Medi-Cal managed care is the way most Californians receive their Medi-Cal benefits: the state contracts with a health plan in your county, and that plan coordinates your doctors, hospitals, prescriptions, and other covered services.1Department of Health Care Services. Medi-Cal Managed Care When you qualify for Medi-Cal, you have 30 days to pick a plan before the state assigns one for you.2Department of Health Care Services. Medi-Cal Managed Care – Frequently Asked Questions What plans you can choose from depends entirely on which county you live in, and the choice shapes which providers you can see and what extra benefits you receive.
Your County Decides Your Plan Options
California uses five managed care structures, and your county determines which one applies to you.1Department of Health Care Services. Medi-Cal Managed Care In some counties you get a real choice; in others, everyone goes into the same plan.
- County Organized Health System (COHS): a single public plan run by the county serves all Medi-Cal members, with Kaiser Permanente sometimes available as an additional option with enrollment limits.3Medi-Cal. County Organized Health System
- Two-Plan Model: you choose between a publicly run Local Initiative and a private commercial plan.4Medi-Cal. Two-Plan Model
- Geographic Managed Care (GMC): used in metros like Sacramento and San Diego, with multiple commercial plans to compare.5Medi-Cal. Geographic Managed Care
- Regional Model: for rural counties, offering a choice between two commercial plans that serve neighboring counties together.6Department of Health Care Services. Managed Care Plan Model Fact Sheet
- Single-Plan Model: some counties have only one contracted plan, so there is no selection to make.
If you live in a COHS or Single-Plan county, your attention shifts from choosing a plan to choosing a primary care doctor within it. The DHCS Medi-Cal Managed Care page shows which model and plans operate in your county.
The 30-Day Window to Choose a Plan
After you’re approved for Medi-Cal, you’re initially covered under fee-for-service Medi-Cal. If your county has more than one plan option, Health Care Options mails you a Medi-Cal Choice Form, and you have 30 days from the date it’s sent to make your pick.2Department of Health Care Services. Medi-Cal Managed Care – Frequently Asked Questions Open the envelope promptly. Miss the deadline and you may end up with a plan that doesn’t include your current doctors.
Before filling out the form, gather what you’ll need:
- Your Case Number, assigned when you applied.
- Your Client Index Number (CIN), on the front of your Benefits Identification Card.7Department of Health Care Services. Other Health Coverage
- Social Security numbers for household members requesting full-scope benefits.8Department of Health Care Services. Medi-Cal Help Center
- The Plan Code, which ties each plan to your county. The Medi-Cal Managed Care Plan Code Directory lists every plan, code, and county.9Medi-Cal. Plan Code Directory
Then do the single most important check: look up your current doctors in each plan’s online provider directory. A plan with a strong reputation means nothing if your cardiologist or your child’s pediatrician isn’t in its network. If you want help comparing, call Health Care Options at 1-800-430-4263.10Health Care Options. Enroll Every plan must also provide interpreter services and translated materials at no cost if you have limited English proficiency.
Health Care Options accepts your selection four ways: online through a Health Care Options account; by phone at 1-800-430-4263 (TTY 1-800-430-7077), Monday through Friday, 8 a.m. to 6 p.m. Pacific time; by mail using the paper Choice Form; or in person at enrollment sites listed on the Health Care Options website.10Health Care Options. Enroll Whichever route you use, confirm the plan code matches the plan name. A mismatched code can delay processing or land you in the wrong plan.
What Happens If You Don’t Choose
If you don’t submit a choice in time, the state assigns you to a plan. The algorithm isn’t random: DHCS scores each plan in your county on quality measures like childhood immunizations, diabetes management, blood pressure control, and follow-up after mental health or substance use emergency visits, and higher-scoring plans receive a larger share of auto-assigned members.11Department of Health Care Services. Auto-Assignment Program Overview Even so, there’s no guarantee the assigned plan includes the doctors you already see. Choosing proactively is always better.
Changing Your Plan After Enrollment
You can request to switch plans through Health Care Options by phone or online. Reasons that allow disenrollment include moving out of the plan’s service area, being incorrectly enrolled in a plan you didn’t pick, or requesting a change for any reason outside a restricted period.12Legal Information Institute. 22 CCR 53891 – Disenrollment of Members
The state can restrict changes during the second through sixth months of your initial enrollment. In that window you need “good cause,” which includes needing covered services the plan can’t provide or an irreparable breakdown with your doctor.12Legal Information Institute. 22 CCR 53891 – Disenrollment of Members Outside the restricted period, you can switch for any reason. Approved changes usually take effect on the first of the following month, so keep using your current plan’s providers until the new coverage starts.
