, imaging centers, transportation, etc.

Not all providers are in all networks. Providers you had in FFS Medi-Cal might not be in your new plan's network.  CoC requires that you may need plan approval to go to some providers. You have rights that include possibly keeping a Medi-Cal provider for up to 12 months who is not in your new plan's network.

What if I have Medi-Cal and Medicare?

This information applies only to your Medi-Cal providers. Your new Medi-Cal plan does not limit Medicare providers. Medicare providers do not have to be in your Medi-Cal plan's provider network. This applies to both Medi-Cal only beneficiaries and those dually eligible for Medicare and Medi-Cal, for their Medi-Cal Providers. 

How Can I Request to Keep Seeing My Doctor?

​​​Call your Plan to find out if you qualify to continue seeing your provider. Tell your Medi-Cal plan that you want to continue seeing your current doctor. You will need to provide the name of your doctor or hospital, your medical condition, and the treatments you are receiving. If your doctor agrees to keep seeing you as a patient and will work with your new Medi-Cal managed care plan, you may be able to continue seeing your doctor for up to 12 months, this is called CoC.

You may be able to get CoC protections to keep a Medi-Cal provider for up to 12 months if all of these apply to you:

• You were required to enroll in a managed care plan, and
• You want to keep a Medi-Cal provider who is not in your new plan, and
• You went to that provider at least once in the last 12 months, and
• Your provider is willing to work with your plan by making an agreement with your new plan to get paid.
  

​​Be sure to read the Frequently Asked Questions for more detailed information about this or contact your ​plan.

Can I get Continuity of Care for all of my providers?

No. CoC doesn't apply to all providers. For some providers, such as transportation providers, you will need a new one from your new Medi-Cal plan's provider network. Plans can tell you which providers you may be able to keep under Continuity of Care.  

Please visit Frequently Asked Questions for more detailed information on the types of providers. 

How do I get Continuity of Care?

There are three ways to get CoC:

1.   Call your new plan. Your plan's phone number is in your enrollment packet and on your health plan card.

Ask your plan if they already work with your doctors and therapists.

• If they do, you can keep your doctors and therapists.
• If they don't, you can ask if you can keep your doctors and therapists. You can only keep them for up to 12 months.

2.   Ask your doctor or therapist to call your plan.​ A provider can call the plan and ask to keep you as their patient.

3.   Ask a family member or person representing you to call your plan. Others can call your plan for you. They can make a request on your behalf as your authorized representative. Your plan may ask you directly if you are okay with someone asking on your behalf.

What if my provider doesn't want to work with my plan?  

If your previous Medi-Cal provider does not want to work with your managed care plan, you will need to choose a new provider in your plan's network.

Can I still get all my medicines?  

Yes, you can usually get the same medicines even if your previous Medi-Cal provider does not work with your new plan. Medi-Cal Rx covers your prescription drugs. Your new provider can prescribe them for you to get from your pharmacy. Your plan also covers drugs your provider gives you in the office or clinic.

To learn more about Medi-Cal Rx prescription drug coverage and pharmacies that take Medi-Cal, go to medi-calrx.dhcs.ca.gov. Or call the Medi-Cal Rx Customer Service Center at
(800) 977-2273 (TTY: State Relay at 711). The call is free.

Talk to your new doctor about the medicines you are taking.

What if I have a scheduled surgery or an appointment with a specialist or doctor I haven't been to before?

If you want to keep a scheduled surgery or appointment with a specialist you have not gone to before, call your plan to ask if you can keep the surgery or appointment. Your plan will either let you keep it or help you schedule it with a provider in your plan's network.

What if I have more questions?

Here are two places to get help:

Office of the Ombudsman
Call (888) 452-8609, Monday through Friday, 8 a.m. to 5 p.m. The call is free. Or email: MMCDOmbudsmanOffice@dhcs.ca.gov

You can call or email for any of these reasons:

• If you contacted your plan or provider but still need help with your CoC request
• To get advice if you do not agree with your treatment or services
• To ask other questions about your plan, provider, or Medi-Cal.​

Or go to www.dhcs.ca.gov/ombudsman

Department of Managed Health Care (DMHC) Help Center

Call (888) 466-2219 24 hours a day, 7 days a week. The call is free.

They can help you find health coverage or help if you have a health plan complaint.

Or go to dmhc.ca.gov

Alternative Formats​

If you would like this information in an alternative format please visit

AFS: Alternative Format Selection (ca.gov)

Contact DHCS with any questions or comments on Continuity of Care at MCQMD@dhcs.ca.gov