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/