MEDICAID IN CALIFORNIA

The CA Department of Health Care Services administers the state’s Medicaid program, called Medi-Cal.

Information about Medi-Cal, including beneficiary information, can be found at: http://www.medi-cal.ca.gov/.

MEDICAID EXPANSION

California is fully participating in the Medicaid Expansion under provisions of the Affordable Care Act (ACA).

For additional background on the State’s policy decisions regarding the Medicaid Expansion option, see: Background.

PROVIDER PARTICIPATION

Providers must enroll in the Medicaid fee-for-service program to receive payments for covered services. Information about enrolling in the Medicaid fee-for-service program can be found at: http://www.medi-cal.ca.gov/.

The Medicaid website provides information about services covered by fee-for-service payments and payment amounts: http://www.medi-cal.ca.gov/.

In order to retain access to all Medicaid patients in the state, providers must also connect to the managed care plans individually.

MEDICAID MANAGED CARE

Some Medi-Cal beneficiaries are enrolled in managed care plans. Basic information about the programs, called Medi-Cal Managed Care, can be found at: http://www.dhcs.ca.gov/services/Pages/Medi-CalManagedCare.aspx.

Some managed care plans cover individual California counties and independent cities. The Medicaid website has jurisdictional information: http://www.medi-cal.ca.gov/.

MEDI-CAL BENEFICIARIES PARTICPATING IN MANAGED CARE

Managed care plans participating in Medi-Cal Managed Care offer detailed information about covered benefits for individuals enrolling in their plans. This information is available on the managed care websites shown below.

REPORTING PROBLEMS

The state Medicaid office is primarily responsible for examining and addressing issues with the Medicaid Managed Care plans offered in the state, and for working with the companies that offer them. If you are experiencing problems as a medical provider with the Managed Care plans or companies operating in the state, or if your patients are experiencing problems with the Managed Care plans or companies in the state, including trouble with access to medications, access to preferred providers, navigating the appeals process, excessive costs, or possible discriminatory policies, or any other problems related to the Affordable Care Act, please report these problems to the state Medicaid Office:

Medi-Cal
www.dhcs.ca.gov/services/medi-cal/pages/default.aspx
916-449-5000

Additionally, if you are experiencing these or other problems, please report these problems to AAHIVM, so that we may track issues affecting our members, and seek additional policies remedies.

MANAGED CARE PLANS PARTICIPATING IN MEDI-CAL MANAGED CARE DIVISION

This list is being routinely updated, and may change as insurers join or leave the Exchange. Please check back for updates.

Alameda Alliance for Health

Plan Website: http://www.alamedaalliance.org/

Provider Enrollment: http://www.alamedaalliance.org/providers/~/link.aspx?_id=7064BD0EADF94D8EAC2BD564C5C4B97E&_z=z

 

AltaMed (PACE)

Plan Website: http://www.altamed.org/seniorservices

Provider Enrollment: http://www.altamed.org/provider_portal/overview

 

Anthem Blue Cross Partnership Plan

Plan Website: https://www.anthem.com/ca/health-insurance/home/overview

Provider Enrollment: http://www.anthem.com/ca/home-providers.html

 

Brandman Centers for Senior Care

Plan Website: http://www.brandmanseniorcare.org/

Provider Enrollment: http://www.brandmanseniorcare.org/

 

California Health and Wellness

Plan Website: Not applicable

Provider Enrollment: Not applicable

 

CalOptima

Plan Website: https://caloptima.org/

Provider Enrollment: http://www2.caloptima.org/providerregistration/

 

CalViva Health

Plan Website: http://calvivahealth.org/

Provider Enrollment: http://calvivahealth.org/contact

 

Care 1st Partner Plan, LLS

Plan Website: https://www.care1st.com/ca/members/plans-and-benefits/medi-cal.asp

Provider Enrollment: https://www.care1st.com/ca/providers/index.asp

 

