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Covered California and Obamacare related questions from consumers, employers and agents are answered by Phil Daigle with the best information available at the time. Archived entries may no longer be accurate as the Covered California and Obamacare knowledge-base is evolving quickly. TO REQUEST A PERSONAL RESPONSE INCLUDE EMAIL ADDRESS.


Medi-Cal Managed Care Options ?

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Question: Hi, I received a Medi-cal card, but no information on where to go, who to see!! It has been weeks, not sure who to contact. I had Kaiser prior which my parents were paying but it became too expensive. I would like to continue with Kaiser since i already have MDs there I am comfortable with. Is this a possibility?

Answer: When you first qualify for Medi-Cal, you are covered under Medi-Cal Fee-for-Service. However, you must choose a managed-care health plan within 30 days. Managed-care plans like Health Net or Anthem come with their own provider networks. What that means to you is you don't have to struggle trying to find doctors that are accepting Medi-Cal patients. If you do not choose a plan within 30 days, the State will choose a plan for you. The county in which you live will determine your choice of Medi-Cal managed-care plans. For example, if you live in Los Angeles county you can choose between LA Care or Health Net while next door in Orange County you have one choice - CalOptima. Click here for a list of Medi-Cal managed care plans available in your county. If you find only one health plan, the county has chosen this plan for you. Please wait for your health plan information mailer in the mail. If you find multiple health plans listed, please explore each plan and choose the one that suits you and your family's needs. Remember, if you do not pick a plan within 30 days of receiving your health plan information mailer, Medi-Cal will pick a plan for you. However, you may also choose to stay in Fee-For-Service Medi-Cal.

13 Comments

Medi-Cal Managed Care in Orange is known as Cal-Optima. You can apply through the Cal-Win website: https://www.mybenefitscalwin.org/ You must be released by LA County DPSS in order to have coverage in Orange County. It should be a seamless process, but LA County has a way of delaying everything that.comes across a DPSS employee’s desk.

Hi, i have enrolled in medi-cal . I finally got La care bit now after 3 years living in los angeles county i moved to orange county. What should i do?? Do i have to get my medi cal change ?? Do i have cancel and apply again?? Can i still use my La care .. ??

Hi Douglas. A ‘permit to enroll’ is acquired from the controlling Medi-Cal HMO Plan organization.

For instance, in Alameda County once enrolled in Medi-Cal, one will be directed to contact Alameda Alliance for Health, the HMO Plan for health plan coverage. If one is also eligible to enroll with Kaiser (in Alameda County, eligibility for Medi-Cal Kaiser enrollment is based upon being in enrolled with Kaiser at least six months prior to one’s initial Medi-Cal enrollment) then you simply need to ask the controlling HMO health Plan, which is Alameda Alliance for Health, for the ‘Permit to Enroll’ in Kaiser. The controlling HMO Health Plan, Alameda Alliance for Health, should then send over your request to Kaiser and Kaiser will enroll you, and all under Medi-Cal.

I don’t believe there is any ‘permit’ form you will need complete, but rather simply make the ‘permit to enroll’ request with whomever you speak at the controlling HMO Health Plan (Alameda Alliance for Health in Alameda County).

Generally you will request your ‘permit to enroll’ in Kaiser when you’re at the stage of actual Health Plan enrollment for medical insurance coverage, once your initial Medi-Cal enrollment through the County has been completed.

… to enroll with Kaiser under Medi-Cal, and then only with a ‘Permit to Enroll’ request . Can you find this Permit to Enroll form online ?

Thank-you

I work part-time for a county agency and am provided free health insurance with a $5000 dollar deductible. I am fully covered by my husbands insurance and thought my free insurance was catastrophic insurance. I had no idea that this would be considered by primary insurance. I have contacted HR and been advised that it is county policy that all employees be covered by the counties health plan. However, when I asked for said policy there is not one. This has caused much emotional and financial hardship - I am now getting charged back from my secondary insurance and will have to pay bills that should have been covered by the premium I have been paying. I have tried working with HR and our Union representative, but nobody seems to care. Any advise would be appreciated.

Hi. Before Obamacare came to the market, my wife and I had a medical policy for both of us with Blue Cross, and my daughter had a separate policy with Healthy Families due to our income level. When Obamacare was enacted, my wife and I qualified for California Care, which we recieved tax credits toward our premiums, and we kept our daughter on Healthy Families, which is now Medi Cal. At the time, I didn’t list her on our California Care Application, because I thought she had to stay with Healthy Families. My first question is: Should of I listed my daughter originally as a dependent when I first signed up for Covered California in 2014? Should I go back to Covered California and make this change? My last concern is, my wife and I have separated and will be divorcing, so should we make this change with my daughter after the divorce, and put her under one of our plans when we make this change with Covered California? I am not sure if we have to cancel my daughters Medi Cal first, than reapply under covered california, at which time my wife and I would have to make the change for the divorce, and than either add my daughter as a dependent, or keep her with Medi Cal. I am concerned that we should of listed her on the original Covered California Plan and make sure what we qualified for. It was very confusing at the time, and we were not sure how that worked. Thank you. cornairpainting@roadrun com ner.

Gregg …

You have been given the correct information from the folks at Alameda Alliance. Your situation is not unlike that of thousands of others throughout California.

