20-578 How Can You Help Your Patients Learn About Medi-Cal?
Date: 07/27/20
This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, and Ancillary providers.
This information applies to Medi-Cal in Fresno, Kings and Madera counties.
Help your existing Medi-Cal patients with Medi-Cal questions AND assist prospective patients in learning more about Medi-Cal.
Many Californians are experiencing income changes due to Covid-19. The reduced income could be from working fewer hours or not having a job, or they might have lost their employer health coverage. If so, they might be eligible for Medi-Cal. And, they may also have questions and not be sure who to ask for assistance.
Should your patient come to you or your front office staff for questions or assistance, use the attached fact sheet to help you answer some of their questions about Medi-Cal and what it has to offer. The fact sheet below is informational and for provider office use only.
We look forward to helping you retain continuity-of-care. Keep seeing your patients through difficult times by sharing coverage information for every step of life.
What you will find attached is information on:
- What Medi-Cal is
- What benefits Medi-Cal offers
- Medi-Cal preventive screenings
- How to explain the Federal Poverty Level and how someone would qualify for a reduced premium and cost sharing
- How your patient can apply for Medi-Cal
- How your patients can get enrollment assistance
- What happens once your patients enroll
- What happens if your patients lose eligibility for Medi-Cal
- What options your patients have if they are not eligible for Med-Cal
- What services patients can take advantage of through CalViva Health
- How you can register for the provider website
Additional Information
Providers are encouraged to access the provider portal online at provider.healthnet.com for real-time information, including eligibility verification, claims status, prior authorization status, plan summaries, and more.
Medi-Cal 101 – Provider Fact Sheet
For office and provider use only.
Do not distribute to patients or post in a patient area.
This fact sheet is informational and for provider office use only.
What is Medi-Cal?
Medi-Cal is a state health program that offers California adults, families with children, seniors, persons with disabilities, pregnant women, children in foster care, and former foster youth up to age 26, no-cost or low-cost health coverage. Qualified individuals can enroll in Medi-Cal year-round.
All children residing in Fresno, Kings and Madera counties who meet the Medi-Cal eligibility requirements, regardless of immigration status, can get comprehensive health care through Medi-Cal.
- $0 doctor visits
- $0 prescription drug coverage
- $0 health education programs
- $0 monthly plan premiums
- $0 immunizations
What benefits does Medi-Cal offer?
Benefits offered are:
- Emergency services
- Hospitalization
- Laboratory services
- Maternity and newborn care
- Mental health services and substance use disorder services, including behavioral health treatment
- Outpatient (ambulatory) services
- Pediatric vision care
- Prescription drugs
- Preventive and wellness services, and chronic disease management
- Rehabilitative and habilitative services and devices
What are some Medi-Cal preventive care screenings that I can encourage my Medi-Cal patients to receive?
- Initial Health Assessments – Includes an age-appropriate history, physical examination and individual health education behavioral assessment (IHEBA).
- Well-Child Visits and Immunizations – It’s important to follow the American Academy of Pediatrics (AAP) well-care schedule.
- Adolescent Visits and Immunizations – It’s important to have teenagers get their checkups.
- Women’s Health – Breast cancer and cervical cancer screenings.
- General Health – Comprehensive diabetes prevention and care, controlling blood pressure.
How do I explain the Federal Poverty Level?
The Federal Poverty Level (FPL) is the measurement standard that the U.S. Department of Health and Human Services uses to determine if an individual or family is eligible for government-regulated programs and services, such as Medi-Cal. Federal poverty level amounts are updated annually and are commonly published by various government agencies. The Department of Health Care Services (DHCS) website at www.dhcs.ca.gov/services/medi-cal/Pages/DoYouQualifyForMedi-Cal.aspx has the latest FPL information.
How would someone know if they qualify for reduced premiums and cost sharing?
To qualify for Medi-Cal, certain income, family size and age requirements must be met. To be eligible, a person’s annual income must be lower than 138% of the FPL which is $1,467 per month (or $17,609 per year) for an individual and $3,013 per month (or $36,156 per year) for a family of four.
With financial help -- such as the federal tax credit or a California state subsidy – individuals or families not eligible for Medi-Cal may qualify for a Covered California health plan including:
- Enhanced Silver plans.
- American Indian/Alaska Native (AIAN) plans.
How does someone apply for Medi-Cal?
Individuals and their families can apply for Medi-Cal by any of the following methods:
Method | How |
Apply for both Medi-Cal and other health care coverage through Covered California with a single streamlined application. To obtain the form in English or other languages, visit www.dhcs.ca.gov/services/medi-cal/eligibility/Pages/SingleStreamApps.aspx. Mail the completed form to: Covered California | |
By Phone | Call their local county social services office or call Covered California at |
In Person | Apply at their local county social services offices, where they can get help completing the application. A list of offices can be found at www.dhcs.ca.gov/services/medi-cal/Pages/CountyOffices.aspx |
Online | |
More | Visit: www.dhcs.ca.gov/services/medi-cal/Pages/ApplyforMedi-Cal.aspx |
Do health plans offer any assistance with enrollment?
Individuals or families may contact their Medi-Cal health plan of choice for further information about the plan. The CalViva Health Enrollment Department can be contacted at 1-877-618-0903 7:30 a.m. – 6 p.m. Monday through Friday. Information is also available on CalViva Health’s website at: www.calvivahealth.org.
What happens after an individual or family applies?
Once the application is submitted, it will be sent to the individual’s local county social services agency for a determination. After reviewing the submitted application, if more information is needed, the county will contact the applicant. If eligible, the individual will be enrolled and will receive a Medi-Cal benefits identification card (BIC) in the mail. Within 45-days of receiving the BIC, the enrollee will receive an information packet in the mail that explains the available Medi-Cal health plan options in their county and how to enroll.
Enrollees will have 30 days to choose a health plan available in their county. If one is not chosen, Medi-Cal will choose a plan for them. Enrollees can go to www.healthcareoptions.dhcs.ca.gov/ to pick a health plan.
For additional information, enrollees can visit DHCS website at www.dhcs.ca.gov/individuals/Pages/Steps-to-Medi-Cal.aspx
What happens if an enrollee loses eligibility for Medi-Cal?
If the Medi-Cal member gets a Medi-Cal Notice of Action telling them that they, or a member of their household, no longer qualify for Medi-Cal due to changes in income or household, they may enroll in a health plan through Covered California.
Medi-Cal members have 60 days from the date listed in the Medi-Cal Notice of Action to enroll in Covered California under special enrollment. To avoid a gap in health coverage, CalViva Health can help CalViva Health members select a new plan before Medi-Cal coverage ends. CalViva Health can also let them know if they qualify for financial help to lower costs. Enrollees can contact the CalViva Health Retention Department at 1-877-618-0904.
What if a patient is not eligible for Medi-Cal?
A variety of individual and family plans are available to patients who are not eligible for Medi-Cal. This includes plans that offer coverage for patient needs through every stage of life.
Additional Information
The Member Services Department and the companion Nurse Advice Line are available 24 hours a day, seven days a week, to offer assistance to members and providers in multiple languages.