All Medi-Cal Recipients Are Now Required to Join a Managed Health Care Plan

By Catalina Island Health

Date Posted: January 4, 2023

medi-cal update

Attention Medi-Cal Recipients!

If you have Medi-Cal as a primary or secondary insurance this notice is for you!

California has had many changes in the past year and the changes continue. All Medi-Cal recipients are now required to join a managed health care plan.

If you have Medicare AND Medi-Cal, you may keep your original Medicare and enroll in a managed care plan for Medi-Cal ONLY.

As of 2023, all Medi-Cal recipients (except those with specialized diagnosis/treatments) will have to choose a plan. The Medi-Cal plan we contract with is LA CARE DIRECT. Your Medi-Cal Card ID should identify one of the doctors at CI Health as your primary care doctor and should have LA CARE DIRECT as your medical plan.

Medi-Cal will only allow you to choose a doctor as your PCP, not a nurse practitioner, however, you can be seen by any provider at our clinic regardless of which physician at our clinic you selected as your PCP.

If your Medi-Cal card does not reflect one of our current doctors and/or LA CARE DIRECT, please see the detailed information below for instructions to help you change your plan.

If you need assistance, please contact our Social Services department directly.

For English
Jenea Dominguez
(310) 510-5142

For Spanish
Adi Casillas
(310) 510-5155

Changing to LA Care Direct

If you already have LA Care Plan:

  1. Call LA Care Medi-Cal (888) 839-9909
  2. Request to change your primary care provider
  3. Provide the representative with Dr. McGroartys’ NPI number: 1891767299
  4. Ask the representative to make the plan effective at the beginning of the month you are calling (This is a courtesy retro authorization)– this will only be approved if you have not seen any other provider that month, if not it will be effective the following month.
  5. Change should show within 48 hours & the patients will get a new ID card within 7-10 business days

If you are in a Health Net Plan or any other plan than LA Care:

  1. Call Health Care Options (800) 430-4263
  2. Request to change the plan/network into LA CARE.
  3. Provide the representative with Dr. McGroartys’ NPI number: 1891767299
  4. Ask the representative to make the plan effective at the beginning of the month you are calling in – they will most likely say that it is up to the plan to decide. Usually, you will get a letter of disenrollment within 7-10 business days. Following that letter, you will receive a new enrollment letter for the new plan with a new ID card.
  5. Typically, this will show active for next month because separate plans don’t share patients. (but it can take anywhere from 30-60 days depending on when this call was initiated)
  6. For special circumstances, the Social Services team can help you call the Ombudsman to see if they can be granted an emergency disenrollment which would be effective the following business day.
  7. Important: If calling the ombudsman you still need to call LA CARE the next business day to choose the correct plan (LA CARE DIRECT) or else the enrollment will be for LA CARE without the correct plan being chosen.

If you have tried doing this on your own or need specialized assistance please call Social Services to make an appointment to assist you.