vania-janet/multiturn-rag-retrieval-data huggingface dataset:
Office of the Patient Advocate - State of California


This page tells you about common kinds of health coverage.
 
Public Programs
Many Californians have health care benefits supported or administered by a federal, state, or local government program. Public supported health care coverage programs include:

Medi-Cal is health insurance for people with low incomes. Most people with Medi-Cal have Managed Care plans, which are like HMOs. You can apply for Medi-Cal through the BenefitsCal website.
Covered California is a marketplace where Californians can choose a health plan and often are eligible to receive federal tax credits to help pay the premium. Covered California plans are primarily HMOs, PPOs, and EPOs.
Medicare is the federal health insurance program for people who are 65 and older, and for some people under 65 who have a disability. Medicare Advantage plans are usually HMOs or PPOs. Traditional Medicare (or Original Medicare) is more like fee-for-service health insurance.
Veterans health benefits are available to many people who served in the U.S. armed forces or were called to active duty in the Reserves or National Guard. Benefits are also available to some family members of certain eligible veterans.

 
Kinds of Insurance Plans
Most Californians have an HMO, PPO, or EPO. Some Californians have a fee-for-service plan, but that is less common.

An HMO (health maintenance organization) has a network. These are the doctors, hospitals, labs, and other providers in the plan. You must get your care from these providers. Learn more about HMOs.
A PPO (preferred provider organization) also has a network. You usually have more choice of providers in a PPO. Learn more about PPOs.
An EPO (exclusive provider organization) also has a network similar to an HMO. Similar to a PPO, you can usually go to a provider without a referral from your main doctor.
Fee-for-service insurance (indemnity insurance) usually costs more than HMOs and PPOs, but it gives you the most choice of doctors. Usually, you pay part of each bill, and the doctor bills your insurance company for the rest.

High-deductible health plans
Office of the Patient Advocate - State of California


If you have original (fee-for-service) Medi-Cal, you can contact your local county office if you have a problem and want to request a Medi-Cal Fair Hearing. To learn more, see the Medi-Cal Fair Hearings section below.
If you have a Medi-Cal Managed Care plan, you can contact the Medi-Cal Managed Care Ombudsman or DMHC if you have a problem with your health plan.
Medi-Cal Managed Care Complaints
All Medi-Cal health plans have a customer/member service office you can call for help. Look on your membership card for the telephone number for your plan. Your health plan member services can often help with a problem before you need to file a formal complaint.

You have the right to file a formal complaint with your health plan.
Call your plan and file a complaint over the phone or in writing. A complaint is also called a grievance.  Your plan must give you a decision within 30 days, or in 3 days if you have an urgent medical issue.
If you are not satisfied with your plan’s decision, or the plan does not meet the deadline for giving you a decision, file a complaint with the state.  You have 2 ways to do this:

Ask for a Medi-Cal Fair Hearing. This is a review of your problem by the state. To learn more, see the next section below.
File a complaint or ask for an Independent Medical Review through the Department of Managed Health Care (DMHC) Help Center. Call
1-888-466-2219 or go to www.healthhelp.ca.gov.

Please note: If you file a complaint with the DMHC Help Center and are not satisfied with the results, you can still ask for a Medi-Cal Fair Hearing. However, if you ask for the Medi-Cal Fair Hearing first, you cannot file a complaint with the DMHC Help Center.
Medi-Cal Fair Hearings
This is sometimes called a State Fair Hearing. You can apply for a fair hearing whether you have original (fee-for-service) Medi-Cal or are in a Medi-Cal Managed Care health plan.
Office of the Patient Advocate - State of California


1-855-501-3077
(Cal MediConnect Ombudsman)
http://calduals.org

Covered California
California’s marketplace for finding health insurance coverage.
1-800-300-1506
www.coveredca.com

Medi-Cal
No-cost to low-cost health insurance. California’s Medicaid program.

Contact your local county office for
Medi-Cal issues.
You can reach the Medi-Cal Managed Care Ombudsman at 1-888-452-8609.
 

www.dhcs.ca.gov/services/medi-cal

Medi-Cal Access Program
(formerly Access for Infants & Mothers – AIM)
Low-cost health insurance for pregnant women with low and middle incomes.
 
