Navigating Your Health Care Options

Medi-Cal health plans provide essential health coverage for approximately 15.2 million Californians across all 58 counties. If you're looking to enroll in a Medi-Cal health plan, here's what you need to know:

• Eligibility: Based on income (adults up to 138% FPL, children up to 266% FPL), age, and residency status

• Coverage: Doctor visits, prescriptions, vaccinations, hospital care, mental health services

• Enrollment Process: Apply through county office or online, then select a plan within 30 days

• Types of Plans: Managed care plans organized into five models (Two-Plan, COHS, GMC, RM, and Single-Plan)

Navigating Medi-Cal can feel overwhelming, especially when you're trying to secure the best possible health care for yourself or a loved one. Whether you're newly eligible, changing plans, or simply trying to understand your options, the enrollment process requires careful consideration of your specific needs, county of residence, and available plan networks.

Unlike private insurance, Medi-Cal health plans operate through managed care systems that emphasize preventive care while providing comprehensive coverage. This approach not only helps contain costs but also ensures that beneficiaries receive coordinated care through established provider networks.

The good news is that Medi-Cal offers robust coverage with no monthly premiums or co-pays for qualifying families. Recent policy changes have also expanded eligibility to include undocumented adults ages 0-25 and those 50 and older, with further expansion to ages 26-49 beginning January 2024.

I'm Marty Burbank, an elder law attorney with extensive experience helping seniors steer Medi-Cal health plans and preserve their assets while securing necessary care. As a recognized expert in estate planning and elder law, I've guided countless families through the complexities of Medi-Cal enrollment and qualification.

Understanding Medi-Cal: Eligibility and Coverage

When it comes to healthcare in California, Medi-Cal serves as a lifeline for millions of residents who might otherwise go without essential medical services. As California's version of the federal Medicaid program, Medi-Cal provides free or low-cost healthcare coverage designed specifically for those with limited income and resources.

Unlike Medicare, which primarily serves older adults regardless of their financial situation, Medi-Cal focuses on ensuring that all Californians can access quality healthcare, regardless of their economic status. This vital program operates through a partnership between federal and state governments, with administration handled by the California Department of Health Services.

One of Medi-Cal's most valuable features is its coverage of long-term care services—something Medicare typically doesn't cover. As the program documentation states, "If a doctor says you have a medical need for nursing home care, Medi-Cal pays for you to go to a nursing home they have a contract with." This benefit alone can make an enormous difference for families facing difficult care decisions.

Who Is Eligible for Medi-Cal?

Qualifying for Medi-Cal health plans isn't as complicated as you might think. The program casts a wide net to help as many Californians as possible, with eligibility primarily based on three key factors: income, age, and residency status.

For income-based eligibility, adults can qualify with income up to 138% of the Federal Poverty Level, while children may qualify with family income up to 266% of the FPL. Pregnant women often qualify under even higher income thresholds, recognizing the importance of prenatal care.

When it comes to age-based eligibility, Medi-Cal covers the full spectrum—from newborns to seniors. Children and young adults under 26, adults of any age meeting income requirements, and seniors 65+ who meet both income and asset requirements can all qualify for coverage.

Residency status has seen significant expansions in recent years. Beyond U.S. citizens and permanent residents, California now offers full-scope Medi-Cal to undocumented individuals of all ages. This historic expansion, fully implemented in 2024, makes California the first state to offer healthcare coverage to all low-income residents regardless of immigration status, a policy that continues to benefit communities throughout 2025.

For those with special circumstances, Medi-Cal extends eligibility to individuals with disabilities, parents and caretaker relatives of children under 21, pregnant women, and former foster youth up to age 26.

For seniors considering long-term care options, there's good news: while Medi-Cal does have specific asset limits, many valuable assets are exempt from these calculations. Your primary residence, one vehicle, personal belongings, and certain retirement accounts typically don't count toward these limits. This means that with proper planning, even individuals with significant assets may qualify for Medi-Cal coverage when they need it most.

What Services Does Medi-Cal Cover?

Medi-Cal health plans provide remarkably comprehensive coverage, addressing both preventive care and treatment needs. The program ensures beneficiaries can access a wide range of necessary health services without the financial burden that often comes with healthcare.

For everyday health maintenance, Medi-Cal covers primary care services like regular check-ups and preventive screenings that help catch potential issues before they become serious problems. When specialized treatment is needed, coverage extends to specialty care, connecting members with experts for specific health conditions.

