Medi-Cal in San Francisco - how does it work?
November 13, 2013 8:55 AM   Subscribe

How will Medi-Cal (Medicaid) work in San Francisco in 2014? Can you choose your doctor?

Asking for a friend of a friend who may be eligible for Medi-Cal this coming year, and who would probably choose Kaiser if eligible for the exchange.

I don't know anything about how Medi-Cal works in San Francisco and I have a million questions.

What happens after you apply?

Assuming you're accepted, what happens next?

Do you go to local city-run clinics?

Can you choose a doctor at Kaiser or UCSF or your local practice?

If you get to choose a doctor, how hard is it to find a doctor who's taking new patients? (Especially now with so many new people joining the system?)

How hard is it to get an appointment?

How does the Medi-Cal experience differ from having insurance?

What are the best resources - online or offline - for figuring this stuff out?

If you're a Medi-Cal participant or know someone who is, I would greatly appreciate any info you can share about your experiences and the logistics of how it all works.

posted by kristi to Health & Fitness (3 answers total) 2 users marked this as a favorite
Here's the main web-site.

You can discuss with your providcers to see if they accept Medi-Cal. Medi-Cal providers agree to accept whatever reimbursement for services is proscribedby the state. Some will, some won't. Same as with regular insurance plans.

I would make sense for your friend to go down and discuss this in person with a case-worker so that your friend can well and truly understand how it works.
posted by Ruthless Bunny at 9:04 AM on November 13, 2013

Best answer: I am not an expert in the intricacies of Medi-Cal, but I can tell you that generally in California if your friend qualifies for the program based on being a non-disabled low-income adult, one of the first things they will need to do is select a managed care plan. In California's Medi-Cal program, every county has two or three plans that compete for Medi-Cal enrollees, and your friend would select from among those plans. After getting into a plan, your friend would generally see the providers who are contracted with that plan, just like would happen in "regular" commercial health insurance that he/she would buy through the exchange. So that will look pretty similar to how things would work under the exchange or if your friend got insurance through a job.

On the upside, by qualifying for Medi-Cal, your friend won't be responsible for paying any part of the premium, and copays/co-insurance/deductibles will be very low or non-existent--much better than what he/she would have gotten through the exchange, where even after the premium subsidies people may face pretty big deductibles before the insurance plan covers anything. On the downside, there's much less choice in terms of health plans in Medi-Cal, and it may be the case the provider networks aren't as extensive. It probably varies quite a bit depending on the county you're in.

This page shows you which plans are available to Medi-Cal enrollees in San Francisco. I am fairly sure that both the Family Mosaic Project and On Lok target specific populations (children and people over 55 who have special health care needs), so your friend is probably looking at choosing between Anthem Blue Cross Partnership Plan and San Francisco Health Plan. Here's a consumer guide (a bit old) that compares the two plans based on how their Medi-Cal enrollees rate their services, which might be helpful. Looking at each plan's website might give you an idea of which doctors work with or accept each plan.

All of this comes with the major caveat that it's possible that more plans or different plans will start serving Medi-Cal in January 2014, with all the other changes going on.
posted by iminurmefi at 9:56 AM on November 13, 2013 [1 favorite]

Best answer: 1. Use the Covered CA website to answer as many of those questions as possible and start the process.

2. If they are eligible for the Low-income Health Program (LIHP) in SF, sign up now. Ask those question there -- there's a phone number on the web site. SF PATH will connect people directly into expanded Medi-Cal.

3. They'll have a medical home, but it can be at a number of different sites. The system is set up now to help connect people to a clinic to be their "home". So finding a doctor or clinic shouldn't be too much of a struggle. The city's been working on expanding capacity for a while.

4. Medi-Cal IS insurance. That's what it is. Not a different thing.
posted by gingerbeer at 11:57 AM on November 13, 2013

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