Medi-Cal Continuity of Care

If you get care from a provider who isn’t part of the Kaiser Permanente Medi-Cal network, you may be able to keep seeing that provider for up to 12 months. So you won’t have to change doctors during that time. This is called Continuity of Care. It’s a right under state law.

The Department of Health Care Services (DHCS) offers Continuity of Care to new members who must switch to a new Medi-Cal plan on January 1, 2024.

To get Continuity of Care or learn more, call Member Services at 1-855-839-7613 (TTY 711 ), 24 hours a day, 7 days a week.

You may qualify for Continuity of Care if:

• You had to transfer from Fee-for-Service Medi-Cal to Kaiser Permanente.
• Your doctor has left Kaiser Permanente.
• You switched from another Medi-Cal plan to Kaiser Permanente as of January 1, 2024, by choosing or being assigned to Kaiser Permanente.
• You were assigned to Kaiser Permanente as part of the state’s matching plan policy for dual-eligible Medicare Medi-Cal beneficiaries. This means your Medi-Cal was assigned to the same county and Kaiser Permanente Medi-Cal plan that offers your Medicare Advantage plan. To learn more about the state’s matching plan policy, call Medi-Cal Health Care Options at 1-800-430-4263 (TTY 1-800-430-7077) Monday through Friday, 8 a.m. to 6 p.m. Or visit healthcareoptions.dhcs.ca.gov.

You may qualify for Continuity of Care if these health conditions apply to you:

• Acute conditions, such as a broken bone or asthma attack
• Serious chronic conditions
• Pregnant or need immediate postpartum care
• Pregnant or postpartum and have mental health conditions
• Terminal illnesses
• Children under 3
• A procedure scheduled within 180 days of the coverage start date and you’re a new member
• A procedure scheduled within 180 days of the provider’s end date

These are only examples and not a full list.

You may qualify for additional Continuity of Care rights if Kaiser Permanente will be your new Medi-Cal health plan starting January 1, 2024. There are also special Continuity of Care protections if you’re part of a Special Population — as defined by DHCS.

Call Member Services at 1-855-839-7613 (TTY 711) to learn more.

It depends. In most cases, a request for Continuity of Care is not automatic. It must be approved first. Some providers and situations don’t qualify. Continuity of Care requests must be for qualified, covered services by qualified providers.

For nonurgent requests, we’ll let you know within 15 days of getting the required information. If your request is urgent, we’ll let you know within 72 hours of getting the request.

You’ll get a written notice explaining why your request was denied. You’ll also get information on your rights to appeal the decision. If your care must transition to a Kaiser Permanente doctor, we’ll work with you and your previous provider to safely transition your care.

Call Member Services at 1-855-839-7613 (TTY 711 ) right away to see if your provider is in our network. We may be able to help you request Continuity of Care with that provider.

Yes, you can get the same medications prescribed by your previous providers. If you get medications from a clinic or doctor, you must request Continuity of Care. That way you can keep getting those medications until your care is transitioned to Kaiser Permanente.

To learn about Medi-Cal Rx prescription drug coverage and pharmacies, visit medi-calrx.dhcs.ca.gov. Or call the Medi-Cal Rx Customer Service Center at 1-800-977-2273 (TTY 711).