Prescription medications are covered under Medi-Cal, ensuring that necessary drugs don't become a financial burden. For unexpected situations, emergency services including ER visits and ambulance transportation are also included.

When more intensive care is required, hospital care covers both inpatient stays and outpatient procedures. Recognizing that health encompasses more than just physical wellbeing, mental health services provide access to counseling, therapy, and psychiatric care, while substance use disorder treatment programs address alcohol and drug dependency.

Your smile matters too—dental services through the Medi-Cal Dental Program (formerly Denti-Cal) cover basic dental care to maintain oral health. Vision care includes eye exams and, in some cases, glasses to correct vision problems.

For growing families, maternity and newborn care covers prenatal visits, delivery, and postpartum services to ensure healthy beginnings. When long-term support is needed, long-term care covers nursing home care when medically necessary, while home and community-based services provide support to help individuals remain in their homes whenever possible.

Children receive special attention through the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit, which provides comprehensive preventive, dental, mental health, developmental, and specialty services for those under age 21.

With such extensive coverage, it's no wonder that Medi-Cal health plans have become essential for millions of Californians. Whether you're exploring options for yourself, an aging parent, or a growing family, understanding what Medi-Cal offers is the first step toward securing the healthcare coverage you need. For more detailed information about California Medi-Cal, visit More info about California Medi-Cal or learn about specific dental coverage at Medi-Cal Dental Plans. You can also find comprehensive information about Medicaid programs nationwide at Medicaid.gov, which provides valuable resources for understanding how these programs work across different states.

Navigating Medi-Cal Health Plans

Once you've figured out that you're eligible for Medi-Cal, you'll need to understand how Medi-Cal health plans actually work and what options you have available. In California, most Medi-Cal services come through what's called "managed care plans" rather than the older fee-for-service system.

Think of Medi-Cal Managed Care as your personal health care team. Instead of hunting down different doctors on your own, you get access to an established network of physicians, specialists, hospitals, and other providers who work together to coordinate your care. This approach not only helps you get better, more consistent treatment, but it also helps keep costs under control for everyone.

California has set up five different models for Medi-Cal health plans across the state, and which one you'll use depends entirely on where you live:

If you live in Los Angeles, San Bernardino, or Riverside counties, you'll be in the Two-Plan Model area. This gives you a choice between a locally-run plan and a commercial plan. It's like having two different health insurance options to pick from, and this model serves 14 counties in total.

For folks in Orange, Santa Barbara, or San Mateo counties (among others), you'll have the County Organized Health Systems (COHS) model. Here, there's just one health plan that serves everyone on Medi-Cal in your county. This simplified approach covers 22 counties.

If you call Sacramento or San Diego home, you're in a Geographic Managed Care (GMC) area, which offers several commercial plans to choose from. This gives you more options to find a plan that might include your preferred doctors.

Living in one of California's 18 rural counties? You'll likely have the Regional Model (RM), which offers a choice between two commercial plans designed to serve less densely populated areas.

And if you happen to be in San Benito County, you have the Single-Plan Model with just one commercial plan available to you.

Knowing which model operates in your county is really important because it determines how many choices you'll have and what type of plans you can access.

The Benefits of Medi-Cal Managed Care

When you enroll in one of the Medi-Cal health plans under managed care, you'll find several advantages that make your healthcare experience smoother and more effective.

First, you'll get truly coordinated care. Each member gets assigned a primary care provider (PCP) who becomes your main healthcare point person. Think of them as the quarterback of your healthcare team – they know your history, keep track of your medications, and make sure all your doctors are on the same page.

"Having a primary care doctor who knows my medical history and can coordinate my care has made a huge difference," shared one Medi-Cal member. "I no longer have to explain my conditions to each new provider I see."

These plans also put a strong emphasis on preventive care. Rather than just treating you when you're sick, they focus on keeping you healthy with regular check-ups, screenings, and immunizations. Catching potential problems early often means simpler, less expensive treatments and better outcomes.

You'll also benefit from established provider networks. Instead of wondering if a doctor will accept your coverage, you'll have access to a pre-approved network of healthcare professionals who have already agreed to work with your plan. This takes the guesswork out of finding care.

The cost-effectiveness of managed care plans benefits everyone. By focusing on prevention and coordination, these plans help control healthcare costs while maintaining quality care. This approach helps ensure that Medi-Cal can continue serving all who need it.

Many managed care plans also offer additional benefits that go beyond what traditional Medi-Cal covers. Depending on your plan, you might have access to transportation to medical appointments, health education programs, and 24/7 nurse advice lines – practical extras that can make managing your health much easier.

