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Office of the Patient Advocate - State of California


The following DHCS consumer assistance service centers provide guidance and referrals for Medi-Cal program issues.
 

Service Center
Phone Number
Website

Office of the Ombudsman
Main line: 1-888-452-8609
TTY/TDD: California Relay Service (711)
Hours of operation: Monday-Friday, 8:00 a.m. – 5:00 p.m. (except state holidays)
www.dhcs.ca.gov/services/medi-cal/Pages/MMCDOfficeoftheOmbudsman.aspx

Medi-Cal Telephone Service Center 
Main line: 1-800-541-5555
TTY/TDD: 916-635-6491
Hours of operation: Monday-Friday, 8:00 a.m. – 5:00 p.m. (except state holidays)

www.dhcs.ca.gov/individuals/Pages/Medi-CalMemberHelpline.aspx

Medi-Cal Dental Telephone Service Center
Main line: 1-800-322-6384
TTY/TDD: 1-800-735-2922
Other lines: 1-866-290-6310 (for patients new to the program)
Hours of operation: Monday-Friday, 8:00 a.m. – 5:00 p.m. (except state holidays)
Some automated services available through the phone system 7 days a week, 24 hours a day. Voicemail checked daily.

https://dental.dhcs.ca.gov/​

Complaint Data Highlights
The highlights below are based on information DHCS reported to OPA about its consumer assistance service centers and about its 2020 State Fair Hearings. State Fair Hearings conducted by the California Department of Social Services (CDSS) are an avenue for Medi-Cal members and applicants to address complaints about the program. More details can be found in the DHCS section of the full Annual Complaint Data Report or on OPA’s webpage about how to file Medi-Cal Complaints.
​
​Consumer assistance volume in 2020:
The 2024-25 Budget: Medi-Cal Analysis
The tax rate on commercial enrollment, which ranges between $1.75 and $2.25 depending on the year, remains at the enacted levels in the Governor’s budget.
bRate applies from April through December 2023.

MCO = managed care organization.

Reduces Overall Funding in Provider Payment Reserve. The administration proposes to deposit less funding in the Medi‑Cal Provider Payment Reserve Fund than originally planned, freeing up more MCO tax funds to further offset General Fund spending in Medi‑Cal ($3.1 billion over the multiyear). According to the administration, the change would not reduce annual spending levels for Medi‑Cal augmentations, but instead would shift the timing of when the reserve funds would be fully spent. Specifically, the administration indicates that the reserve would be fully spent at around mid‑2028, rather than at the end of 2029 as originally anticipated in the 2023‑24 budget.
Leaves Small Reserve by the End of the Term of the Tax. Accounting for the proposed budget solution, the administration has submitted a multiyear spending plan for the MCO tax package. As Figure 10 shows, under the plan, the annual offset to General Fund spending would begin to decline in 2025‑26, as the cost of the proposed augmentations ramp up. When the tax ends in 2026‑27, the state would have $841 million of MCO tax funds left in reserve. This reserve would be available to help sustain—but not fully cover—the augmentations in the MCO tax package in 2027‑28 (potentially shifting up to the low billions of dollars of cost pressure to the General Fund). By contrast, without the proposed fund shift, the reserve would be around $4 billion in 2026‑27, enough to cover the augmentations over a somewhat longer period of time. (The reserve would be even larger in 2026‑27 were the state to renew the MCO tax in 2027, with the amount of funds depending on the size of the future version of the tax.)

Figure 10
Multiyear Plan Leaves Small Reserve to Help Sustain Proposed Augmentations
Revised MCO Tax Package Proposed in the Governor’s Budget (In Millions)

2023‑24

2024‑25
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The 2024-25 Budget: Medi-Cal Analysis
Proposes MCO Tax Budget Solution to Increase General Fund Offset. As part of the Governor’s package of proposed budget solutions intended to address the state’s budget problem, the Governor proposes to modify the recently enacted MCO tax package. The proposal, which would increase the General Fund offset by $4.6 billion from 2023‑24 through 2026‑27, is the result of two key actions, described further below.
Increases Size of MCO Tax. The administration proposes early action trailer bill legislation to increase the MCO tax rate on Medi‑Cal enrollment. As Figure 9 shows, the increase would be effective January 2024, assuming it receives federal approval. The tax rate on commercial enrollment would remain unchanged from the enacted levels. With an increase in the rate on Medi‑Cal enrollment, the MCO tax would yield more revenue and a larger net fiscal benefit ($1.5 billion over the multiyear).

