Your Rights to Midwifery Care as a Medi-Cal Beneficiary
What is a Managed Care Medi-Cal Plan?
Individuals enrolled in Medi-Cal are frequently placed into health plans that manage their care. These health plans are required to issue the same services as "Straight" Medi-Cal (also known as Fee for Service Medi-Cal). The plans are private companies who are issued money from the State of California to care for Medi-Cal patients. These plans have their own networks of providers and restrict the care a patient can get to those networks.
How do I change my Managed Care Medi-Cal Plan?
If you are not happy with your medical plan, you can choose another medical plan, if available. To change your medical plan, call Health Care Options at1-800-430-4263(TTY 1-800-430-7077). Or you can complete and mail a Medi-Cal Choice Form. Health Care Options will send you a letter confirming that your plan has changed, however the fastest way to confirm this is to ask Health Care Options when you call when the new plan will be effective.
Do I have the option to not participate in a Managed Care Medi-Cal Plan?
Sometimes. If the provider you are wanting to see is not In-Network with a plan in your county, and you have not been enrolled in a plan yet, you can request that the provider file a Medical Exemption Request (also known as an MER) to keep you from being enrolled in a plan (and on "Straight" Medi-Cal).
What is an IPA/Independent Physician Association/Medical Group?
The plans sometimes further delegate their patients to more specific groups of physicians that can be known as IPAs (Independent Physician Associations) or Medical Groups. So while you may be a member of a plan, you may only be able to see a provider who is associated with a specific smaller group within that plan. The group tends to also manage the billing component of your care.
How do I change my IPA/Medical Group?
Call the plan directly (the Member Services number should be on the back of your card) and tell them you need to change your group. Health Care Options does not handle group changes, only plan changes.
What are my rights regarding home birth with a Licensed Midwife?
What are my rights regarding birth in a freestanding birth center with a Licensed Midwife?
What can I do if these rights are being violated?
What resources can I provide to my Managed Care Medi-Cal plan regarding their need to cover my care?