Understanding how Medi-Cal health plans work in your area gives you the knowledge to make the best choice for your healthcare needs. Whether you have multiple options or just one plan available, these managed care models are designed to provide comprehensive, coordinated care that focuses on your overall wellbeing.

How to Enroll in a Medi-Cal Health Plan

Joining a Medi-Cal health plan isn't as complicated as it might seem at first glance. The process happens in two main stages: first, you'll need to qualify for Medi-Cal itself, and then you'll select a specific health plan that serves your county.

Getting started with Medi-Cal is straightforward. You can apply online through either the Covered California website (www.coveredca.com) or BenefitsCal (www.benefitscal.com). If you prefer a more traditional approach, you can download and mail an application, visit your local county social services office in person, or simply pick up the phone and call Covered California at 1-800-300-1506.

When you apply, be prepared to share some basic information about your household. This typically includes details about your income, family size, and proof that you live in California. Having documents like your ID, recent pay stubs, and utility bills handy will make the process go much more smoothly.

Once you're approved for Medi-Cal, you'll initially be covered under what's called "Fee-for-Service" Medi-Cal. This temporary coverage keeps you protected while you make your next important decision – choosing your ongoing health plan.

In most counties across California, you'll have 30 days to select your Medi-Cal health plan. Take this timeframe seriously! If you don't make a choice within those 30 days, Medi-Cal will automatically assign you to a plan, which might not be the best fit for your specific needs.

The good news is that you'll receive a helpful "My Medi-Cal Choice" packet in the mail. This packet contains valuable information about all the available plans in your county. When reviewing your options, pay special attention to:

Which doctors and hospitals participate in each plan's network, especially if you already have healthcare providers you trust and want to keep seeing

What additional benefits each plan might offer beyond the standard Medi-Cal coverage

How convenient the plan's facilities are to your home or workplace

Once you've made your decision, enrolling is easy. You can call Medi-Cal Health Care Options at (800) 430-4263, enroll online at www.healthcareoptions.dhcs.ca.gov, or simply complete and mail back the choice form that came in your packet.

If you happen to live in a County Organized Health System (COHS) county, the process is even simpler – you'll be automatically enrolled in the single available health plan, and you'll receive a welcome packet with all the information you need to get started.

"The enrollment process can feel overwhelming at first," shares Marty Burbank of OC Elder Law, "but taking the time to understand your options can make a significant difference in your healthcare experience. We often help clients steer this process to ensure they're choosing the plan that best fits their unique situation."

For more information on the application process, visit our detailed guide on How Do I Apply for Medi-Cal.

Updating Your Contact Information

One of the most crucial yet overlooked aspects of maintaining your Medi-Cal health plan coverage is keeping your contact information current. This simple step ensures you receive important notices about your benefits, upcoming renewals, and any changes to your coverage.

If you move, change phone numbers, or get a new email address while enrolled in Medi-Cal, it's important to notify your local county social services office within 10 days. You can do this by phone, by updating your information online through your Covered California or BenefitsCal account, or by submitting a change of address form by mail or in person.

This timely notification is particularly important now that California has reinstated annual Medi-Cal eligibility reviews following the COVID-19 public health emergency. If county workers can't reach you to verify your continued eligibility, you might find yourself unexpectedly without coverage.

"The number one reason people lose their Medi-Cal coverage is because we can't reach them," explains one county eligibility worker. "A simple address update can prevent unnecessary gaps in coverage."

Think of updating your contact information as an insurance policy for your insurance policy – it's a small step that protects your access to essential healthcare services. Set a reminder on your calendar to verify your contact information every few months, especially after any life changes like moving or switching phone carriers.

Maintaining continuous coverage is much easier than having to reapply if your benefits lapse. A quick call or online update today could save you hours of paperwork and potential healthcare gaps down the road.

Choosing the Right Medi-Cal Health Plan Based on Your County

When it comes to Medi-Cal health plans, your zip code plays a surprisingly important role. The plans available to you depend entirely on your county of residence, which means your neighbor across the county line might have completely different options than you do.

Think of it like local restaurants—each county has its own unique "menu" of health plans based on which managed care model operates there. Some counties offer several choices, while others have just one plan serving everyone.

Accessing Plan Options in Your Area

Finding out which Medi-Cal health plans are available to you is actually quite straightforward. The easiest way is to visit the Medi-Cal Managed Care Health Plan Directory online, where you can search by county and see all your options at a glance. If you prefer talking to a real person, the Medi-Cal Health Care Options team is just a phone call away at (800) 430-4263—they're incredibly helpful and can walk you through your specific choices.

