Medi Cal Managed Care – HMO health
plans – providers
One must choose a Managed Care – HMO health plan – provider within 30 days after enrollment in Medi-Cal otherwise the State will pick plan for you. Medi-Cal Website
Medi-Cal Managed Care – Health Care Options – This Government Site allows you to review and choose the HMO that you want to deliver your Medi-Cal health Care. You can also visit the Insurance Company website, by scrolling down to the ones you’re interested in.
Los Angeles County Medi-Cal #Providers you can choose from
- Cal Medi Connect – Medi-Cal & Medicare – Medi Medi Dual Eligible D SNP
- Health Net Solutions
- LA Care – Medi Cal & Covered CA
- Molina Health Care
Medi-Cal Managed Care – Health Care Options
EOC’s, Forms & Income Charts from Insure Me Kevin.com
Medi-Cal Listing of HMO plans by county *
Medi Cal HMO – Managed Care Providers by County –
Provider Search – Statewide Fee for Service
Enroll in Medi-Cal ONLINE – Los Angeles
My Medi-Cal
How to get the Health Care You Need
24 pages
Smart Phones – try turning sideways to view pdf better
Medi Cal Explained CHCF
More
February 2019 17 pages
10 Essential Health Benefits
Video
Western Poverty Law – Exact Legal Rules on
Coverage for Low Income Californian’s
Historical Guide 2006 CHCF 174 pages
Our Webpage on
COVID 19
Historical Medi Cal Provider Issues
54% of MD’s accept Medi-Cal 4.3.2015
Litigation on Medi-Cal violating Judges order and putting people into HMO’s, rather than fee for service. CA Health Line 8.10.2017
Number of Medi-Cal Providers down by 25% californiahealthline.org/2014/7/15
Paul Ryan – more and more MD’s just won’t take Medi-Cal – Medicaid Fact Checker Washington Post 2.1.2017
Video on problems finding doctors
Many large physician groups no longer contract with health plans serving adult Medi-Cal patients, saying that government reimbursements are too low to cover the cost of treating patients.
For the typical office visit, Medi-Cal pays doctors only about a third of what their peers at federally qualified health centers receive, $150 on average. If the health centers’ fees exceed what insurers will pay, their administrators can bill the state for the residual amount. So, the state is forced by federal law to pay more for office visits at federally qualified health centers than it would have paid physicians in private hospital groups. Sacramento Bee 10.2.2017
The U.S. Supreme Court’s ruling October 2014 that private health care providers cannot file lawsuits against state Medicaid agencies over low reimbursement rates could limit future Medi-Cal lawsuits, the Los Angeles Times‘ “PolitiCal” reports. CA Health Line
Medi-Cal is California’s Medicaid program (Megerian, “PolitiCal,” Los Angeles Times, 3/31).
Los Angeles Times 8.14.2014 – Few Providers, etc
There are now about 11 million Medi-Cal beneficiaries, constituting nearly 30% of the state’s population
Under the Affordable Care Act, the federal government pays 100% of the costs for newly eligible Medi-Cal enrollees for the first three years. But the state is responsible for 50% of the costs for those who qualified for the program before the Obamacare expansion, even if they hadn’t previously enrolled
With payments of $18 to $24 a visit, “doctors can’t continue to accept new patients and keep their doors open,” said Molly Weedn, a spokeswoman for the California Medical Assn. Without enough doctors, Medi-Cal patients could continue landing in costly emergency rooms — the opposite of Obamacare’s aims.
There is application backlog of about 490,000 people,
California has already demonstrated to the rest of the country that it can dramatically cut its rate of uninsured, largely by increasing the size of Medi-Cal. Now it needs to show that its public insurance program can actually deliver the care its new enrollees are counting on. latimes.com
Money in CA budget to expand Medi-Cal but 10% reduction in payments to MD’s california health line.org
Covered CA Certified Agent
No extra charge if you qualify for Covered CA Subsidies.
We don’t get compensated to help you with Medi Cal. Here’s Medi-Cal’s contact information.
Get a Covered CA Quote, including subsidy calculation
Video on why you should have an agent
Disability Rights – Medi Cal provider HMO’s, what are they? What do I need to know about them?
https://www.disabilityrightsca.org/system/files?file=file-attachments/549501.pdf
Stanford Medical told me I would have to drop my Medi-Cal to get their full financial assistance (charity care)?
I was told that I could not come to Stanford for any health care if I was a Medi-Cal recipient……… because then Stanford would be commiting FRAUD. I was told I would have to ‘quit’ my Medi-Cal or get the permission from Kaiser (who I have for my Medical-Cal) to see a ‘out of network’ surgeon…….
How do I opt out of Medi-Cal?