1-800-433-2611
 
mcap.dhcs.ca.gov

Medi-Cal Managed Care
Additional help is available to Medi-Cal beneficiaries in a managed care plan.
1-888-452-8609 (Medi-Cal Managed Care Ombudsman)
1-800-430-4263 (Health Care Options)
 

www.dhcs.ca.gov/services/medi-cal

Medicare
Federal health insurance program for people aged 65 and older, people with disabilities, and people with end-stage renal disease.
1-800-434-0222 (HICAP – Help with Medicare issues)
1-800-633-4227
(Medicare – Beneficiary information)
1-877-588-1123
(Livanta – File a discharge appeal or complaint about quality of care)
 
 

www.medicare.gov

Major Risk Medical Insurance Program (MRMIP)
State insurance program for people with pre-existing conditions.
1-800-289-6574
  www/dhcs.ca.gov/Pages/MajorRiskMedicalInsuranceProgram

U.S. Department of Veterans Affairs
Provides health care benefits to men and women who have served in the U.S. armed forces.
Office of the Patient Advocate - State of California


There is a time limit. You must ask for the hearing within 90 days of the action by the county, state agency, or Covered California. (This is often the mailing date of the Notice of Action).
To learn more, visit the Department of Health Care Services website and the Department of Social Services website.

Cal MediConnect
Cal MediConnect is a program in eight counties for people with both Medicare and Medi-Cal. If you have a problem with your services or a Cal MediConnect plan, you can get help from the Cal MediConnect Ombudsman program.

To reach Cal MediConnect Ombudsman services, call 855-501-3077.
Visit the Calduals.org website for more information and office locations.

More Information and Help with Medi-Cal

Check out the Medi-Cal website.
If you need help applying for low-cost coverage programs such as Medi-Cal visit www.coveredca.com or contact Covered California at
1-800-300-1506.
If you have a Medi-Cal Managed Care plan, you can call the Medi-Cal Managed Care Ombudsman at 1-888-452-8609 for guidance about how to address a problem or complaint. The office is open 8am-5pm/ Monday to Friday.
If you want help selecting a Medi-Cal Managed Care health plan or want to enroll in a new plan, you can call 1-800-430-4263.
You can also contact local consumer assistance organizations on our local resources page.

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Testing Options | Sierra County, CA - Official Website
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HomeCounty DepartmentsPublic HealthCommunicable DiseaseCoronavirus (COVID-19)Testing Options 



Testing Options 	

Residential households in the U.S. can order one set of #4 FREE at-home tests from USPS.com. Here's what you need to know about your order:Limit of one order per residential addressOne order includes #4 individual rapid antigen COVID-19 tests (COVID.gov/tests has more details about at-home tests, including extended shelf life and updated expiration dates)Have Medi-Cal? Follow these steps to receive free tests.

 
 

MyTurn.ca.gov to find testing
 
 
 
 
 

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Below are facilities offering testing in or near Sierra County. Many clinics offer Drive-Thru Testing options.Eastern Plumas Health Care (Loyalton) - (530) 993-1231Monday thru Thursday by appointmentEastern Plumas Health Care (Portola)- (530) 832-6600 Monday thru Friday by appointmentPlumas District Hospital (Quincy) - (530) 283-5640Sierra Nevada Medical Center (Grass Valley) - (530) 274-6000Tahoe Forest Hospital (Truckee) - (530) 582-3450 Western Sierra Medical Clinic (Downieville) - (530) 274-9762Find Testing Near You Search Tools in California and Nevada

 
 
 

FAQs about payment for COVID-19 testing:1. Must health plans cover COVID-19 testing? Yes. Health plans must cover COVID-19 tests that are FDA approved or authorized, or approved by the state, without prior authorization and at no cost to the enrollee. This includes follow-up (serial/sequential) tests. This requirement applies to such tests administered by a skilled nursing facility.  Biden-Harris Administration Requires Insurance Companies and Group Health Plans to Cover the Cost of At-Home COVID-19 Tests, Increasing Access to Free Tests (January 10, 2022)2.
Office of the Patient Advocate - State of California


If you have recently experienced a major life change, you still may be able to sign up. Qualifying events include the loss of health coverage through a job, the birth of a child, and other life-changing events. Learn more
If you are eligible for Medi-Cal, you can sign up at any time of the year.
Usually if the ​open enrollment period is closed and you have not experienced a qualifying event, the next time you can sign up for a Covered California plan would be during the next open enrollment period.