The Medi-Cal system is a fouled up bureaucracy. Instead of being managed from a central point, as Medicaid is in most other states, California chose many years ago to stick its thumb into the pie at the state level, but to turn the rest of the pie over to the local county Medi-Cal agencies (the Dept of Public Social Services in many counties) to administer.

All this does is add a layer of unnecessary expense and waste to a system that is mired in technicalities. You can thank the public employee unions for a large part of this mess. Job security at taxpayer expense.

You will have to demand the restoration of your coverage through the local agency. Not by phone — that’s a general waste of time, as you have learned, because no one answers their phone (why do that? it only means having to do some work) — but in person … which is still going to be mostly a waste of your time. Sadly, there is not much else you can do.

There may be some attorney(s) somewhere in California looking for folks like you to file another class action against the state and counties for this mismanagement of the public trust. You and others like you have a great case — although there is little or no money in it for you. It’s the principle of the matter that you would be fighting for.

The Medi-Cal system is not supposed to abuse folks like you have been abused. The state and the counties have had more than four years to figure out how they were going to manage millions of new beneficiaries, and they blew it. The federal government could punish the state for its inefficiencies, but that wouldn’t help anyone — it would simply diminsh the dollars available to pay medical and other expenses, which the rest of us taxpayers would be forced to pick up.

This is the worst facet of “socialized” medicine coming to light. It has virtually nothing to do with the insurance companies. For those who continue to cry out for a “single payer system” of health care … take a good close look at these problems with Medi-Cal, which is “providing” health care for about 10 million persons in California. If they can’t manage it like this, what are they going to do when there are 39 million people to have to account for?

There are no simple solutions to this problem. But taking away administration of Medi-Cal at the local county level would be a good start. It would probably add another few tens of thousands of folks to the Medi-Cal roster … who would justly get a taste of their own medicine.

Hi, There was mix up at Medi-cal office and they deactivated my coverage for family of 5. Which in turn deactivated my Alameda Alliance insurance for my family.

I had to make 5 trips to the main office in Oakland to get my Medi-cal issue fixed (btw they NEVER notified me in any way shape or form) they just turned Medi-cal back on…..really a mess of serivce. You can not ever get a live person, nor did i ever get reply to many voice mails i left.

At the time they had me running around, they ALSO made me re-file for Alameda Alliance coverage, but after 2 weeks it appears my Alameda Alliance coverage is still deactivated. I need this coverage for me and my family, especially being i’m in the middle of a treatment plan that they have stopped due to Alameda Alliance being turned off right now.

Ive tried talking to Alameda Alliance folks, but they just tell me i have to get Medi-call folks to fix….

What a mess

where do i get answers/help????

Nicole is correct in that Kaiser is available in many California counties, yet I am unfamiliar and have not heard of Kaiser being closed to new patients generally so.

Kaiser is available in several California counties. Napa, Los Angeles, Alameda, Orange, and there are more.

Each county seems to have its requirements to be eligible to enroll with Kaiser under their specific county’s Medi-Cal program. For instance, in Alameda County, one must have been enrolled with Kaiser at lease six (6) consecutive months prior to Medi-Cal enrollment in order to be eligible to enroll with Kaiser under Medi-Cal, and then only with a ‘Permit to Enroll’ request as sent from the Alameda Alliance for Health HMO plan to Kaiser, thereby allowing permission for the Medi-Cal enrollee to enroll with Kaiser.

Yet, in Los Angeles County it seems there are no limitations to enroll with the Kaiser HMO plan, as through LA Care, when enrolling and enrolled in Medi-Cal.

As far as I can tell, Kaiser is a Medi-Cal Managed Health Care Plan in only two counties: San Diego and Sacramento.

According to the DHCS link Phil provided, Kaiser is NOT an MMHCP option in Orange County. But I don’t have any active Medi-Cal clients in Orange County, so I cannot confirm Catheriine’s statements one way or another.

I have one applicant in San Diego County (applied 11-26-14) who had not yet been contacted by the county Medi-Cal agency as of 1/3/15, so I don’t know what choices she has been/will be offered.

Kaiser is available as a Medi-Cal Managed Care plan in California (not all counties), but it is closed to new patients in almost every county that it’s available in. The only way you can enroll is with a special request and you have to meet certain criteria to be able to make a special request (children under the age of 18, be enrolled in Kaiser in the last year with no break in coverage, etc).

Thanks Catherine. I wonder if KP is available (on the down-low) in any other CA counties? Anybody know?

Phil, as a follow- up to your Q&A below, fyi if you are in Orange County, Caloptima offers one of its medical groups OR Kaiser. It’s right on the enrollment form. 90% of my Orange County clients choose Kaiser. If they do not choose Kaiser when they get the form which incidentally is taking them longer than 30 days to send out they can not change to Kaiser Medi-cal during open enrollment. Not sure why, that’s what Cal-Optima told me. So it’s right out of the gate or no longer an option.

I’m sure Kaiser was a ‘safety net provider’ when the state gave CalOptima the contract and so they had to include them. But since they don’t make any money delegating everything to Kaiser they probably don’t prefer it. In fact the option is only found on the actual enrollment form, it’s no where in the booklet or other info so it’s easily missed.

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