Medicaid is a government program that provides health care for millions of Americans. In California, it’s called Medi-Cal. It covers low-income adults, children, pregnant women, elderly adults and people with disabilities. If you qualify, you’ll be covered for a wide variety of benefits and services including:
Before you can get coverage, you need to make sure you qualify for Medi-Cal. Medi-Cal is the state of California’s Medicaid program. First, you need to apply for Medi-Cal. Once you’re approved for Medi-Cal, you choose Aetna Better Health of California as your health plan.
No, but you need to update your coverage every 12 months. For most members, your county automatically renews your Medi-Cal benefits. They will verify the information that you gave them last year, and if nothing changed, then you’re all set. If they notice any changes or are missing information, you will need to give it to them before moving forward.
We always try to give you the best health care experience possible. You’re encouraged to file a complaint if you’re unhappy with the service that you got from us or one of our providers.
You can file an appeal if we deny, delay or change a service. If you don’t agree with the decision of your appeal, you can:
Tell us. You have the right to report anyone that you believe is committing fraud or abusing the Medi-Cal system. You can use this form to report fraud or abuse.
Learn more about what you can do when someone commits fraud or abuse
You can call Member Services at 1–855-772-9076 (TTY: 711). Lines are open 24 hours a day, 7 days a week. Or you can take a look at your Aetna Better Health of California member’s handbook.
You can order a new Medi-Cal ID card for free on our secure Member Portal. Or you can ask for a new one by calling Member Services at 1-855-772-9076 (TTY: 711).
If you want to choose or change your PCP, call Member Services at 1-855-772-9076 (TTY: 711). You can also choose a PCP on our secure Member Portal. Your PCP must be part of the Aetna Better Health of California provider network. You can use the provider directory that we gave you in your welcome packet. Or use our online provider search tool, to find PCPs in your area. If you don’t choose a PCP, we can help you find one, or we'll choose one for you.
You’ll get an Aetna Better Health of California ID card with the name of your PCP. In most cases, your PCP request will be approved the same day.
If you get a bill, call your Medi-Cal provider’s office. If you keep getting bills, call Member Services for help at 1-855-772-9076 (TTY: 711).
Your PCP can refer you to a specialist in the Aetna Better Health of California network. Specialists are doctors who treat specific conditions.
Whether it’s day or night, your PCP or on-call provider will be able to tell you what to do. If they’re not in the office, leave a message, and the PCP will return your call. Your provider must give you an appointment within 24 hours if you need urgent care.
If you think you need to go to the ER when your PCP isn’t available:
Rides in an ambulance are always covered. We also cover your rides to medical and nonmedical visits.
Your nonemergency medical transportation (NEMT) services cover your rides to your doctor. All rides are covered when your condition prevents you from getting to your appointment by car, bus or train.
Your nonmedical transportation (NMT) services cover rides to specialists. We cover any means of public or private transportation to get you to your appointment. We’ll reimburse gas mileage if it’s a private vehicle.
If you need a ride, call Member Services three days before your appointment at 1-855-772-9076 (TTY: 711).
Pregnant women need special care. It’s important to get care early. If you’re pregnant, call Member Services as soon as possible at 1-855-772-9076 (TTY: 711).
A formulary is a list of medications that a health plan covers. We update our formulary every night.
We carefully choose the medications that we add to our formulary. A group of doctors and pharmacists, known as the Pharmacy and Therapeutics (P&T) committee, helps us choose the right medicines. New medications may be added every year. We try to remove medications from the list once a year. And some medications are benefit exclusions under the Medi-Cal benefit policy.
Some medications need preapproval because doctors feel that they should only be used after other medications have been tried first. You can call Member Services at 1-855-772-9076 (TTY: 711) if you have any questions about preapproval.
Quantity limits are set for different reasons. Limits are set because some medications have a maximum limit or a maximum dose for safety reasons. The limits are set after being reviewed by clinical staff.
We do make exceptions in some cases. Have your doctor contact our pharmacy staff. They will review the information provided by your doctor and make a decision.
The following medications are not covered under the formulary:
You can call Member Services at
1-855-772-9076 (TTY: 711).
You can call Member Services at
1-855-772-9076 (TTY: 711).
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