Health

Health

Making sure patients receive essential treatment as the law requires

Frequently Asked Questions

What does our Health Consumer Center do?

The Health Consumer Center at CCLS helps people get, keep, and use their health insurance coverage. If you have a health-related problem, we may be able to help you. We work with our clients to help ensure insurance companies, doctors, hospitals, and other health care providers, are not creating unlawful barriers to access to healthcare. We assist people who are being harassed or sued for medical debt, advising our clients on their options, working with the debt collectors, or going to court as needed. CCLS also helps with Medi-Cal (including Medi-Cal Estate Recovery), Medicare, and Covered California issues.

Get more information by calling our Health Consumer Center at 1-800-464-3111 or find health resources at LawHelpCA.org and HealthConsumer.org.

Unwinding of Public Health Emergency (PHE)

Medi-Cal Renewal

If I have Medi-Cal, Do I need to complete a Medi-Cal renewal packet?

You may soon need to take steps to find out if you still qualify for Medi-Cal. Counties will mail you a letter about your Medi-Cal eligibility. You may need to complete a renewal form. Make sure your current contact information is updated with your local county office, if it has changed.

Your local county office will only ask you for more information if they need it to renew your Medi-Cal. If you receive a renewal packet or a letter asking for more information, you may submit the information by mail, phone, in person, or online.

When do I need to fill out and return my Medi-Cal renewal packet?

You will get a letter in the mail. The letter will tell you if your Medi-Cal coverage was renewed automatically or if your county needs more information to renew your Medi-Cal. If you receive a renewal packet or a letter asking for more information, you may submit the information by mail, phone, in person, or online. Counties will mail you a letter about your Medi-Cal eligibility. You may need to complete a renewal form. The letter from your county should arrive around the same time as when you have received similar letters in past years. For example, if your Medi-Cal renewal was due in April in past years, you should watch for a letter from your county in the two months before April.

What if I have moved since I enrolled in Medi-Cal?

Make sure you contact your Medi-Cal office to provide them with your most current contact information. Any time you move or your contact information changes, you should contact your county office to make sure they have your information updated in your file.

What can I do to prepare for my Medi-Cal renewal?

If you moved recently, or if any of your contact information, like your phone number or email address, has changed, report your changes to your local county office to make sure you get important information about your Medi-Cal coverage. If you got a new job or your income has changed, be prepared to provide verifications. Check your mail – Counties will mail you a letter about your Medi-Cal eligibility. You may need to complete a renewal form. If you're sent a renewal form, submit your information by mail, phone, in-person, or online, so you don't lose your coverage. Create or check your online account – Covered California, BenefitsCal, or MyBenefitsCalWIN to sign up to get text or email alerts about your case. You may submit renewals or requested information online.

How do I report a change if I have SSI?
  • If you get SSI, do not have a U.S. mailing address, and are unable to change your address online, you can report your change by:
  • Calling (800)7 72-1213 (TTY (800) 325-0778), Monday through Friday, 8 a.m. – 7 p.m.
  • Contacting your local Social Security office via their online locator.
  • If you get SSI, Social Security will process your Medi-Cal renewal. If you have questions, call (800) 772-1213, or contact your local Social Security office.
How do I report a change if I have SSI?

If you no longer qualify for Medi-Cal, you may be able to get health coverage through Covered California. Losing Medi-Cal allows you to enroll in a Covered California plan outside of the open enrollment period. The local county office will send you information about how to sign up.

Medi-Cal Eligibility

Do I qualify for Medi-Cal?

Medi-Cal is the health care insurance program for low-income individuals who live in California. Other states call their program Medicaid. You must financially qualify for Medi-Cal. Most single individuals will qualify for Medi-Cal if their income is under $1,564 per month. Most couples will qualify if their income is under $2,196 per month. If you have disabilities, your income can be slightly higher.

As of July 1, 2022, you can qualify for Medi-Cal even if you have assets. The state moved the Medi-Cal asset limit from $2,000 to $130,000 for a single individual and from $3,000 to $195,000 for a couple.

If you need health insurance, you should apply right away. They will screen you for all of the Medi-Cal programs and put you in the best one for your family. You can apply for Medi-Cal at your county welfare office or online.

Can I apply for Medi-Cal if I have Medicare?

Yes. Medi-Cal will work with your Medicare coverage. You could reduce your Medicare monthly premium to zero and eliminate most out-of-pocket costs.

What does Medi-Cal cover?

Medi-Cal covers primary care, specialty care, prescription drugs, and dental if it is considered "medically necessary." Most people who have Medi-Cal do not pay co-pays or out-of-pocket costs.

I got a notice my Medi-Cal benefits are stopping or my “share of cost” is increasing.

During the COVID-19 pandemic, the county will not stop your Medi-Cal benefits even if your income goes up until March 31, 2023. It is unlikely that the County will take action on your case until after your next redetermination. We do not expect to see terminations until July 1, 2023. Visit DHCS' website for more information on how to keep your coverage.

You have the right to appeal the county’s action and have a hearing before an independent hearing officer. If you appeal the notice before the date of the change in your Medi-Cal, the county must not make the change until the hearing officer decides on your appeal. Even if you did not request a hearing before your benefits changed, you still have 90 days from the date of the notice to appeal.

