Medi-Cal

This pub tells you about your rights when discharged from a hospital and you have Medi-Cal or Medicare. It tells you what to do if you are not ready to leave the hospital. It tells you about services you can get once home. It tells you what to do if you are homeless. It tells you how to complain about the hospital and where to get help.

Did you know that if you get Medi-Cal and your disability makes it hard for you to communicate, Medi-Cal might pay for communication supports that you need?

There are different Medi-Cal programs to help people with disabilities and seniors stay in their homes. These programs can help them return home from places like hospitals and nursing homes. This pub gives you information about these programs. It tells you what to do if you need help getting one of the programs.

This pub tells you how to look up Medi-Cal on the Internet. Medi-Cal gives health care to people with low income and limited ability to pay for health care. Medi-Cal is California’s form of the federal “Medicaid” program. Medi-Cal laws can be hard to follow. You may want to look at some of our other Medi-Cal pubs first before you research the Internet.

Many people have questions about how a nonrecurring lump sum (one-time-only) payment will affect their Medi-Cal eligibility.  This publication describes how lump sum payments affect eligibility for certain Medi-Cal programs for seniors and persons with disabilities. It explains what happens to your Medi-Cal when you receive a one-time or lump-sum payment, and when and whether an unspent lump-sum payment counts as a resource in the following month. 

The Coordinated Care Initiative (CCI) is a program that changed the way certain people in California get their health care and their long-term services and supports (LTSS).

Since 2011, California has been in the process of moving seniors and people with disabilities (SPDs) with Medi-Cal only and those eligible for both Medicare and Medi-Cal (dual eligible) into Medi-Cal managed care plans (Medi-Cal MCP) instead of traditional, regular, or fee-for-service Medi-Cal.

This pub tells you about appealing a decision by or raising other matters with a Medi-Cal managed health care plan. First talk to your provider or call your plan’s customer service number. If that does not work, this pub tells you about other options. It tells you about using a grievance, filing an appeal or asking the Department of Managed Health Care for help.

This publication tells you about Medi-Cal “continuity of care.” If you have to enroll in a Medi-Cal managed care plan, you may be able to see your regular Medi-Cal health care provider. This is what “continuity of care” means. The publication tells you what to do if you cannot get it.

This publication gives you information about Medi-Cal managed care plans. Managed care is a way to provide and pay for health care. You receive most of your health care from a managed care plan. A managed care plan is an organized network of health care providers that focuses on primary and preventive care.  Hospitals, physicians and other health care providers are members of the network. The publication tells you how to pick one. It tells you what to do if you do not want to join one. It tells you about the services the plans offer.

Medi-Cal managed care health plans have networks of providers. Providers are doctors, pharmacies, clinics, labs, and hospitals. Most of the time, you must use the plan providers. There are times when you can get health care from providers who are not plan providers. They are “out-of-network” providers. This pub tells you when you can use such a provider. If Medi-Cal tells you that you cannot go “out-of- network, the pub tells you what to do.

You can get some mental health services from fee-for-service Medi-Cal or Medi-Cal managed care plans. You can only get certain services from county Mental Health Plans. This publication tells you what services you have to get from the county and about mental health services available from Medi-Cal managed care plans. Managed care is a way to provide and pay for health care. You receive most of your health care from a managed care plan. A managed care plan is an organized network of health care providers that focuses on primary and preventive care. Hospitals, physicians and other health care providers are members of the network. This publication tells you what services you can get. It tells you what to do if you do not agree with the health plan.

Medi-Cal managed care plans have to have providers within a certain time and distance from the patients’ home or “time and distance” standards. Managed care is a way to provide and pay for health care. You receive most of your health care from a managed care plan. A managed care plan is an organized network of health care providers that focuses on primary and preventive care. Hospitals, physicians and other health care providers are members of the network. This publication tells you about the “time and distance” standards for providers. It tells you what to do if your plan does not follow its “time and distance” standards.

This tells you how to get transportation to medical appointments from your Medi-Cal managed care plan. Managed care is a way to provide and pay for health care. You receive most of your health care from a managed care plan. A managed care plan is an organized network of health care providers that focuses on primary and preventive care. The pub also tells you how to get transportation services if you have fee for service or traditional Medi-Cal.