Covered California Service Center
Main Phone Number: 1-800-300-1506
TTY/TDD:1-800-889-4500
Other Phone Numbers:
العربية (Arabic)  1-800-826-6317
Հայերեն (Armenian)  1-800-996-1009
中文 (Chinese) 1-800-300-1533
فارسی (Farsi)  1-800-921-8879
Tagalog (Filipino) 1-800-983-8816
Hmoob (Hmong)  1-800-771-2156
Khmer  1-800-906-8528
한국어 (Korean)  1-800-738-9116
Lao  1-800-357-7976
ру́сский (Russian)  1-800-778-7695
Español (Spanish) 1-800-300-0213
Tiếng Việt (Vietnamese) 1-800-652-9528
Hours of operation: Monday-Friday, 8:00 a.m. – 6:00 p.m. (except state holidays)
Extended hours during peak enrollment season (open until 8:00 p.m. Monday-Friday and 8:00 a.m. to 6:00 p.m. on Saturday)
Website: www.coveredca.com

Complaint Data Highlights
The highlights below are based on information Covered California reported to OPA about its consumer assistance service center and about its 2020 State Fair Hearings.
The 2024-25 Budget: Medi-Cal Analysis
Health care services covered by Medi‑Cal include visits to the doctor’s office, stays at the hospital, prescription drugs, behavioral health services, long‑term care, and dental services, among many other areas. The Governor’s budget assumes an average monthly Medi‑Cal caseload level of 14.8 million in 2023‑24, over one‑third of Californians.
Medi‑Cal Is a Sizable Portion of California’s Budget. More than half of Medi‑Cal’s budget is supported by federal funds, with the remainder supported by the General Fund and other state and local government sources. The General Fund portion of Medi‑Cal comprises a sizable share of overall state General Fund spending, ranging between 13 percent and 17 percent in most of the last ten years. As a share of General Fund spending, Medi‑Cal is the state budget’s second largest program (after Proposition 98 [1988], the California Constitution’s minimum spending requirement for K‑14 education).
Medi‑Cal Delivers Services in Many Ways. The primary way Medi‑Cal delivers services to beneficiaries is by contracting with health insurance plans, also known as managed care plans. The state provides managed care plans monthly payments to enroll Medi‑Cal beneficiaries, while the plans in turn are required to arrange for the health care of their enrollees. While most services are delivered in the managed care system, some are delivered in other ways. For example, Medi‑Cal pays for some health care services, such as pharmacy benefits, by reimbursing providers directly—known as the “fee‑for‑service” delivery system. County governments also play a key role in delivering certain services, particularly behavioral health care.
Overall Budget Picture
Overall Spending Is Up Over Enacted Level. As Figure 1 shows, the Governor’s budget estimates overall Medi‑Cal spending to be $157 billion in 2023‑24, up from $152 billion at budget enactment. Overall spending in 2024‑25 is projected to decline slightly from the revised 2023‑24 level.

Figure 1
Governor’s Budget Projects Growth in Overall Spending Over Enacted Level
Medi‑Cal Budget (Dollars in Billions)

2023‑24
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It is an objective of the State of California to achieve a drug-free State work place. Any applicant for State employment will be expected to behave in accordance with this objective, because the use of illegal drugs is inconsistent with the law of the State, the rules governing civil service, and the special trust placed in public servants.

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Examination and/or Employment Application (STD 678) forms are available at the California Department of Human Resources, local offices of the Employment Development Department, and through your CalCareer Account (www.CalCareers.ca.gov). If you meet the requirements stated on this examination bulletin, you may take this examination, which is competitive. Possession of the entrance requirements does not assure a place on the eligible list. Your performance in the examination described in this bulletin will be rated against a predetermined job-related rating, and all applicants who pass will be ranked according to their scores. State Air Resources Board reserves the right to revise the examination plan to better meet the needs of the service, if the circumstances under which this examination was planned change.
The 2024-25 Budget: Medi-Cal Analysis
The 2024-25 Budget: Medi-Cal Analysis

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Brief
February 14, 2024

The 2024‑25 Budget
Medi-Cal Analysis

Introduction
Overview
Caseload
MCO Tax Budget Solution
MCO Tax‑Funded Provider Payment Increases
Other Budget Solutions