Most new Medi-Cal members also receive a "My Medi-Cal Choice" packet in the mail after qualifying. This packet is like your personal roadmap, explaining exactly which plans are available in your area and how to enroll.

The plan landscape varies dramatically across California. In Los Angeles County, which operates under the Two-Plan Model, residents choose between L.A. Care Health Plan (the local initiative) and Health Net Community Solutions (the commercial option). Meanwhile, Orange County has a County Organized Health System (COHS), meaning everyone enrolls in the same plan—CalOptima.

San Diego County offers the most variety under the Geographic Managed Care model. Residents there can choose from Blue Shield of California Promise Health Plan, Community Health Group Partnership Plan, Health Net Community Solutions, Kaiser Permanente, or Molina Healthcare of California Partner Plan.

When deciding which plan fits your needs best, consider what matters most to you. Is keeping your current doctor a priority? Then check each plan's provider network first. Do you take regular medications? Review the plan's formulary to make sure your prescriptions are covered. Some plans even offer valuable extras like transportation to appointments or specialized programs for chronic conditions like diabetes.

Location matters too—think about how far you're willing to travel for care. A plan with providers closer to your home or workplace might save you significant time and stress, especially if you have frequent appointments or mobility challenges.

Each Medi-Cal health plan offers provider directories that you can request by phone or access online. These directories are treasure troves of information, listing every doctor, specialist, hospital, and facility in the network. Many plans also have online search tools where you can look up specific providers to see if they're covered.

You can change your Medi-Cal plan online if you find your initial choice isn't working out. The system allows for flexibility as your healthcare needs evolve.

For those considering Kaiser as an option, it's worth looking into their specific coverage areas and eligibility requirements, as Kaiser Medi-Cal Plan operates differently than some other providers.

Choosing a health plan might seem overwhelming at first, but breaking down the decision into these practical factors makes it much more manageable. The goal is finding a plan that not only covers your medical needs but also fits seamlessly into your life.

Medi-Cal Renewal Process and Maintaining Coverage

Staying enrolled in your Medi-Cal health plan isn't a one-and-done process—it requires a bit of attention each year to make sure your coverage continues without interruption. Think of it as an annual health check-up for your benefits!

Each year, about 60 days before your renewal date, you'll receive a renewal packet in the mail. This is your cue to provide updated information about your income, household size, and any significant life changes that might affect your eligibility. The process is designed to be straightforward, with several convenient ways to complete your renewal—online through your Covered California or BenefitsCal account, by mail using the form in your packet, by phone, or in person at your local county office.

"Many people panic when they receive their renewal notice, but it's actually a simple process designed to make sure you continue getting the coverage you need," explains Marty Burbank of OC Elder Law. "The key is not to ignore it."

After the temporary pause during the COVID-19 pandemic, California has resumed these annual eligibility reviews. This means it's more important than ever to stay on top of your renewal to avoid any gaps in your healthcare coverage.

Beyond your annual renewal, it's crucial to report significant changes in your life within 10 days of them occurring. Changes in income, family size, address, employment status, or disability status can all affect your eligibility and benefits. Keeping your information current ensures you receive the right level of coverage and helps avoid complications down the road.

"I always tell my clients that the most important thing they can do is keep their contact information up-to-date," says Marty. "If the county can't reach you with important notices, you could lose your coverage without even realizing it."

If you're unsure about when your renewal is due or have questions about the process, don't hesitate to contact your local county office. They're there to help ensure your benefits continue smoothly. You can also find more information in our Medi-Cal Made Easy: A Step-by-Step Eligibility Guide.

What to Do If You Receive a Bill

Opening your mailbox to find an unexpected medical bill can be alarming when you're covered by a Medi-Cal health plan. But don't panic—and definitely don't ignore it.

First, take a deep breath. Then pick up the phone and call the member services number on your ID card. Explain that you've received a bill for services that should be covered under your Medi-Cal plan. The representative can help verify whether the service was covered and if the provider was in your network.

"Many billing issues are simply misunderstandings or administrative errors," Marty explains. "Your health plan can often resolve these directly with the provider, saving you both stress and money."

Ask your health plan to investigate the bill and contact the provider on your behalf. In most cases, they'll be able to clarify that you're not responsible for the charges. If your plan determines that you do owe the bill, you have the right to file an appeal.

