Medi-Cal:
Where to Find Laws, Regulations, and Other Helpful, Free Information on the Internet

March 2012, Pub #5511.01

Medi-Cal is a state and federal program that ensures health care coverage to many low-income people.  The lead state agency for Medi-Cal in California is the Department of Health Care Services, www.dhcs.ca.gov.  There are other state agencies that play a role in Medi-Cal, including the Department of Managed Health Care, the Department of Mental Health, the Department of Developmental Services, and others.

Medi-Cal is California’s version of the federal “Medicaid” program.  The federal agency that administers Medicaid is the Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS), http://www.cms.gov/.

This document provides basic information about how to do research on the Internet regarding Medi-Cal.  We recommend that you follow the order of the document—Medi-Cal regulations and laws can be hard to follow, so you may find it useful to look at manuals and other explanations before you research the law. 

 

The Health Consumer Alliance website, www.healthconsumer.org, is a very helpful resource for health care information.  Their website says the following:  “If you're looking for information about health care coverage and services you've come to the right place. At the Health Consumer Alliance (HCA) we help low-income Californians get the health care they need.” 

The Health Consumer Alliance posts the very helpful National Health Law Program (NHeLP) manual on Medi-Cal at http://www.healthconsumer.org/publications.htm#manuals.  This manual, published in 2008, is a useful first-stop resource for doing research regarding Medi-Cal.  It contains extensive citations to laws and regulations, answering many questions that arise, and makes it easier to do further research. 

The Health Consumer Alliance also posts numerous consumer-friendly materials at http://www.healthconsumer.org/publications.htm.  These materials are easy to understand, and they cover a wide range of topics of great interest to consumers. 

Disability Rights California’s website has information about various health care issues, including information about the Medi-Cal program, at http://www.disabilityrightsca.org/issues/government.htm.

Disability Benefits 101 has helpful information about numerous benefits programs, including Medi-Cal, at http://ca.db101.org/

The website of the National Health Law www.healthlaw.org, also includes general information and updates on Medicaid.  Review the publications and look for "Medicaid.”

Chapter 13 of Disability Rights California’s Rights Under the Lanterman Act manual, which covers the Medicaid Home and Community-Based Services Developmental Disabilities Waiver for regional center consumers, is available at http://www.disabilityrightsca.org/pubs/506301index.htm.

California Advocates for Nursing Home Reform (www.canhr.org) has a wealth of consumer and advocate material, including very useful information about Medi-Cal for Long Term Care, available at:
http://canhr.org/medcal/index.html.


 

You can research California laws (statutes) using the following website:  www.leginfo.ca.gov/calaw.html.

General California Medi-Cal statutes are in California Welfare & Institutions Code §§ 14000 through 14685.

California statutes addressing Mental Health Services are available in California Welfare & Institutions Code §§ 5775-5782, 14680-14685.

 

Website to find California Code of Regulations:

California Medi-Cal regulations are developed by state agencies that administer Medi-Cal. 

General Medi-Cal regulations are available in California Code of Regulations, Title 22, Division 3, §§ 50000 through 59999.

The Medi-Cal Manual of Criteria, http://www.dhcs.ca.gov/services/medi-cal/Pages/ManualofCriteria_ada.aspx, sets out the standards for approving or denying a Treatment Authorization Request, or TAR, and is incorporated into the Medi-Cal regulations by 22 C.C.R. § 51003(e).

Medi-Cal Mental Health regulations are available in California Code of Regulations, Title 9.  You can find a copy here:  http://www.dmh.ca.gov/Laws_and_Regulations/docs/FinalRegsText_CLEAR_06Jun27.pdf.  Updates are here:  http://dmh.ca.gov/Laws_and_Regulations/CompletedRegulations.asp.

DMH letters and notices can be found here:  http://dmh.ca.gov/DMHDocs/default.asp.           

 

You have a right to ask for a fair hearing regarding your Medi-Cal, and you have other options, as well.  The DHCS website explains your options at
http://www.dhcs.ca.gov/services/medi-cal/Pages/Medi-CalFairHearing.aspx.  This website is a good place to start your research if you are considering asking for a Medi-Cal fair hearing.  Many of the materials discussed above in section 1 of this document also have helpful information about fair hearings.

For more information about fair hearings generally, visit the website of the Department of Social Services' State Hearings Division,   http://www.dss.cahwnet.gov/shd/default.htm.