CenCal Health

Plan Website: http://www.cencalhealth.org/

Provider Enrollment: http://www.cencalhealth.org/for_providers/contracting/index.html

 

Center for Elders Independence (PACE)

Plan Website: http://www.cei.elders.org/home.html

Provider Enrollment: http://www.cei.elders.org/Providers/tabid/192/Default.aspx

 

Central CA Alliance for Health

Plan Website: http://www.ccah-alliance.org/

Provider Enrollment: http://www.ccah-alliance.org/join.html

 

Community Health Group Partnership Plan

Plan Website: http://www.chgsd.com/

Provider Enrollment: http://www.chgsd.com/providerServices.aspx

 

Contra Costa Health Plan

Plan Website: http://cchealth.org/healthplan/

Provider Enrollment: http://cchealth.org/healthplan/provider-join.php

 

Gold Coast Health Plan

Plan Website: http://goldcoasthealthplan.org/

Provider Enrollment: http://goldcoasthealthplan.org/providers/credentialing.aspx

 

Health Net Community Solutions, Inc.

Plan Website: https://www.healthnet.com/portal/home.ndo

Provider Enrollment: https://www.healthnet.com/portal/provider/content/iwc/provider/unprotected/working_with_HN/content/features.action

 

Health Plan of San Joaquin

Plan Website: http://www.hpsj.com/english/

Provider Enrollment: http://www.hpsj.com/english/providers/default.aspx

 

Health Plan of San Mateo

Plan Website: http://www.hpsm.org/

Provider Enrollment: http://www.hpsm.org/providers/provider-services.aspx

 

Inland Empire Health Plan

Plan Website: https://ww2.iehp.org/

Provider Enrollment: https://ww2.iehp.org/en/providers/

 

InnovAGE (PACE)

Plan Website:http://www.myinnovage.org/

Provider Enrollment:http://www.myinnovage.org/Resources.aspx#Healthcare_Professionals

 

Kaiser Permanente

Plan Website: https://healthy.kaiserpermanente.org/html/kaiser/index.shtml

Provider Enrollment: Not applicable

 

Kern Family Health Care

Plan Website: http://www.kernfamilyhealthcare.com/

Provider Enrollment: http://www.kernfamilyhealthcare.com/providers/index.html?page_id=203

 

LA Care Health Plan

Plan Website: http://www.lacare.org/

Provider Enrollment: http://www.lacare.org/providers/becomeprovider

 

Molina Healthcare of CA Partner Plan, Inc.

Plan Website: http://www.molinahealthcare.com/Pages/index.aspx

Provider Enrollment:http://www.molinahealthcare.com/medicaid/providers/ca/Pages/home.aspx

 

On Lok Lifeways

Plan Website: http://www.onlok.org/

Provider Enrollment: http://www.onlok.org/Contact.aspx

 

Partnership Health Plan of CA

Plan Website: http://www.partnershiphp.org/

Provider Enrollment: http://www.partnershiphp.org/Provider/Provider.htm

 

Positive Healthcare

Plan Website: http://positivehealthcare.net/california/

Provider Enrollment: http://positivehealthcare.net/california/php/consider-php/

 

San Francisco Health Plan

Plan Website: http://www.sfhp.org/

Provider Enrollment: http://www.sfhp.org/providers/contact_provider_relations.aspx?show=5

 

Santa Clara Family Health Plan

Plan Website: http://www.scfhp.com/

Provider Enrollment: http://www.scfhp.com/provider/default.aspx

 

SCAN Health Plan

Plan Website: http://www.scanhealthplan.com/

Provider Enrollment: http://www.scanhealthplan.com/provider-tools/

 

St. Pauls PACE

Plan Website: http://www.stpaulspace.org/

Provider Enrollment: http://www.stpaulspace.org/contactus.html

 

Sutter Senior Care (PACE)

Plan Website: http://www.checksutterfirst.org/seniorservices/seniorcare.html

Provider Enrollment: http://www.checksutterfirst.org/about/