Keeping a Doctor Who Isn’t in Your New Plan
If you’re moving from fee-for-service into managed care and your doctor isn’t in the new plan’s network, you can request up to 12 months of continued care with that provider.13Department of Health Care Services. Continuity of Care FAQ You qualify if you’ve seen the provider in the past 12 months, the provider agrees to the plan’s contracted rates, and there are no outstanding quality-of-care issues. Contact your new plan directly to make the request. The plan has 30 days to respond, and you can file a grievance if it denies the request or misses the deadline.
Separately, California law requires plans to let you finish a course of treatment with a provider who leaves the network when you have an acute condition, a serious chronic illness, a high-risk pregnancy, a terminal illness, or a previously authorized surgery.13Department of Health Care Services. Continuity of Care FAQ These protections apply whether or not you’re transitioning from fee-for-service.
When You Can Stay in Fee-For-Service Instead
In limited cases, you can request a temporary medical exemption to remain in fee-for-service Medi-Cal rather than joining a managed care plan. You must have a complex medical condition that would worsen with a change in providers, and your current fee-for-service doctor must not participate in any managed care plan in your county.14Department of Health Care Services. Request for Temporary Medical Exemption
Qualifying conditions may include high-risk pregnancy, HIV/AIDS, chronic dialysis, active cancer treatment, organ transplant evaluation or recovery, and complex neurological or hematological disorders. Routine management of a chronic condition does not qualify on its own. An approved exemption lasts up to 12 months and can be renewed. One catch: if you’ve already been enrolled in a managed care plan for more than 90 consecutive days, you no longer qualify.15Legal Information Institute. 22 CCR 53887 – Exemption from Plan Enrollment
If You Also Have Medicare
If you have both Medicare and Medi-Cal, your Medi-Cal plan must align with your Medicare plan. Under the state’s matching plan policy, which expanded to every California county as of January 1, 2026, your Medicare Advantage choice leads and your Medi-Cal plan follows.16Department of Health Care Services. Medi-Cal Matching Plan Policy for Duals If you pick a Medicare Advantage plan with an affiliated Medi-Cal plan, you’ll be matched into that Medi-Cal plan automatically. Enrolling in managed care does not change your Medicare benefits or limit which Medicare providers you can see.
When Your Plan Says No
If your plan denies a service, reduces your benefits, or provides care you believe is substandard, start with an internal grievance filed with the plan. The plan must resolve a standard grievance within 30 days. Ask for an expedited grievance if your health is at immediate risk, and the plan must address it within 72 hours.2Department of Health Care Services. Medi-Cal Managed Care – Frequently Asked Questions
If the plan’s answer doesn’t resolve things, you have two external paths. You can request a State Fair Hearing through DHCS within 90 days of the plan’s written Notice of Action.17Department of Health Care Services. Medi-Cal Fair Hearing If the dispute involves medical necessity or an experimental treatment denial, you can also request an Independent Medical Review (IMR) through the Department of Managed Health Care after participating in the plan’s grievance process for at least 30 days.18California Legislative Information. California Health and Safety Code 1368 The DMHC assigns independent doctors who weren’t part of the original decision to review your case.19Department of Managed Health Care. DMHC FAQ IMR is not available if you’re in fee-for-service Medi-Cal; the State Fair Hearing is your remedy in that case.
What Happens After You Enroll
Once your enrollment processes, the state confirms your coverage start date and you receive two cards: your state-issued Benefits Identification Card (BIC) and a separate ID card from your managed care plan. Bring both to every medical appointment. The BIC proves your Medi-Cal eligibility, while the plan card routes billing and authorization through the correct network.
Your plan’s welcome packet includes a provider directory, a summary of covered benefits, and member services contact information. The plan should schedule an initial health assessment within the first 120 days of enrollment, covering your medical history, screening for chronic conditions, and connecting you with a primary care provider. Don’t wait. Call member services early to pick a primary care doctor and book that assessment.
Managed care plans also arrange transportation to medical, dental, mental health, and substance use appointments. If you can’t get to a covered appointment, contact member services for a ride. Non-emergency transportation by ambulance or wheelchair van requires a prescription from your provider.20Department of Health Care Services. Transportation Services
Keeping Your Coverage Year to Year
Staying enrolled in your plan depends on keeping your Medi-Cal eligibility, which is reviewed annually. Check your renewal date through your BenefitsCal account or watch for a letter.21Department of Health Care Services. FAQs – Keep Your Medi-Cal Often your local office can verify eligibility through government databases without action from you, and you’ll just receive a notice confirming the renewal. When they need more information, you’ll get a renewal form in a bright yellow envelope. Complete and return it, or your coverage will end.
If you miss the deadline, you have 90 days from the date on the letter to submit the form and have your case reviewed without starting a new application. After that, you’ll need to reapply from scratch. Report changes in income, household size, other health coverage, or immigration status promptly. You do not need to report non-income assets like bank accounts, vehicles, or your home.