For those who are dual-eligible for both Medicare and Medi-Cal, the billing process works a bit differently. Providers should bill Medicare first, then Medi-Cal for any remaining costs. You should never be billed for Medicare deductibles or co-insurance.

Maria, a Medi-Cal beneficiary from Orange County, shares her experience: "When I received a bill after my hospital stay, I was worried sick about how I'd pay it. But after calling my health plan, they explained it was a coding error and took care of everything. I didn't have to pay a penny."

One of the main benefits of having Medi-Cal health plans is protection from overwhelming medical costs. If you receive a bill, there's a good chance it's being sent to you in error. Being proactive and contacting your health plan immediately is the best way to resolve these situations quickly and protect your financial wellbeing.

If you're struggling with ongoing billing issues or need assistance navigating the renewal process, consider reaching out to an elder law attorney who specializes in Medi-Cal. At OC Elder Law, we've helped countless seniors maintain their coverage while protecting their assets and peace of mind.

Medi-Medi Plans: Integrating Medicare and Medi-Cal

If you're eligible for both Medicare and Medi-Cal, you may have heard the term "Medi-Medi" floating around. This isn't just healthcare jargon – it represents a valuable opportunity to simplify your healthcare coverage through specialized plans that bring together the best of both worlds.

Think of Medicare Medi-Cal Plans (affectionately called "Medi-Medi Plans") as the ultimate healthcare package for dual-eligible Californians. These plans are a specific type of Medicare Advantage plan designed with you in mind if you qualify for both programs.

What makes these plans special? For starters, they wrap all your Medicare benefits – hospital care (Part A), medical services (Part B), and prescription drugs (Part D) – together with your Medi-Cal services into one comprehensive package. This means you'll have just one health plan to manage, one card to carry, and one team coordinating all your care needs.

Perhaps the best part is that Medi-Cal health plans of this type come with no additional cost beyond what you're already eligible for. That means no premiums, no deductibles, and no co-pays for covered services. Many plans even sweeten the deal with extra benefits like dental care, vision services, hearing aids, transportation to appointments, and allowances for over-the-counter medications.

"Having my Medicare and Medi-Cal benefits in one plan has been life-changing," shares Maria, a 72-year-old from Orange County. "Before, I was constantly confused about which card to use where. Now, I have one team handling everything, and they even help coordinate my transportation to appointments."

How to Enroll in a Medi-Medi Plan

Qualifying for a Medi-Medi Plan isn't complicated, but there are a few boxes you'll need to check. You must:

• Be enrolled in both Medicare Parts A and B

• Have active Medi-Cal coverage

• Be at least 21 years old

• Live in a county where these plans are available

Currently, Medi-Cal health plans with Medi-Medi integration are offered in 17 California counties, including Los Angeles, Orange, Riverside, San Bernardino, San Diego, and several others throughout the state. The availability continues to expand as more counties recognize the benefits of integrated care.

Getting enrolled is straightforward. You can start by calling your current Medi-Cal plan to ask about their Medi-Medi options. Alternatively, reach out directly to Medicare at (800) MEDICARE (800-633-4227) or contact Health Care Options at 1-800-430-4263 (TTY 1-800-430-7077).

It's worth noting that if you already have a Medicare Advantage plan and live in one of the counties offering Medi-Medi integration, you might be automatically matched with a compatible Medi-Cal health plan. This automatic pairing helps ensure your benefits work together seamlessly.

For those with more intensive care needs, other integrated options exist as well. The Program of All-Inclusive Care for the Elderly (PACE) serves those 55 and older who need nursing home-level care but prefer to remain in their communities. Another option in certain counties is SCAN Connections, available to those 65 and older with dual eligibility.

As you steer these choices, the goal of these integrated plans is to make your healthcare experience simpler, more coordinated, and ultimately more effective. The right Medi-Medi plan can transform what was once a fragmented healthcare experience into a cohesive system designed around your specific needs.

Managing Your Medi-Cal Health Plan

Once you've successfully enrolled in a Medi-Cal health plan, knowing how to steer and manage your coverage becomes essential. Think of your health plan as a tool that works best when you understand how to use it properly. Let's walk through some key aspects of making the most of your coverage.

Continuity of Care

Life transitions happen, and sometimes that means switching to a new Medi-Cal health plan. But what about the doctor you've been seeing for years who understands your medical history? This is where continuity of care comes in.

If your current doctor isn't in your new plan's network, you don't necessarily have to say goodbye. You may be able to continue seeing them for up to 12 months through what's called "continuity of care."