If I quit or gave up my Medi-cal , will I be able to reinstate it or reapply when I am ready…assuming I still qualify/?
We’re out of the country right now so it’s difficult to do all the research check this paper titled Uneasy Relationship between Medicaid Medi Cal and Charity Care and maybe the answers in there
Kaiser only allows one to have Medi-Cal through them if you were previously with Kaiser https://thrive.kaiserpermanente.org/medicaid/medi-cal-california/how-to-apply so if you drop out I doubt that you’ll be able to get back in with Kaiser and you would have to use another Medi-Cal HMO
Hypothetically, what if Stanford messes up the procedure, do you think Kaiser would want to have to fix that.
If you drop Medi Cal, what about other health services that you might need?
Will any of the other Medi-Cal HMO’s allow them https://medi-cal.healthreformquotes.com/hmo-managed-care-providers/ to do the surgery that you want because it’s my understanding that you could change Medi-Cal HMO anytime you want
I’m in Los Angeles, the Medi Cal rules are different for every county, even though it the same federal Medicaid law…. Here’s a list of the Medi Cal plans that Stanford accepts https://stanfordhealthcare.org/for-patients-visitors/health-insurance-plans/medi-cal.html
What reasons do you qualify for Medi Cal on?
It’s also a shame that Covered CA mandates agents help people enroll in Medi Cal, but don’t pay them a nickel for that or to maintain there 2nd to none, website. How much time and research do you think it took me to find this information for you?
What county are you in?
Yolo?
Sacramento? https://www.dhcs.ca.gov/individuals/pages/mmcdhealthplandir.aspx#sacramento
https://www.healthcareoptions.dhcs.ca.gov/choose/tips-help-you-choose-medical-plan
https://www.healthcareoptions.dhcs.ca.gov/frequently-asked-questions-faqs
Exemption from enrolling in a Health Care Plan
https://www.healthcareoptions.dhcs.ca.gov/download-forms?location=23
https://www.healthcareoptions.dhcs.ca.gov/sites/default/files/Documents/MU_0003383_ENG_TempMedExemptionWEB.pdf
You May Get A Medical Exemption If:
• You have a complex medical condition; AND
• The care you get from your Regular Medi-Cal doctor for the complex medical condition
cannot be changed, because your condition could get worse; AND
• Your Regular Medi-Cal doctor is NOT part of a plan in your county. You may see
more than one Regular Medi-Cal doctor. If you do, have the form filled out by the
doctor who sees you most often. Ask your Regular Medi-Cal doctor if he or she is part
of a Plan in your county. This should be done before you submit this form.
See our webpage on IMR Independent Medical Review
Watch this page and we’ll update in between a recreational activities and going to museums and learning a foreign language
Do you have Medicare?
No. I do not qualify.
Here’s what we found on Stanford’s website:
https://stanfordhealthcare.org/for-patients-visitors/financial-assistance.html
https://stanfordhealthcare.org/content/dam/SHC/patientsandvisitors/billing/docs/shc-financial-assistance-policy-plain-language-summary.pdf
stanfordhealthcare.org/content/dam/SHC/patientsandvisitors/billing/docs/faa-2014-english.pdf
Did you list your Medi Cal on question # 4 Other Coverage – #2 State Assistance Programs?
My mom got diagnosed with stage 4 lung cancer(which has spread to brain) last week at Stanford Emergency center. She has Medi-cal managed health plan(Santa Clara Family Health plan managed by VHC). Stanford is in-network only for emergencies and things the community hospital can’t provide.
Medi-cal denied our request to be seen by Stanford doctor and has referred us to valley medical center.
When I asked stanford about seeing doctor there and paying out of pocket they said if I do that she will lose her Medi-cal insurance.
Even if I try to get second opinion she could lose her medi-cal….which is so strange to me. Can you vouch for that ? how would medi-cal know ?
Can I get second opinion out of state(john hopkins or some other medical center) and will she still be at risk of losing insurance ?
Also, I was trying to find a insurance plan that can include stanford cancer specialists and found one by Health Net (PPO). But read really bad reviews about them on consumer reports(shady tactics to avoid paying).
Do you recommend any insurance plans that are hassle free from patient perspective that I can pay out of pocket for her treatment ?
Here’s what we have on finding an Insurance Plan when you’re on Medi-Cal.
We don’t get compensated to help people with Medi-Cal, so no, we can’t really recommend or shop a plan for you.
“If you have been enrolled in a Medi-Cal Managed Care Plan for more than 90 days you cannot get a medical exemption and you should not submit this form. ”
Since my mom has been enrolled in Medi-Cal qualifying for exemption is not an option.
