Member Handbook - Los Angeles County Department of Health ...

Medi-Cal Member Handbook / Benefit Year 2006-2007• has a complex medical condition (such asHIV/AIDS or cancer), and• has been in Medi-Cal managed care less than90 days, and• is being treated by a doctor who does notwork with any Medi-Cal managed care healthplan.Otherwise, the member must choose a health planlike L.A. Care.Voluntary Medi-Cal Managed CaremembersIn Los Angeles County, some people with Medi-Cal can choose to enroll in a health plan. Memberswho choose to enroll in a health plan arecalled “voluntary members.” A voluntary membercan choose to leave their health plan andreturn to fee-for-service Medi-Cal at any time.Voluntary members include:• Disabled or elderly receiving SupplementalSecurity Income (SSI)• Those 65 years or older• Native American Indians and their household,and others who are eligible to get servicesfrom an Indian Health Center or NativeAmerican Health Clinic• Children in foster care or the Adoption AssistanceProgram• Members with HIV/AIDS diagnosison the last day of the month in which Health CareOptions approves your request. Disenrollmenttakes about 15 to 45 days. You must continue toreceive services through Community Health Planuntil you are disenrolled from L.A.Care/Community Health Plan.If you leave L.A. Care, you cannot stay enrolledwith Community Health Plan for yourMedi-Cal coverage.Involuntary disenrollmentsYou will lose managed care coverage with L.A.Care and Community Health Plan if any of thefollowing happens:• You move out of Los Angeles County permanently.• You are in a long-term care or intermediatecare facility beyond the month of admissionand the following month.• You require medical health care services notprovided by Community Health Plan (for example,some major organ transplants, andchronic kidney dialysis).• You have other non-government or government-sponsoredhealth coverage.• You are in prison or jail.If you are a mandatory or voluntary member youalso can be disenrolled from L.A.Care/Community Health Plan, even if you don’twant to leave, if:Voluntary disenrollmentTo “disenroll” means you leave a health plan andare no longer a member. To disenroll fromL.A. Care, call Health Care Options at 1-800-430-4263. Health Care Options enrolls or disenrollsMedi-Cal beneficiaries in or out of a Medi-Cal managed care health plan. They will send youa disenrollment form. Your membership will end• You take part in any fraud having to do withservices, benefits or facilities of the plan.• You show an ongoing significant disruptivebehavior towards other members, providers,provider staff, or L.A. Care/CommunityHealth Plan.• Community Health Plan is not able, in goodcause, to give health care services to you.38Community Health Plan Member Services Department toll-free 1-800-475-5550L.A. Care Health Plan Member Services Department toll-free 1-888-4LA-Care or 1-888-452-2273