To make this happen, reach out to your new health plan's member services as soon as you enroll. Explain your situation and provide details about your existing treatment relationship. The plan will generally approve your request if you've seen this provider at least once in the past year, the provider agrees to work with your new plan, and there aren't any quality concerns.

As Maria from San Diego shared, "When I switched plans, I was worried about finding a new endocrinologist who understood my complex diabetes. The continuity of care option let me keep seeing Dr. Chen while I slowly transitioned to in-network providers. It made all the difference in managing my condition."

Accessing Specialists

When you need specialized care under your Medi-Cal health plan, there's typically a process to follow. In most cases, your primary care provider (PCP) serves as your healthcare quarterback, coordinating your care and providing referrals to specialists when needed.

Before scheduling with a specialist, verify they're in your plan's network to avoid unexpected costs. Some specialized services might require prior authorization from your health plan—a process where your doctor requests approval before the service is covered.

Health plans must provide timely access to specialists. For urgent issues, you should be able to see a specialist within 96 hours. For non-urgent matters, the wait should be no more than 15 business days.

Prescription Coverage

Managing medications is often a crucial part of healthcare, and understanding how your Medi-Cal health plan handles prescriptions can save you both time and stress.

Since January 2022, pharmacy benefits for Medi-Cal beneficiaries are administered through a program called Medi-Cal Rx, rather than through individual health plans. This standardized approach aims to improve access to medications across the state.

Each plan has a formulary—a list of covered medications—so it's worth checking if your current prescriptions are included. Some medications may require prior authorization, where your doctor needs to explain why a specific medication is medically necessary for you.

For medications you take regularly, ask your doctor about 90-day supplies to reduce pharmacy trips. Some plans even offer mail-order pharmacy services, delivering medications straight to your door—particularly helpful for those with mobility challenges or busy schedules.

Making Changes to Your Medi-Cal Health Plan

Life circumstances change, and sometimes your Medi-Cal health plan needs to change with them. Perhaps you've moved, your favorite doctor joined a different network, or you're simply not satisfied with the care you're receiving. Whatever the reason, you have the right to switch plans at any time.

To make a change, contact Health Care Options at (800) 430-4263 or visit their website at www.healthcareoptions.dhcs.ca.gov. You can submit a new plan choice form online or by mail. Just be aware that the transition typically takes up to 30 days to process, so plan accordingly.

"I needed to switch plans when my son's pediatrician changed networks," explains Carlos from Fresno. "The process was straightforward—I called Health Care Options, explained my situation, and had new cards within three weeks. My son didn't miss a single check-up."

In some situations, you might qualify for a medical exemption that allows you to remain in Fee-For-Service Medi-Cal instead of a managed care plan. This option is particularly valuable for people with complex medical conditions who need to maintain relationships with providers who don't contract with available health plans.

To request this exemption, you'll need to complete a Medical Exemption Request form with documentation from your doctor explaining your medical situation. Submit this to Health Care Options for review.

Medi-Cal health plans like Kaiser Medi-Cal Plan are designed to work for you, providing access to necessary care while keeping costs manageable. Taking an active role in understanding and managing your plan ensures you receive the maximum benefit from your coverage.

Additional Resources for Medi-Cal Beneficiaries

Navigating Medi-Cal health plans doesn't have to be a solo journey. There's a wealth of support available to help you understand your options, resolve issues, and make the most of your benefits. Think of these resources as your personal support team—ready to guide you through any challenges you might face.

Your first stop for help should often be Medi-Cal Health Care Options (HCO). They're the specialists in helping you choose or change health plans, find providers in your area, and sort out any enrollment hiccups. You can reach them at (800) 430-4263 (or TTY: 1-800-430-7077) or visit their website at www.healthcareoptions.dhcs.ca.gov.

For broader questions about Medi-Cal programs and services, the Department of Health Care Services (DHCS) Medi-Cal Helpline is just a call away at (800) 541-5555. They can point you in the right direction for almost any Medi-Cal question.

"Sometimes the system can feel overwhelming," shares Maria, a Medi-Cal beneficiary from San Diego. "When I had trouble with my coverage, the Medi-Cal Managed Care Ombudsman helped me resolve it quickly. I didn't even know this service existed before!"

Indeed, the Ombudsman serves as your advocate when you're having problems with your Medi-Cal health plan that you haven't been able to resolve directly. They're available at (888) 452-8609 and are committed to ensuring you receive the care you're entitled to.

