Your Right to Continuity of Care
What is Continuity of Care?
“Continuity of Care" is a right that means you may be able to keep a Medi-Cal provider for up to 12 months after you enroll in a new managed care plan. This includes your primary care doctor, specialists, and most therapists. Therapists you may be able to keep include physical, occupational, respiratory, and speech therapists, and behavioral health treatment providers.
You may be able to get Continuity of Care protections to keep a Medi-Cal provider for up to 12 months if all of these apply to you:
- You were required to enroll in a managed care plan, and
- You want to keep a Medi-Cal provider who is not in your new plan, and
- You went to that provider at least once in the last 12 months, and
- Your provider is willing to work with your plan by making an agreement with your new plan to get paid
Can I get Continuity of Care for all of my providers?
No. Continuity of Care doesn't apply to all providers. For some providers, such as transportation providers, you will need a new one from your new L.A. Care Medi-Cal provider network. Plans can tell you which providers you may be able to keep under Continuity of Care.
Continuity of Care is provided when the following requirements are met:
- L.A. Care is able to determine that you have a pre-existing relationship with the Provider
- The Provider is willing to accept L.A. Care’s contract rates for Medi-Cal Fee For Service rates
- The Provider meets L.A. Care’s applicable professional standards and has no disqualifying quality of care issues
- The Provider is a California State Plan approved Provider and is enrolled and participating in the Medi-Cal program
How do I get Continuity of Care?
There are three ways to get Continuity of Care:
1. Call L.A. Care.
Please call L.A. Care Member Services at 1-888-839-9909 (TTY 711), 24 hours a day, 7 days a week, including holidays.
Ask if L.A. Care already works with your doctors and therapists.
- If we do, you can keep your doctors and therapists.
- If we do not, you can ask to keep your doctors and therapists. You can only keep them for up to 12 months.
2. Ask your doctor or therapist to call L.A. Care.
A provider can call L.A. Care and ask to keep you as their patient.
3. Ask a family member or person representing you to call L.A. Care. Others can call L.A. Care for you. They can make a request on your behalf as your authorized representative. L.A. Care may ask you directly if you are okay with someone asking on your behalf.
Can I keep my providers in my new Medi-Cal plan?
You will get most of your needed health care services through L.A. Care’s Medi-Cal provider network. It has doctors, therapists, imaging centers, transportation, etc.
Not all providers are in all networks. Providers you had previously might not be in the L.A. Care Medi-Cal network. You may need plan approval to go to some providers. You have rights that include possibly keeping a Medi-Cal provider for up to 12 months who is not in your new plan's network.
What if I have Medi-Cal and Medicare?
This information applies only to your Medi-Cal providers. The L.A. Care Medi-Cal plan does not limit Medicare providers. Medicare providers do not have to be in the L.A. Care Medi-Cal provider network.
What if my provider doesn't want to work with my plan?
If your previous Medi-Cal provider does not want to work with L.A. Care, you will need to choose a new provider in the L.A. Care Medi-Cal provider network.
Can I still get all my medicines?
Yes, you can usually get the same medicines even if your previous Medi-Cal provider does not work with L.A. Care. Medi-Cal Rx covers your prescription drugs. Your new provider can prescribe them for you to get from your pharmacy. Your plan also covers drugs your provider gives you in the office or clinic.
To learn more about Medi-Cal Rx prescription drug coverage and pharmacies that take Medi-Cal, go to the Medi-Cal RX website. Or call the Medi-Cal Rx Customer Service Center at 1-800-977-2273 (TTY: State Relay at 711). The call is free.
Talk to your new doctor about the medicines you are taking.
What if I have a scheduled surgery or an appointment with a specialist or doctor I haven't been to before?
If you want to keep a scheduled surgery or appointment with a specialist you have not gone to before, call L.A. Care Member Services at 1-888-839-9909 (TTY 711), 24 hours a day, 7 days a week, including holidays, to ask if you can keep the surgery or appointment. L.A. Care will either let you keep it or help you schedule it with a provider in Medi-Cal network.
What if I have more questions?
Here are some ways to get help:
L.A. Care Member Services
Please call L.A. Care Member Services at 1-888-839-9909 (TTY 711), 24 hours a day, 7 days a week, including holidays to ask for assistance
Office of the Ombudsman
Call 1-888-452-8609, Monday through Friday, 8 a.m. to 5 p.m. The call is free. You can also email MMCDOmbudsmanOffice@dhcs.ca.gov. You can also visit the Ombudsman website.
You can call or email for any of these reasons:
- To ask to keep your provider for up to 12 months after you join a new managed care plan.
- If you contacted your plan or provider but still need help with your Continuity of Care request.
- To get advice if you do not agree with your treatment or services.
- To ask other questions about your plan, provider, or Medi-Cal.
Department of Managed Health Care (DMHC) Help Center
Call 1-888-466-2219, 24 hours a day, 7 days a week. The call is free. They can help you find health coverage or help if you have a health plan complaint. You can also visit the DMHC website.