 

DHCS’s website says the following:  “The Medicaid State Plan is based on the requirements set forth in Title XIX of the Social Security Act and is a comprehensive written document created by the State of California that describes the nature and scope of its Medicaid (Medi-Cal) program.  It serves as a contractual agreement between the State of California and the federal government and must be administered in conformity with specific requirements of Title XIX of the Social Security Act and regulations outlined in Chapter IV of the Code of Federal Regulations.   The State Plan contains all information necessary for the Centers for Medicare and Medicaid Services (CMS) to determine if the State can receive Federal Financial Participation (FFP).”  

California’s Medi-Cal state plan is available at:  http://www.dhcs.ca.gov/formsandpubs/laws/Pages/CaliforniStatePlan.aspx.  This website also has a link to approved State Plan Amendments (SPAs), which update the State Plan.

 

The DHCS website says the following about waivers:  “Medi-Cal waivers are programs under Medi-Cal that provide additional services to specific groups of individuals, limit services to specific geographic areas of the state, and provide medical coverage to individuals who may not otherwise be eligible under Medicaid rules. 

When California wants to make significant changes to its Medicaid program, it must take one of two steps:  either (1) amend its State Medicaid Plan – the State’s contract with the federal government; or (2) receive an exemption or Medicaid waiver from portions of Title XIX of the Social Security Act by the U.S. Department of Health and Human Services (DHHS).”

Information about many of California’s Medi-Cal waivers is available on the DHCS website at
http://www.dhcs.ca.gov/services/medi-cal/Pages/MediCalWaivers.aspx.

Information about California’s “Bridge to Reform” 1115 waiver for expansion of Medi-Cal coverage:  http://www.dhcs.ca.gov/provgovpart/Pages/WaiverRenewal.aspx

In addition, see the Disability Rights California websites discussed above in Section 1 for information about waivers.

 

DHCS has consumer information about Medi-Cal managed care here:  http://www.dhcs.ca.gov/individuals/Pages/MMCDConsumerGuide.aspx.  This website is particularly helpful because it gives you links to individual counties, which have a lot of variation.

The Department of Managed Health Care has information about Medi-Cal managed care for seniors and persons with disabilities here:  http://www.dmhc.ca.gov/aboutthedmhc/gen/gen_factsheet.aspx

 

DHCS posts data and statistics about the Medi-Cal program, including links to data and statistics developed by others, at
http://www.dhcs.ca.gov/DATAANDSTATS/Pages/default.aspx.

 

See NHeLP’s Medi-Cal manual, Chapter 1, discussed above in question 1, for a list of Medi-Cal materials on the DHCS website, along with links.

DHCS provides All County Welfare Directors Letters (ACWDLs) and Medi-Cal Eligibility Information Letters (MEBILs) regarding new or changed policies and/or procedures used in determining eligibility for Medi-Cal benefits.  These documents are available at http://www.dhcs.ca.gov/ProvGovPart/county/Pages/default.aspx.

The DHCS Medi-Cal Eligibility Procedures Manual (MEPM) “provides clarification to county social services staff on policies and procedures for making eligibility determinations for the Medi-Cal program.”  It is available at
http://www.dhcs.ca.gov/services/medi-cal/eligibility/Pages/MedEligProcManual.aspx.

DHCS posts provider manuals, with information designed to help providers navigate the Medi-Cal system, at http://www.dhcs.ca.gov/formsandpubs/publications/Pages/Manuals.aspx.

 

Federal Medicaid laws (statutes) are in Title XIX of the Social Security Act, 42 U.S.C. 1396 -1397v.  You can search the law at http://uscode.house.gov/search/criteria.shtml.

Federal Medicaid laws can be hard to follow.  We recommend starting your research with other materials, including the NHeLP manual described above in question 1, before you start researching federal laws. 

 

Federal Medicaid regulations are developed by the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS).  These regulations are in Title 42, Chapter 4 of the Code of Federal Regulations, sections 430 et seq.  You can review the Medicaid regulations directly on the following website http://www.access.gpo.gov/nara/cfr/waisidx_08/42cfrv4_08.html.
You can search the Code of Federal Regulations generally on one of the two following websites:

http://www.law.cornell.edu/cfr/text.   

Like federal Medicaid laws, the regulations can be hard to follow.  We recommend starting your research with other materials, including the NHeLP manual described above in question 1, before you start researching federal laws.

Numerous materials developed by CMS are available at the following CMS websites:

Federal statistics about Medicaid are available on the CMS website at http://www.cms.hhs.gov/home/rsds.asp.

The CMS website is a bit complex and can change often.  Finding useful information sometimes requires some navigation.