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

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Medi-Cal Member Handbook / Benefit Year 2006-2007Community Health Plan will use their bestefforts to provide the needed services.If you are disenrolled from L.A. Care/CommunityHealth Plan, we will send you a letter that sayswhen your coverage will end and why. You mayfile an appeal with the California Department ofHealth Care (DMHC) if you think that yourcancellation is because of your health status orneed for services. This means you can ask DMHCto make sure we are allowed to disenroll you.You may also ask for a review from CaliforniaDepartment of Health Services. This is talkedabout in the section “Complaints: What should Ido if I am unhappy?” in this handbook. You canalso call L.A. Care to find out more.Expedited disenrollmentL.A. Care will process an Expedited Disenrollmentif we are not able to provide you medicalservices due to your condition or situation whichis indicated in L.A. Care’s contract with theDepartment of Health Services (DHS). This mayinclude a major organ transplant, long-term careservice, Foster Care or Adoption AssistancePrograms, or you move out of Los AngelesCounty. We will submit a disenrollment requestto DHS who will make a decision within 72hours. When we receive the decision, we willnotify you and your PCP doctor of the effectivedate of disenrollment. Your health care for thecondition will be covered by regular Medi-Cal.Transitional Medi-CalTransitional Medi-Cal is also called “Medi-Calfor working people.” You may be able to gettransitional Medi-Cal if you stop getting Medi-Cal because:• You started earning more money; OR• your family started receiving more child orspousal support.For example, if you are the person in yourhousehold who earns the most money, you mightget transitional Medi-Cal. Even if you are acaretaker relative, you might get transitionalMedi-Cal if you started earning more money oryou are receiving more child or spousal support.Parents and caretaker relatives who get transitionalMedi-Cal can get free Medi-Cal coveragefor six to 24 months. If you have stopped gettingMedi-Cal, you should ask your eligibility workerif you qualify for transitional Medi-Cal. Call youreligibility worker at DPSS toll-free at 1-877-481-1044. You can stay with L.A. Care/CommunityHealth Plan if you are eligible for transitionalMedi-Cal.39Community 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
Medi-Cal Member Handbook / Benefit Year 2006-2007Getting involved:How do I participate?Many of the L.A. Care/Community Health Planpolicies are decided by California Department ofHealth Services. Other policies are set byL.A. Care and/or Community Health Plan andmembers like you.Community Health Plan Public PolicyCommitteeCommunity Health Plan has a public policycommittee you may join. This committee discussesmember and health plan issues. To find outmore, please call Community Health Plan.Board of Governors meetingsThe Board of Governors decides policies forL.A. Care. Anyone can attend these meetings.The Board of Governors meets on the firstThursday of each month from 2 p.m. to 4 p.m. Tofind out more call the L.A. Care Meeting InformationLine at 213-438-5408.Communicating policy changesAs a L.A. Care member, you will get informationon all policy changes that affect your health care.All important information will be included inyour member newsletter or special mailings.L.A. Care Regional Community AdvisoryCommittees (RCAC)There are 11 L.A. Care Regional CommunityAdvisory Committees (RCAC) in Los AngelesCounty. (“RCAC” is pronounced “rack.”) Theirpurpose is to:• Talk about member issues• Advise the L.A. Care Board of Governors• Educate and empower the community onhealth care issuesRCACs meet once a month. RCACs includeL.A. Care members, member advocates (supporters)and health care providers. To find out moreabout RCACs, call the L.A. Care CommunityOutreach and Education Department toll-free at1-888-522-2732.40Community 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
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