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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:
- Preventive care
- Chronic disease management
- Behavioral health services
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:
- Ask for a state fair hearing
- Ask for an independent medical review (IMR)
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.
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.
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.
Coverage and benefits
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:
- Call Member Services at 1-855-772-9076 (TTY: 711) and choose the option for our 24-Hour Nurse Line. The nurse can help you decide if you need to go to the ER or to urgent care.
- Call 911 or go to the closest hospital if you’re having an emergency.
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).
Sensitive services include any health care services related to:
- Sexual assault
- Substance use disorder
- Family planning/birth control
- Sexually transmitted diseases (STDs)
These services are considered “sensitive” because they come with additional privacy protections. For example, if you’re under age 18, you can get some services without your parent or guardian’s permission. This is called “minor consent.”
If you are between the ages of 12 and 18, you can get these sensitive services without your parent or guardian’s permission:
- Mental health care treatment (outpatient) for issues like:
- Sexual assault
- Physical assault
- Child abuse
- Thoughts of hurting yourself or others
- HIV/AIDS prevention, testing and treatment
- STD prevention, testing and treatment
- Substance use disorder treatment
(You can also get sexual assault treatment without parental consent even if you are under age 12.)
If you’re under 18, you can see a doctor without permission from your parents or guardian for:
- Pregnancy-related services
- Birth control (including sterilization)
- Abortion services
If you’d rather not see your regular doctor for some sensitive services, we understand. You can see any doctor, even if they’re not in our network, for:
- Pregnancy testing
- Birth control
- Screening and treatment of STDs