Medi-Cal Managed Care
Starting in 2011, the state of California moved most seniors and persons with disabilities (SPDs) who receive Medi-Cal but not Medicare also into Medi-Cal Managed Care.
The Coordinated Care Initiative (described below) is part of California’s move to provide most Medi-Cal in the state through managed care plans to additional SPDs who receive both Medi-Cal and Medicare. More information about Medi-Cal managed care is below.
This pub tells you about health programs for people with low income, such as Medi-Cal. The pub tells you how to apply for them. It tells you how “Covered California” and county Medi-Cal offices deal with your application. It tells you about computer systems used by the programs.
This pub tells you about the Coordinated Care Initiative (CCI). This program changes the way some people get health care and long-term services and supports. The CCI coordinates health care and services like mental health and IHSS. It is only in seven counties. It affects people who get Medi-Cal only and people who get Medi-Cal and Medicare. The state hopes it will be easier for you to get services and they will work better. The pub tells you how to get help if you disagree with a decision by your health plan.
The federal Medicaid program provides health care to low-income people, including seniors, people with disabilities, and children. Medicaid is funded through a combination of state and federal dollars. States run their own Medicaid programs and have to follow certain federal rules, but have some flexibility in the services they offer.
If you have regular Medi-Cal and you are now being told that you must enroll in a Medi-Cal managed care plan (MCP), you may be able to continue to see your regular Medi-Cal health care provider. This is what is meant by “continuity of care.”
1. What are out-of-network services?
Medi-Cal managed care organizations (MCO)1 have networks of providers, including doctors, pharmacies, clinics, labs, and hospitals (“plan providers”). Most of the time, members must use the plan providers when getting medical care in order for services to be covered by the MCO. There are instances when you can get medical services from providers who are not plan providers.
Some mental health services are available through fee-for-service Medi-Cal1 providers or Medi-Cal managed care plans, while others are available only through county Mental Health Plans under the Specialty Mental Health Services Waiver.2 Examples of specialty mental health services include intensive day treatment, day care rehabilitation and adult residential treatment services.3 For more information on specialty mental health services see “Getting Medi-Cal Outpatient Specialty Mental Health Services” Publication 5084.01.4
This fact sheet explains how to obtain transportation to your medical appointments from your Medi-Cal Managed Care Plan (MCP). The end of this publication discusses how to obtain transportation services if you have Fee-For-Service (FFS) Medi-Cal.