Since January 2022, Medi-Cal's pharmacy benefits have been managed separately through Medi-Cal Rx. If you have questions about your prescriptions or pharmacy coverage, their Customer Service Center can help at (800) 977-2273.

For those facing more complex coverage issues, the Health Consumer Alliance offers free assistance, including help with applications and problem resolution. You can contact them at (888) 804-3536 or visit www.healthconsumer.org. Their team of advocates specializes in cutting through red tape and ensuring you understand your rights.

Don't forget about your local County Social Services Office. These local heroes are on the front lines of Medi-Cal administration and can help with applications, renewals, reporting changes, and answering eligibility questions. They're often your best resource for in-person assistance.

If you're juggling both Medicare and Medi-Cal, the Health Insurance Counseling and Advocacy Program (HICAP) offers free, unbiased counseling to help you maximize your benefits from both programs. Reach them at (800) 434-0222 to schedule a consultation.

Support for Special Populations

Medi-Cal health plans recognize that different groups have unique needs, and specialized resources are available to address these differences.

For undocumented individuals, California has made tremendous strides in expanding access to care. Beyond the recent expansion of full-scope Medi-Cal to all age groups regardless of immigration status, many health centers provide care without asking about immigration status. Various county programs also offer limited health services to ensure everyone has access to basic care.

American Indian and Alaska Native members have special rights under Medi-Cal, including the option to receive care from Indian Health Care Providers and exemption from mandatory enrollment in managed care plans. Cultural resources and support are also available to ensure care respects traditional practices and values.

Seniors and persons with disabilities can find additional support through Area Agencies on Aging, Independent Living Centers, and the Long-Term Care Ombudsman Program. These organizations understand the unique challenges faced by older adults and can connect you with community resources beyond what Medi-Cal health plans provide.

"In a constantly changing financial and legislative environment, expert guidance is essential," particularly for seniors who are balancing health care needs with concerns about protecting their assets. At OC Elder Law, we specialize in helping seniors steer the complexities of Medi-Cal qualification while preserving their hard-earned assets for their families.

Whether you're new to Medi-Cal or have been a beneficiary for years, help is always available. Don't hesitate to reach out to these resources—they exist to ensure you receive the care and support you deserve. After all, understanding your benefits is the first step to making the most of your Medi-Cal health plan.

Frequently Asked Questions about Medi-Cal Health Plans

How Can I Keep My Doctor if They Are Not in My New Medi-Cal Health Plan Network?

When you switch to a new Medi-Cal health plan, one of the biggest concerns is often whether you can continue seeing your trusted doctor. The good news is that California's "continuity of care" provision may allow you to maintain your relationship with your current physician, even if they're not in your new plan's network.

This provision is particularly valuable if you have an ongoing health condition or are in the middle of treatment. You may qualify if you've visited your doctor at least once in the past year for a non-emergency appointment. Your doctor must also be willing to accept your new health plan's payment rates, and there can't be any documented quality or safety concerns with their care.

To keep seeing your current doctor, reach out to your new health plan's member services team right away—ideally as soon as you enroll. Explain your situation clearly, providing details about your medical condition and current treatment plan. It's also a good idea to speak with your doctor to make sure they're open to working with your new plan.

If approved, continuity of care typically lasts up to 12 months. This gives you valuable time to either transition gradually to an in-network provider or, in some cases, for your doctor to join your new plan's network.

As Maria from San Diego shared with us, "I was worried about changing plans because my son's specialist wasn't in the network. The continuity of care option gave us time to properly transition his care without disrupting his treatment."

What Should I Do If My Contact Information Changes While Enrolled in Medi-Cal?

Keeping your contact information current isn't just a formality—it's essential for maintaining your Medi-Cal health plan coverage. With California's annual eligibility reviews firmly established in 2025, having outdated contact information could literally cost you your healthcare coverage.

If you move, change phone numbers, or get a new email address, you should report these changes to your local county social services office within 10 days. You can update your information in several ways: online through your Covered California or BenefitsCal account, by submitting a change of address form by mail or in person, or by directly contacting your caseworker if you have one.

Why is this so crucial? When your address isn't current, you might miss important notices about your benefits, including renewal paperwork. If the county can't reach you to verify your continued eligibility, your coverage could be terminated—even if you still qualify for Medi-Cal.

Robert, a Medi-Cal beneficiary from Riverside County, learned this lesson the hard way: "I moved apartments but forgot to update my address with Medi-Cal. Six months later, I finded my coverage had been terminated because I never received or responded to the renewal notice. It took weeks to get everything reinstated."

