Continuity of Care
L.A. Care is committed to ensuring that Cal MediConnect eligible members receive medically necessary services without interruption.
For physicians and other health care providers not contracted with a Cal MediConnect plan, the following continuity-of-care process will apply: Patients may continue to see their non-contracted physicians for a period of up to 12 months for their Medicare services or for their Medi-Cal services after enrolling in a Cal MediConnect plan, as long as the following Continuity of Care guidelines are met:
- The enrollee or their representative requests continuity of care from the Cal MediConnect plan.
- There is a demonstrated preexisting relationship between the patient and the physician prior to enrollment in Cal MediConnect.
- The physician is willing to accept the Cal MediConnect plan rate or the applicable Medicare rate, whichever is higher, and agree to receive payment from the plan.
- There are no quality-of-care issues or a failure to meet federal or state requirements that would exclude the physician from the plan’s network.
Any services provided during that 12-month period will be paid at the Medicare or Medi-Cal rate, as appropriate.
What will happen after the Continuity of Care period ends?
After the 12-month Continuity of Care period ends, physicians will have the option to join the plan’s Cal MediConnect provider network. If a physician chooses not to join, Cal MediConnect patients will need to select a physician who is participating in the network.
What about Cal MediConnect members who disenroll from their plan?
Please note that for individuals who do request to be disenrolled from Cal MediConnect, it may take up to 45 days for this change to be processed. Until the disenrollment is effective, if the individual is an L.A. Care Cal MediConnect member, L.A. Care will continue to cover their services.
DHCS has provided a variety of Continuity of Care Resources on their website.
We also have dedicated L.A. Care staff who will work with you to answer any questions and facilitate service continuity. Please contact the L.A. Care Continuity of Care Unit at 855-351-9251 or email COC@lacare.org with questions or for more information.