Figure 9
Proposal Would Increase Rate on Medi‑Cal Enrollment in Most Years
MCO Tax Rate on Medi‑Cal Enrollmenta

2023a

2024

2025

2026

Enacted in 2023‑24 budget

$182.50

$182.50

$187.50

$192.50

Proposed in 2024‑25 Governor’s Budget

182.50

205.00

205.00

205.00

Percent increase

—

12%

9%

6%

aRate applies to each plan’s aggregate monthly enrollment level between 1,250,001 and 4,000,000 member months during calendar year 2022, with certain adjustments. The tax rate on commercial enrollment, which ranges between $1.75 and $2.25 depending on the year, remains at the enacted levels in the Governor’s budget.
bRate applies from April through December 2023.

MCO = managed care organization.

Reduces Overall Funding in Provider Payment Reserve. The administration proposes to deposit less funding in the Medi‑Cal Provider Payment Reserve Fund than originally planned, freeing up more MCO tax funds to further offset General Fund spending in Medi‑Cal ($3.1 billion over the multiyear).
The 2024-25 Budget: Medi-Cal Analysis
Recognizing this risk, last year’s package anticipated some funds in the Medi‑Cal Provider Payment Reserve Fund would be held in reserve and be available, along with funds from a much smaller future MCO tax, to sustain the augmentations after the end of the term of this tax. The administration stated at the time that the reserve would be fully spent around the end of 2029. Absent the Legislature modifying the augmentations or identifying another fund source, the shortfall would fall on the General Fund to backfill. 
Federal Government Recently Approved Enacted Tax… Very shortly after budget enactment, DHCS submitted a new MCO tax‑related waiver to the federal government for approval. In December 2023, the federal government announced its approval of this waiver, enabling the MCO tax to into effect under California law and for the tax to draw down federal Medicaid funds under federal law.
…But Also Signaled Intent to Change Rules to Approve Tax in the Future. As part of its approval letter, the federal government noted its concern that the MCO tax, while technically meeting current federal rules, falls disproportionately on Medi‑Cal services. That is, the tax derives 99 percent of its revenue from Medi‑Cal enrollment, even though Medi‑Cal comprises around 50 percent of taxable enrollment. This is of concern to the federal government because nearly all of the cost of the tax falls on the Medi‑Cal program—which is partly supported by federal funds—rather than more proportionately between Medi‑Cal and private insurance. To address this concern, the letter states intent to change the rules around approving the MCO tax. The letter does not specify the scope of the rule changes or the timeline to enact them.
Proposals
Proposes MCO Tax Budget Solution to Increase General Fund Offset. As part of the Governor’s package of proposed budget solutions intended to address the state’s budget problem, the Governor proposes to modify the recently enacted MCO tax package. The proposal, which would increase the General Fund offset by $4.6 billion from 2023‑24 through 2026‑27, is the result of two key actions, described further below.
Increases Size of MCO Tax.
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The 2024-25 Budget: Medi-Cal Analysis
Hospital outpatient services

Set rate for each procedure.

Generally not adjusted.

Inpatient services at UC and county hospitals

Cost‑based reimbursement.

Adjusted based on changes in cost.

Inpatient services at private and district hospitals

Global payment for each stay, based on patient diagnosis and acuity.

Set to maintain overall spending at around $3.2 billion total funds each year.

Services at federally qualified health centers

Rate for each visit, with rates tied to the average cost of care.

Adjusted using the Medicare Economic Index, a measure of medical cost inflation.

Long‑term care

Projected cost of care, including state mandated services.

Generally adjusted based on projected changes in cost.

Pharmacy

Cost to acquire drug and rate for dispensing drug.

Generally adjusted based on changes in drug acquisition costs.

Some Rates Are Adjusted Over Time, but Others Generally Have Remained Unchanged. Medi‑Cal takes different approaches to adjust fee‑for‑service rates for providers. For example, cost‑based payments are adjusted over time based on changes in actual or projected costs. By contrast, payments for physician and professional services tend to not be adjusted over time. Instead, these rates usually are set initially at 80 percent of the comparable rate paid by Medicare, a federal program that covers health care for the elderly and disabled. The rates then remain at their initially enacted levels, unless the Legislature explicitly provides funding for a rate increase.
Many Providers Receive Supplemental Payments. Over the years, the state has established supplemental payments in Medi‑Cal for certain providers. Sometimes these payments add to the base rate and therefore are allocated based on the relevant base payment methodology (such as utilization or reported costs.) In other cases, the approach is tied to other criteria. For example, some supplemental payments are tied to meeting certain performance outcomes, delivering high‑value services, or serving disproportionate numbers of Medi‑Cal or uninsured patients.
Medi‑Cal Uses Different Fund Sources to Support Base and Supplemental Payments. The cost of fee‑for‑service payments generally is shared by federal funds and state and local government sources.
Member Education - CalPERS
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