Help for Beneficiaries with Medicare and Medi-Cal
Return to Integrated Care for Dual Eligible Beneficiaries
In California there are a variety of Ombudsperson programs ready to assist beneficiaries. The primary duties of an Ombudsperson program is to help individuals explore and assist them in determining options to help resolve conflicts and to bring systemic concerns to the attention of those best suited to solve the problem.
Ombudsperson Program Crosswalk & Contact Information
Program Name
| General Scope of Services
| Contact and Logistics
| Population Served
|
Medicare and Medi-Cal Ombudsperson Program (MMOP)
| Provides education and advocacy to people with both Medicare and Medi-Cal, known as “dual eligibles.” The MMOP helps beneficiaries enrolled in Medicare Advantage plans, including Medicare Medi-Cal Plans (MMPs), Medicare Advantage Special Needs Plans (SNPs), and the Program of All-Inclusive Care for the Elderly (PACE). Also, any dual eligible beneficiary with an eligibility, coverage, or access to care barrier. The MMOP answers questions about coverage, enrollment, and obtaining care, as well as assist beneficiaries file complaints and appeals with their plan.
| 1-855-501-3077
Services provided by Health Consumer Alliance local legal aid Managed by Legal Aid Society of San Diego
| All dually eligible beneficiaries in California
|
Medi-Cal Managed Care Ombudsman
| All types of Medi-Cal managed care questions, for all Medi-Cal benefits and populations. For dual eligibles this is primarily around Medi-Cal enrollment issues.
| 1-888-452-8609 Managed by DHCS
| All Medi-Cal beneficiaries
|
Long-Term Care Ombudsman
| Local Long-Term Care Ombudsman representatives assist residents in long-term care facilities with issues related to day-to-day care, health, safety, and personal preferences.
| 1-800-231-4024 Managed by the California Department of Aging, State Long-Term Care Ombudsman
| All residents of Long-Term Care facilities regardless of age or payer.
|
Health Insurance Counseling and Advocacy Program (HICAP)
| Provides Medicare counseling including free, confidential one-on-one counseling, education, and assistance to individuals and their families on Medicare, long-Term Care insurance, other health insurance related issues, and planning ahead for Long-Term Care needs. Referrals to county eligibility offices for Medi-Cal.
| 1-800-434-0222 Managed by the California Department of Aging
| All Medicare beneficiaries
|