Summary
Under Governor’s Budget, Budget Solutions Help Reduce General Fund Spending on Medi‑Cal. The Governor’s budget includes $35.9 billion General Fund spending in 2024‑25 on Medi‑Cal, the state’s Medicaid program. This amount reflects a $1.4 billion (3.8 percent) reduction from the previous‑year level. The net decline in General Fund spending primarily is driven by a series of proposed fund shifts, delays, and reductions to help address the state’s budget problem. Absent these proposals, spending in Medi‑Cal would grow by $1.3 billion in 2024‑25 under the Governor’s budget.
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The 2024-25 Budget: Medi-Cal Analysis
The Governor proposes to reduce General Fund spending on an existing supplemental payment program for physician services. The program was established in the 2017‑18 Budget Act and originally supported entirely by Proposition 56 (2016) revenues. Since then, Proposition 56 revenues have declined, resulting in the General Fund backfilling a portion of the program’s costs. The administration states that the reduction in General Fund spending would be more than offset by increased funding for physician payments in the proposed MCO tax package. (We provide more information on this package in the “MCO Tax‑Funded Provider Payment Increases” section.)
Reverts Unspent Funds for Clinic Workforce Retention Payments. The Governor proposes to revert back to the General Fund unspent funds from a one‑time retention payment initiative. The initiative, which was focused on clinic workers, initially received $70 million General Fund in 2022‑23. Under current law, any unspent funds would transfer to the Department of Health Care Access and Information for workforce initiatives. The administration instead proposes to revert the unspent funds, which total $15 million. (The 2022‑23 budget also provided $1.1 billion in California Emergency Relief Fund for retention payments to hospital and skilled nursing facility workers. The Governor also proposes reverting $57 million unspent funds for this initiative, which ultimately would revert to the General Fund.)
Assessment and Recommendations
Given Fiscal Constraints, Proposed Budget Solutions Are Warranted. Given the substantial budget problem facing the state, the Governor’s proposed Medi‑Cal budget solutions are warranted. The proposed budget solutions are reasonable, as they focus primarily on one‑time actions that would not disrupt or reduce the core Medi‑Cal program. We therefore recommend adopting the Governor’s other proposed budget solutions in Medi‑Cal as a starting point.
Reductions, Rather Than Delays, May Be More Reflective of the Budget Situation. A number of the Governor’s proposed budget solutions, particularly in Medi‑Cal, are delays of limited‑term spending. While these solutions are warranted to address the current budget problem, we estimate that the state is likely to face significant operating deficits in the coming years.
Top 7 Member Questions Answered by Our Experts - CalPERS PERSpective
Our Using myCalPERS guide helps you take advantage of this platform, as well as resolve issues related to logging in, registering, recovering a username, and more.
You also have access to a series of videos for both active and inactive members, as well as retirees, beneficiaries and survivors. Use these tools to get the most from your myCalPERS account.
4. How Do I Take Advantage of Health Benefits into Retirement?
One of the biggest benefits to your CalPERS membership is the health benefits available to retirees. To be sure you’re eligible for a CalPERS-administered health plan as a retiree, you must meet all the following criteria:

Be eligible for health coverage upon separation of employment
Retire from an employer that contracts with CalPERS for health benefits
Receive a monthly CalPERS retirement allowance
Retire within 120 days of the date of your separation of employment

Explore page 20 of our Planning Your Service Retirement (PDF) guide for further information on how health benefits are applied in your retirement. For more resources on coordinating CalPERS health coverage with Medicare, you can access our CalPERS Medicare Enrollment Guide (PDF).
5. What Is Dependent Eligibility Verification and How Does it Work?
Dependent Eligibility Verification (DEV) is the process of reverifying the eligibility of a member’s dependents who are receiving health coverage through them. These can include your:

Spouse
Domestic partner
Children or stepchildren
Domestic partner’s dependents enrolled in our medical or dental benefits

The eligibility of any dependents you claim will be reverified every three years, with cycles determined by the member’s birthdate. You can visit our Dependent Eligibility Verification page for more details on required documents and your Dependent Verification Affidavit form.
If you’re retired, materials may be submitted electronically through your myCalPERS account. Additional information is also available on page 8 of our CalPERS Health Program Guide (PDF).
6. Is December 31 the Best Day to Retire?
Your service retirement is often one of the most important decisions of your life. Key considerations include when to retire, your retirement lifestyle, and how much it will cost.