Plans and Providers
This program is administered
by the Department of Health Care Services (DHCS).
Plans and Providers
Who will provide health care services for you and your baby?
Enrollment before October 1, 2016
If you applied before October 1, 2016, you will choose a health plan available in your county. Then, when your MCAP coverage starts, your health plan will manage your health care. The plan will let you know what doctors, midwives, medical groups, hospitals, and other providers you can use and what services are available. The plan will let you know how to get the services you need. MCAP members who enrolled into the program prior to October 1, 2016, continue to receive coverage through their selected MCAP health plan.
All plans in MCAP offer the same health coverage. Differences among plans are in the choices of providers and special services offered. To find out which doctors and hospitals work with a plan, call the plan directly. To find out the special services a plan offers, read the plan descriptions click here. Wellness classes or a telephone help line are examples of special services.
Many providers work with MCAP and its health plans. You may be able to use the same doctor, hospital, or pharmacy that you use now. Call the health plans in your county to see if they work with a provider that you want.
Enrollment after October 1, 2016
Effective October 1, 2016, all new MCAP enrollees no longer choose a health plan. Health care services including, dental and vision, are now provided through the Medi-Cal Fee-For-Service (FFS) delivery system. Please remember that you need to see a doctor who accepts Medi-Cal FFS. If your doctor doesn’t accept Medi-Cal FFS, you should contact another Medi-Cal provider. You will be sent a Medi-Cal Benefits Identification Card (BIC) in the mail, and you can use your BIC for health care services through Medi-Cal FFS from enrolled Medi-Cal providers. You may contact MCAP at 1-800-433-2611 if you have not received your BIC.
If you need help finding medical care providers, you may contact your local county human services agency who may be able to help you find a medical provider or provide a list of providers in your area. For dental care providers, you may contact the Denti-Cal call center at 1-800-322-6384. For vision care providers, you may visit the on-line directory, or contact firstname.lastname@example.org if you have questions.
Coverage for Your Baby
Since you are enrolled in MCAP, your baby automatically qualifies for the Medi-Cal Access Infant Program unless you tell us not to or your baby is enrolled in employer-sponsored insurance or no-cost Medi-Cal. You must submit the Infant Registration Form to notify the Medi-Cal Access Infant Program of the birth and to register your baby with the Medi-Cal Access Infant Program. If your baby qualifies for the Medi-Cal Access Infant Program, the coverage will begin on their date of birth. Your baby will receive medical, dental and vision care through Medi-Cal health care providers and managed health care plans. Your baby will not be covered until Medi-Cal Access Infant Program receives the required Infant Registration Form.
Your baby will stay covered in the Medi-Cal Access Infant Program if, at the first Annual Eligibility Review, you meet the income guidelines. At your baby’s second Annual Eligibility Review, your family income will be evaluated to see what coverage the infant qualifies for.
For more information, click here.