Is Medi-Cal managed care the same as Medi-Cal?

Asked by: Rafael Bode  |  Last update: February 11, 2022
Score: 4.5/5 (12 votes)

All counties now have Medi-Cal managed care plans sometimes also called Medi-Cal health care plans. These types of Medi-Cal managed care plans are a type of Managed Care Organization. ... There are two basic types of Medi-Cal managed care plans: COHS (County-Organized Health Systems) model plans and non-COHS model plans.

What are the two types of Medi-Cal?

This guidebook explains the two kinds of Medi-Cal: Regular Medi-Cal and Medi-Cal Health Plans.

How do I know which Medi-Cal plan I have?

To get more details, or to choose your health plan or change your health plan at any time go to: Health Care Options' website. For information on accessibility and how to see your Medi-Cal provider, go to: Accessibility and How to See Your Medi-Cal Provider.

Is there another name for Medi-Cal?

The California Medical Assistance Program (Medi-Cal or MediCal) is California's Medicaid program serving low-income individuals, including families, seniors, persons with disabilities, children in foster care, pregnant women, and childless adults with incomes below 138% of federal poverty level.

Is Medicaid and Medi-Cal the same thing?

Medi-Cal is California's part of a national health coverage program called Medicaid. Each state runs its own Medicaid program. ... The state Medicaid programs are paid for with a combination of county, state, and federal money. You can think of Medi-Cal as a single program that you can qualify for in many different ways.

Medi-Cal Coverage 101: Regular vs. Managed Care

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Is CalOptima the same as Medi-Cal?

Medi-Cal — also known as Medicaid — is a public health insurance program for low-income people offered by the state. ... CalOptima provides health care coverage for Orange County residents who are eligible for full Medi-Cal.

What is a managed care plan?

Managed care plans are a type of health insurance. They have contracts with health care providers and medical facilities to provide care for members at reduced costs. These providers make up the plan's network. ... They still pay part of the cost if you go outside the network.

What does Medi-Cal managed care mean?

Managed care means that you receive most of your health care from a managed care plan. A managed care plan is an organized network of health care providers that focuses on primary and preventive care. ... Over 80% of Medi-Cal beneficiaries are enrolled in a managed care plan.

Who manages Medi-Cal?

County Organized Health System (COHS)

A non-profit, independent public agency that contracts with the State to administer Medi-Cal benefits through local care providers and/or Health Maintenance Organizations. Medi-Cal eligible beneficiaries are mandatorily enrolled in the single COHS plan in the county.

How many Medi-Cal managed care plans are there?

Currently, a total of 24 plans contract with the Department of Health Care Services (DHCS) to provide Medi-Cal managed care services to beneficiaries. Of these, 16 are local health plans.

How do I change my Medi-Cal managed care plan?

To change your medical plan, call Health Care Options at 1-800-430-4263 (TTY 1-800-430-7077). Or you can complete a Medi-Cal Choice Form. You can find the form on the Download forms page.

Is Medi-Cal HMO or PPO?

Medi-Cal is health insurance for people with low incomes. Some counties have Medi-Cal Managed Care, in which the State contracts with HMO plans to provide health care services to Medi-Cal members.

How do Medi-Cal managed care plans work?

Under managed care, the state contracts with health plans to deliver Medi-Cal benefits to enrollees in exchange for a monthly premium, or “capitation” payment for each enrollee. The plans are accountable for and at financial risk for providing the services in the contract.

Does Kaiser accept Medi-Cal?

Kaiser Permanente participates in Medi-Cal in many counties. This means that, if you are a current Kaiser Permanente member and your situation changes, you may be able to keep your same doctor and continue your care with Kaiser Permanente if you qualify for Medi-Cal.

What is an example of a managed care plan?

A good example of a managed care plan is an HMO (Health Maintenance Organization). HMOs closely manage your care. Your cost is lowest with an HMO. You are limited to seeing providers in a small local network, which also helps keep costs low.

How do I apply for Medi-Cal managed care?

Apply online at . Applications are securely transferred directly to your local county social services office, since Medi-Cal is provided at the county level. If you need additional help applying or have additional questions, you can contact a trained Certified Enrollment Counselor (CEC) for free.

How are providers paid under managed care?

States typically pay managed care organizations for risk-based managed care services through fixed periodic payments for a defined package of benefits. These capitation payments are typically made on a per member per month (PMPM) basis.

What is the difference between managed care and Medicaid?

Under the FFS model, the state pays providers directly for each covered service received by a Medicaid beneficiary. Under managed care, the state pays a fee to a managed care plan for each person enrolled in the plan.

What are the four types of managed care plans?

There are four main types of managed health care plans: health maintenance organization (HMO), preferred provider organization (PPO), point of service (POS), and exclusive provider organization (EPO).

What is the difference between managed care and health insurance?

Traditional health insurance allows you to select your health care providers, such as your favorite doctor or hospital. ... The managed care network will control and direct access to your health care services.

Is Medi-Cal Medicare?

Medi-Cal is California's Medicaid health care program. Medi-Cal pays for a variety of medical services for children and adults with limited income and resources. Medicare is a federally funded insurance program for eligible participants 65 or over.

What services does Medi-Cal cover?

Medi-Cal covers most medically necessary care. This includes doctor and dentist appointments, prescription drugs, vision care, family planning, mental health care, and drug or alcohol treatment. Medi-Cal also covers transportation to these services.

Is CalOptima the same as Covered California?

As of January 1, 2015 you will be receiving your health care benefits from CalOptima Medi-Cal. You previously received your health care benefits from Covered California. ... If your doctor does, you may keep your doctor with CalOptima.

Can you have Medicaid and Medi-Cal at the same time?

The short answer to whether some seniors may qualify for both Medicare and Medi-Cal (California's Medicaid program) is: yes.