Medi-Cal: Where to Find Laws, Regulations, and Other Helpful, Free Information on the Internet
Medi-Cal: Where to Find Laws, Regulations, and Other Helpful, Free Information on the Internet
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. [click here for DHCS's website]. 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). [click here for CMS's website].
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.
1. Where Can I Find Easy to Understand Information About Medi-Cal?
The Health Consumer Alliance website, [click here for HCA's website], is a very helpful resource for health care information. Their website says: “The Health Consumer Alliance (HCA) offers free assistance over-the-phone or in-person to help people who are struggling to get or maintain health coverage and resolve problems with their health plans.” The Health Consumer Alliance also posts numerous consumer-friendly materials at [click here for website to Consumer Rights]. These materials are easy to understand, and they cover a wide range of topics of great interest to consumers.
The Western Center on Law and Poverty posts the very helpful Health Care Eligibility Guide on Medi-Cal at [click here for WCLP's website]. This guide, published in 2016, provides California advocates - legal services attorneys, enrollment counselors, health care workers, community organizers and others - with the relevant statutes, regulations, and guidance needed to help their clients access health care coverage.
Disability Rights California’s website has information about various health care issues, including information about the Medi-Cal program, at [click here for website to DRC Health Care info].
Disability Benefits 101 has helpful information about numerous benefit programs, including Medi-Cal, at [click here for website to Disability Benefits 101].
The website of the National Health Law [click here for NHL's website], 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 [click here for website to the RULA publication].
California Advocates for Nursing Home Reform [click here for website to CANHR] has a wealth of consumer and advocate material, including very useful information about Medi-Cal for Long Term Care, available at:[click here for website to CANHR LTC].
2. Where Can I Find California’s Medi-Cal Statutes?
You can research California laws (statutes) using the following website: [click here for website to California Legislative Info].
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.
3. Where Can I Find California’s Medi-Cal Regulations?
Website to find California Code of Regulations:
- California Office of Administrative Law, California Code of Regulations, https://oal.ca.gov/publications/ccr/, or
- General information about regulations at Office of Administrative law, [click here for OAL's website].
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, [click here for Medi-Cal Manual's website] 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: [click here for Title 9 Regs' website]
4. What are Medi-Cal Fair Hearings, and Where Can I Find DHCS Information about Them?
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
[Click here for website to Fair Hearing]. 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.cdss.ca.gov/inforesources/State-Hearings.
5. What is California’s Medicaid State Plan, and Where Can I Find It?
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 Centers for Medicare and Medicaid Services (CMS) 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 CMS to determine if the State can receive Federal Financial Participation (FFP) for its Medicaid program. This website includes the current Medicaid State Plan for California as well as State Plan Amendments (SPAs).”
California’s Medi-Cal state plan is available at: [click here for Medi-Cal Plan's website]. This website also has a link to approved State Plan Amendments (SPAs), which update the State Plan.
6. What are California’s Medi-Cal Waivers, and Where Can I Find DHCS Information About Them?
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 [click here for website to Medi-Cal Waivers]
Information about California’s “Bridge to Reform” 1115 waiver for expansion of Medi-Cal coverage: [click here for website to Section 1115 Medicaid Waiver]
In addition, see the Disability Rights California websites discussed above in Section 1 for information about waivers.
7. Where Can I Find Information about Medi-Cal Managed Care?
DHCS has consumer information about Medi-Cal managed care here: [click here for website to Medi-Cal Managed Care]. 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: [click here for website to Health Care Benefits and Services Fact Sheet].
8. Where Can I Find California Data and Statistics About Medi-Cal?
DHCS posts data and statistics about the Medi-Cal program, including links to data and statistics developed by others, at [click here for website to Data & Statistics].
9. What Other Materials Does DHCS Write About Medi-Cal, and Where Can I Find Them?
See Western Center’s Medi-Cal guide, 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 [click here for Resources for Counties' website].
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 [click here for Manual of Medi-Cal Eligibility Procedures' website].
DHCS posts provider manuals, with information designed to help providers navigate the Medi-Cal system, at [click here for Provider Manuals' website].
10. Where Can I Find Federal Medicaid Laws?
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 [click here for United States Code's website].
Federal Medicaid laws can be hard to follow. We recommend starting your research with other materials, including the Western Center guide described above in question 1, before you start researching federal laws.
11. Where Can I Find Federal Medicaid Regulations?
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 [click here for CFR's website].
You can search the Code of Federal Regulations generally here: [click here for the CFR's website]
Like federal Medicaid laws, the regulations can be hard to follow. We recommend starting your research with other materials, including the Western Center guide described above in question 1, before you start researching federal laws.
12. What Other CMS Materials are there about Medi-Cal and Where Can I Find Them?
Numerous materials developed by CMS are available at the following CMS websites:
- Medicaid home page: click here for Medicaid's website.
- State Medicaid Director Letters and Dear State Health Official Letters: [click here for website to Medicaid Policy Guidance]
- Medicaid Manual (Pub#45), CMS' directions to the states on implementing the Medicaid Act.: [click here for website to CMS Guidance Manual]
- Regulations and guidance: [click here for website to CMS Regulations & Guidance].
Federal statistics about Medicaid are available on the CMS website at [click here for website to CMS Research, Statistics, Data & System].
The CMS website is a bit complex and can change often. Finding useful information sometimes requires some navigation.
Click links below for a downloadable version.