The Medi-Cal program complies with state and federal laws and regulations relating to the legal liability of third parties for health care services to members.
L.A. Care will take all reasonable measures to ensure that the Medi-Cal program is the payer of last resort.
Medi-Cal members may have other health coverage (OHC), also referred to as private health insurance.
As a condition of Medi-Cal eligibility, you must apply for or retain any available OHC when it is free.
Federal and state laws require Medi-Cal members to report OHC and any changes to an existing OHC. You may have to repay DHCS for any benefits paid by mistake if you do not report OHC quickly. Submit your OHC on the DHCS OHC web page.
If you do not have access to the internet, you can report OHC to L.A. Care by calling L.A. Care Member Services at 1-888-839-9909 (TTY 711). Or you can call DHCS’s OHC Processing Center at 1-800-541-5555 (TTY 1-800-430-7077 or 711 or 1-916-636-1980.
The California Department of Health Care Services (DHCS) has the right and responsibility to be paid back for covered Medi-Cal services for which Medi-Cal is not the first payer. For example, if you are injured in a car accident or at work, auto or workers’ compensation insurance may have to pay for your health care first or pay back Medi-Cal if Medi-Cal pays.
If you are injured, and another party is liable for your injury, you or your legal representative must notify DHCS within 30 days of filing a legal action or a claim.
Submit your notification online:
To learn more, visit the DHCS Third Party Liability and Recovery Division webstie or call 1-916-445-9891.