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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 not automatically take sides in a complaint. We consider all sides in an impartial and objective way.  It is our job to help develop fair solutions to health care access problems.

The Office of the Ombudsman:

  • Serves as an objective resource to resolve issues between Medi-Cal managed care members and managed care health plans.
  • Helps members with urgent enrollment and disenrollment problems.
  • Offers information and referrals.
  • Identifies ways to improve the effectiveness of the Medi-Cal managed care program.
  • Educates members on how to effectively navigate through the Medi-Cal managed care system.
  • Help you find information in order to access appropriate mental health services 
  • Connect you with the right person/department to help you resolve a problem 
  • Connect you with local resources in your county who can help you
  • Connect you with patient’s’ rights services

 

How can I contact the Office of the Ombudsman?

 
*Please note: E-mail 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 (1-888) 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 expedited:

  • 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.

What can you expect from us?

  • We will treat you with courtesy and respect.
  • We will respond to you in a timely manner.
  • We will keep you informed of our progress.
  • We have policies and procedures in place that protect the privacy of your health information.

Helpful Resources and Links

 

​Outside Resources

NATIONAL SUICIDE PREVENTION LIFELINE (Not DHCS) ARE YOU IN CRISIS? PLEASE CALL 1-800-273-8255 (TALK) 

The California DEPARTMENT OF AGING, LONG-TERM CARE OMBUDSMAN PROGRAM (LTCOP) (Not DHCS) 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.  (Not DHCS)

The California DEPARTMENT OF SOCIAL SERVICES OMBUDSMAN FOR FOSTER CARE  (Not DHCS) 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 1-877-846-1602 e-mail address: fosteryouthhelp@dss.ca.gov (Not DHCS) For complaints, please go to: File a Complaint. (Not DHCS)
 
DISABILITY RIGHTS CALIFORNIA (Not DHCS) (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. 1-800-776-5746 (Voice) 1-800-719-5798 (TTY) Handbook of Patient's Rights Advocates contact information listed by county. (Not DHCS)

NATIONAL LONG-TERM CARE OMBUDSMAN RESOURCE CENTER (Not DHCS) 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.
 
U.S. DEPARTMENT OF JUSTICE, AMERICANS WITH DISABILITIES ACT (Not DHCS) 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.
 
 
NETWORK OF CARE (Not DHCS)
 
 
 
 

 

 
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Last modified on: 10/9/2018 10:16 AM