Once you appeal, there will be a hearing scheduled to give you a chance to explain why your Medi-Cal should not stop or change and for the judge to decide if the county is right or wrong. If the hearing officer decides you are right, he can order the county to continue your Medi-Cal or to recalculate your share of cost. Contact us at 1(800)464-3111 if you would like assistance with your appeal

(Note-calling our office does not guarantee that a CCLS advocate will represent you at hearing).

More Info

You can find out more information about your Medi-Cal rights and the hearing process at the Department of Health Care Services.

I do not have health insurance and I need health care.
  • Under the Affordable Care Act (ACA), almost everyone has access to health care. There are many options for free or affordable health insurance.
  • There are five ways to get insurance:
  • Sign up for government programs, like Medicare or Medi-Cal. If you are eligible for a government program, all or most of your health care costs will be covered at no charge to you.
  • Get health insurance through your employer or your spouse’s or parent’s employer.
  • Buy insurance from Covered California, the state’s health insurance “exchange.” Most people will qualify for Advanced Premium Tax Credits (APTCs) to help them pay for a plan.
  • Buy insurance from a private insurance company on your own.
  • Sign up for your county operated health program

More Info: Here’s how you apply for the government programs:

Medi-Cal

  • In-person at your local welfare office.
  • Online at www.CoveredCA.com
  • Mail in an application.

Covered CA

  • Online at www.CoveredCA.com

Medicare

  • In-person at your local Social Security office.
  • Online at Social Security’s website.

Covered California

I make too much for Medi-Cal. Are there other options?

Yes. If you make too much to qualify for Medi-Cal, you can apply for Covered California. Covered California is a state-run health care insurance exchange that offers financial assistance to reduce your premiums payments. Go to CoveredCA.com to see if you qualify for financial assistance to make your health care more affordable.

Medicare

Can someone help me understand my Medicare benefits?

Yes. Every California county has a Health Insurance Counseling & Advocacy Program (HICAP). HICAPs provide free and objective information and counseling about your Medicare enrollment and benefits. Volunteer counselors can help you understand your rights and health care options. You can find your closest HICAP on this site.

I received a notice about a Medi-Cal managed care transition. Can I still see my doctor?

Yes. Starting on January 1, 2023, people who have Medicare and fee-for-service Medi-Cal will be required to enroll into a Medi-Cal managed care plan. Notices went out in November and December 2022. You should be able to see all of your Medicare providers as normal. Starting January 1st, your providers will bill a Medi-Cal managed care plan instead of fee-for-service Medi-Cal. Your providers can still bill the Medi-Cal managed care plan even if they are not contracted with that plan.

You can call us if your doctor says that they can no longer see you, cancels your appointment or sends you a bill for services.

Here is a factsheet with more information.

I have Medi-Cal and Medicare

I have both Medi-Cal and Medicare. Where can I find out information about having coverage from both programs?
I have both Med-Cal and Medicare and have received a bill for my care. What do I need to know?

If you have both Medi-Cal and Medicare, it is generally unlawful for a provider to bill you for a covered service (there are some exceptions). Please refer to this DHCS fact sheet for more information, or call the Health Consumer Center at 1(800) 464-3111 to open a case to discuss the details of your situation and find out what your options are.

Health Rights

I need to see my doctor and my plan says that I have to wait.
  • Most health insurance plans are required by law to allow patients to see their doctors within specified time frames. Here are the basic rules:
  • Non-Urgent Doctor Appointment - within 10 business days
  • Non-Urgent Specialty Appointment - within 15 business days
  • Non-Urgent Mental Health Appointment - within 10 business days
  • Urgent Care Appointment (prior authorization not required by plan) - within 48 hours

More Info:

Care (DMHC), you can file a complaint online or by telephone at 1-888-466-2219. DMHC can force the plan to schedule an earlier appointment for you.

My health plan denied my doctor’s request for a surgery, medical procedure, or testing.

First, you must complain to your health plan. You can call your health plan’s customer service line and request to file a grievance. They should give you a confirmation number. If the plan does not respond to your grievance within 30 days or denies your grievance, you can elevate your appeal to the Department of Managed Health Care (DMHC).

If your plan is regulated by the DMHC, you can file a request for an Independent Medical Review (IMR). An IMR is an independent review of your medical records and your doctor’s request to determine if your plan should cover the service. DMHC processes most IMRs within 30 days.

If you are on Medi-Cal, you might consider filing an appeal to the state fair hearing office.

More Info

Review of decisions under your health plan can be very complicated. You should contact the CCLS Health Consumer Center so you can talk to a CCLS advocate for an individualized assessment of your case.

My medical appointment was cancelled because of COVID-19. What can I do to get the care I need during this pandemic?

Many non-urgent, non-essential, or elective procedures and appointments have been postponed, or moved to telehealth mode pursuant to public health guidance in order to preserve critical health care resources and limit the spread of coronavirus. However, urgent appointments, such as cancer treatment, acute emergency procedures, and pregnancy-related services, should proceed. If you have had an appointment cancelled or postponed and your medical need is urgent, you can contact us for assistance with getting your appointment rescheduled.

I need help with a different health problem.

We may be able to help! Contact the CCLS Health Consumer Center so we can talk to you and see what can be done to help you.

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