The following document applies only to Participating Physician Groups (PPG), Hospitals, and Ancillary Providers.

A member may disenroll at any time and without cause by contacting the Health Care Options (HCO) enrollment contractor, who then issues disenrollment forms directly to the member.

Members in a mandatory aid code must simultaneously re-enroll in another health plan or the HCO enrollment contractor assigns them a health plan. Members in non-mandatory aid codes may choose a new health plan or return to the Medi-Cal fee-for-service (FFS) program.

Disenrollment of a member is mandatory when:

• Member requests disenrollment, subject to any lock-in restrictions on disenrollment under the Federal lock-in option, if applicable.
• Member’s eligibility for enrollment with the health plan is termed or eligibility for Medi-Cal has ended, including the death of the member.
• Member's enrollment violated state marketing and enrollment laws, and DHCS or member requested dis-enrollment.
• Member requests disenrollment as a result of plan merger or reorganization.
• Member moves out of the plan's approved service area.
• Member's Medi-Cal aid code changes to an aid code not covered under the health plan

Health Net continues to be responsible for the member's health care until disenrollment is approved by the Department of Health Care Services (DHCS), not the plan. The disenrollment request may take 30 days to complete.

To request disenrollment of a member, providers must contact the Health Net Medi-Cal Member Services Department , Community Health Plan of Imperial Valley Member Services Department or CalViva Health Medi-Cal Member Services Department (for Fresno, Kings and Madera counties). Providers are asked to describe the circumstances leading them to request the Member Non-Compliant disenrollment and may be asked to submit documentation regarding their requests.

On notification, the Health Net Medi-Cal Member Non-Compliance Unit, the Customer Service Advocate (CSA) will contact the member and provide guidance. If necessary, the CSA will reassign the member to a new primary care physician (PCP) within the plan.

A provider-initiated member non-compliant disenrollment request based on the breakdown of the provider-member relationship is considered good cause, only if one or more of the following circumstances occur:

Provider non-compliant request is a formal written complaint from a contracted provider (PCP, PPG, Specialists, Health Care Services, other Health Net units) against a member who exhibits inappropriate behavior. The Provider is required to fax a detailed letter regarding the member non-compliance incident including specific details such as:

The letter must provide details of what the provider has done to manage the member’s behavior such as providing the member with education, to bring them back into complying. This includes referrals to pain management, case management, mental health etc.

If the letter is not received within 30 days from the time the non-compliance incident is reported to the health plan, the case will be closed.

Formal letter and all supporting document’s must be faxed or mailed to Non-Compliance Unit.