I don’t have ready access to Santa Clara’s Family Health Plan Member Handbook or EOC Evidence of Coverage. LA Cares Member Handbook says you can get a 2nd Opinion from an IN NETWORK provider.
It doesn’t look like Independent Medical Review applies…
Healthcare providers are prohibited by law from billing people with Medi-Cal for charges not covered by their insurance. LA Times
Under the Medicaid (Medi-Cal) program, a provider agrees to accept payment under the Medicaid program as payment in full for services rendered. A provider may not make a private pay agreement with a beneficiary to accept a Medicaid fee for a particular covered service and then provide a different upgraded service (usually a service that is beyond the scope of the Medicaid program) and agree to charge the beneficiary only the difference in fee between two services, in addition to billing Medicaid for the covered service.
It is an unacceptable practice to knowingly demand or collect any reimbursement in addition to claims made under the Medicaid program, except where permitted by law. New York – College of ER physicians
CA DOI no surprize bills
Consumer Reports
See our webpage on Fraud
Handbook for New Doctors on Avoiding Medicare & Medi-Cal Fraud
What if you have your Mom live with you and you take her as a dependent?
Then maybe she will qualify for Covered CA subsidies?
What would be your combined income?
Here’s our webpage on rules for a household taking a dependent.
Here’s where to get quotes, based on household income… for Covered CA.
Here’s where to get more details on each Insurance Company in Covered CA.
Sometimes it’s difficult to get out of Medi-Cal…
I could spend on private insurance to at least see the doctor of my choice if not be treated by him.
I know little about how PPO plans work…could I literally buy an $800 a month plan just long enough to consult with Dr. xx?
Continue it just long enough just to be treated? Or would there be contracts and delays?
I’m also concerned Cedars might refuse to give me an appointment without the medi-cal being fully cancelled.
I’m willing to cancel it but again there could be delays from state documenting cancellation.
Here’s our quote engine to get Blue Shield PPO You can get quotes there or here.
Private coverage would pay first, so I don’t think you would then be considered a Medi Cal patient and have the prohibition of the doctor or hospital being accused of fraud, see above.
I’m NOT an attorney or authorized representative for Medi Cal! Thus, I’m NOT giving you any advice or recommendation!
See our webpage on surprise & balance billing.
Try the Medi Cal Ombudsman? and Complex Assistance See our contact page
Here’s the closest I’ve found to a citation in the law about a medical provider not being able to bill you for anything that Medi Cal doesn’t cover. Section 1902(n)(3)(B) of the Social Security Act, as modified by section 4714 of the Balanced Budget Act of 1997.
Please review the research we’ve done above and if you find anything that might be helpful to other website visitors, please post it. You don’t have to put in your name.
https://www.latimes.com/california/story/2020-09-30/delays-los-angeles-hospitals-patients-deaths
I live in Sacramento County and Medi Cal wants me to choose a Medi Cal managed care plan.
But we both know by law I can keep straight Medi Cal.
How do I fix this?
I’m not familiar with any law that says you can keep straight fee for service Medi Cal and not pick an HMO or have one picked for you. If you have a citation that I don’t, please place it in the reply section. You don’t have to put in your name.
This page on Medi Cal’s site, clearly states you have to pick an HMO. More details on the change, as it used to be that you were right and you could have fee for service.
You can also contact Medi Cal through our contact page.
HELP!!!
I have blood in my stool. Medi-Cal won’t let me have a colonoscopy for 3 months.
What can I do to get an appointment sooner?
What Medi-Cal HMO carrier are you with? Check out their EOC evidence of coverage for appeals procedures. See the list of providers that we have above. We might already have links.
Try using the contact information we have for Medi-Cal and see how they can help you. Medi-Cal has PAID staff to help you. We don’t get paid to help you.
Check out our appeals and grievances website.
Try filing with the Department of Insurance – Managed Health Care a request for Independent Medical Review.
Medical Necessity?
Review the clinical guidelines, for various types of colonoscopy.
Research meaning of blood in stool
https://www.mayoclinic.org/tests-procedures/fecal-occult-blood-test/about/pac-20394112
Positive result. A fecal occult blood test is considered positive if blood is detected in your stool samples. You may need additional testing — such as a colonoscopy — to locate the source of the bleeding.
https://www.webmd.com/colorectal-cancer/guide/fecal-occult-blood-test#1
https://www.webmd.com/colorectal-cancer/guide/colorectal-cancer-overview-facts
How urgent is a colonoscopy?
https://kennethbrownmd.com/blood-in-toilet/
I’m not a doctor, attorney or paid staff at Medi Cal. Check with them…
Reply from Medi-Cal
The individual would need to go through the doctors and health care plan in order to speed up the process.