Take a moment right now to verify that your contact information is up to date. That simple step could save you from a healthcare coverage gap when you need it most.

Are There Options for Undocumented Individuals Under Medi-Cal?

California has taken remarkable steps to expand Medi-Cal health plans to include undocumented residents, making it one of the most inclusive healthcare programs in the nation. If you're undocumented and wondering about your options, there's encouraging news.

As of 2025, California's historic expansion of Medi-Cal to undocumented individuals of all ages has been fully implemented for over a year. This means that all income-eligible Californians can access full-scope Medi-Cal regardless of immigration status. This policy, which began its final phase of implementation in January 2024, has effectively removed immigration status as a barrier to comprehensive healthcare coverage throughout the state.

What does "full-scope" Medi-Cal include? Essentially everything: preventive care like check-ups and screenings, emergency services, hospital stays, maternity care, mental health services, prescription medications, lab tests, and management of chronic conditions. It's the same comprehensive coverage that other Medi-Cal recipients receive.

Even if you don't qualify based on income, you might still be eligible for restricted-scope Medi-Cal, which covers emergency and pregnancy-related services.

The application process works the same way as for other applicants. You'll need to provide information about your income and household size, and while you'll be asked about immigration status, this information is used solely to determine which benefits you qualify for—not for immigration enforcement.

Elena, a community health worker in Los Angeles, has seen the impact firsthand: "Many families were afraid to apply before, worried about potential immigration consequences. Now I'm seeing parents get treatment for chronic conditions they've managed on their own for years. The peace of mind and improved health is changing entire families."

For more information about healthcare options for immigrants, you can visit the National Immigration Law Center which provides up-to-date resources on immigrant access to healthcare across the United States.

Conclusion

Finding your way through the maze of Medi-Cal health plans might feel overwhelming at first, but you're not alone in this journey. With a little guidance and the right information, you can make choices that best support your health and wellbeing.

I've worked with countless families who initially felt confused by their options but soon finded that Medi-Cal offers incredible flexibility and comprehensive coverage. What's particularly exciting is how California has expanded eligibility in recent years. As we move through 2025, the full implementation of Medi-Cal coverage for undocumented individuals of all ages continues to be a truly life-changing development for many California families.

Where you live matters significantly when it comes to your plan options. Your county of residence determines which managed care model applies to you and which health plans you can choose from. Some counties offer multiple plan options, while others have a single county-organized system.

If you're worried about changing plans because you don't want to lose your trusted doctor, take heart. Medi-Cal health plans often provide continuity of care provisions that allow you to keep seeing your current healthcare providers for up to 12 months after transitioning to a new plan. This gives you valuable time to either find new in-network providers you're comfortable with or for your current doctors to join your new network.

For seniors who qualify for both Medicare and Medi-Cal, integrated Medi-Medi Plans offer a streamlined approach to healthcare. These plans combine your benefits, simplify paperwork, and often provide additional services not covered by either program alone. It's one of the most underused opportunities I see in my practice.

One piece of advice I give to all my clients: keep your contact information current with your county office. With California's annual eligibility reviews firmly established in 2025, missing an important notice could result in an interruption of your coverage. A simple update can save you significant stress down the road.

If you ever feel stuck or confused, reach out for help. From the Medi-Cal Health Care Options hotline to your local county office to specialized organizations serving specific populations – resources exist to guide you through every step of the process.

At OC Elder Law, we specialize in helping seniors steer the complexities of Medi-Cal eligibility while protecting their hard-earned assets. Many of our clients are surprised to learn that with proper planning, they can qualify for Medi-Cal health plans even with significant assets. Legal strategies exist that can help protect your home, savings, and legacy while ensuring you receive the care you need.

Our team, led by U.S. Navy veteran Marty Burbank, brings both compassion and expertise to the table. We understand that Medi-Cal planning isn't just about paperwork – it's about preserving family harmony, protecting your dignity, and ensuring you receive quality care when you need it most.

Whether you're just becoming eligible for Medi-Cal, switching between plans, or thinking ahead about potential long-term care needs, taking time to understand your options will pay dividends in peace of mind and quality of care. The choices you make today about your Medi-Cal health plans can significantly impact your healthcare experience for years to come.

For personalized guidance with Medi-Cal planning and asset protection strategies, our offices in Fullerton and Orange County are ready to help you steer your healthcare journey with confidence. After all, you deserve healthcare that respects both your medical needs and your life's legacy.

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