UnitedHealthcare Community Plan of California Medi-Cal

Care Manager

Do you have a serious health problem? If so, our case managers are in your corner. They will:

• Explain medical terms in plain language.
• Coordinate your doctor appointments.
• Provide your care team with your medical records.

The care manager will stay with you throughout your medical journey. He or she will:

• Think beyond your medical needs.
• Make sure you have support at home.

 

Choice of Doctor

Each member can choose a primary care physician (PCP). Use the “Doctor Lookup” tool to see if your doctor is in our network. 

Your PCP is your main doctor for:

• Preventive care.
• Treatment if you are sick or injured.
• Referrals to specialists for certain conditions.

For members who don’t have a doctor or whose doctor is not in our network, we can help find a new one close by.  

Diabetes Prevention Program

Diabetes Prevention Program is a covered benefit offered to our eligible members designed to assist in preventing or delaying the onset of Type 2 Diabetes by making lifestyle changes.

UnitedHealthcare Community Plan is pleased to offer a healthy lifestyle program at no cost to qualified members. The program can help you make small changes to live a healthy life, lose weight and lower your chance of developing type 2 diabetes.

To see if you qualify:

• Take a 1-minute quiz at solera4me.com/UHC.
  
• Or call 1-888-305-6015, TTY 711, Monday - Friday, 6 a.m. - 6 p.m. PT. 

Disease Management

If you have chronic or high-risk illnesses, our disease management services are designed to support you.

We have special programs for:

• Chronic obstructive pulmonary disease (COPD)
• Coronary artery disease (CAD)
• Congestive heart failure (CHF)
• Diabetes
• High Risk Pregnancy and Neonatal Intensive Care Unit
• Sickle Cell Disease

 

 

Equipment and Supplies

Some members may need extra support to live safely at home.

Our plan covers medical equipment ordered by a member's doctor or care manager. This can include supplies like:

• Oxygen tanks.
• Walkers or wheelchairs.

Foot Care

We provide the exams needed to help keep feet in great shape. And for those with diabetes, good foot care can help prevent much more serious problems.

Our podiatry coverage includes:

• Routine foot exams.
• Tips about foot care and choosing the right shoes.
• Information about nerve damage warning signs.

 

Health Homes Program (HHP)

UnitedHealthcare Community Plan of California covers Health Homes Program (HHP) services for Members with certain chronic health conditions. These services are to help coordinate physical health services, behavioral health services, and community-based long term services and supports (LTSS) for Members with chronic conditions.

You may be contacted if you qualify for the program. You can also call UnitedHealthcare Community Plan of California, or talk to your doctor or clinic staff, to find out if you can receive HHP services.

You may qualify for HHP if:

• You have certain chronic health conditions. You can call UnitedHealthcare Community Plan of California, to find out the conditions that qualify; and
• You meet one of the following:
  • You have three or more of the HHP eligible chronic conditions;
  • You stayed in the hospital in the last year;
  • You visited the emergency department three or more times in the last year; or
  • You do not have a place to live.

You do not qualify to receive HHP services if:

• You receive hospice services; or
• You have been residing in a skilled nursing facility for longer than the month of admission and the following month.

Covered HHP Services:

HHP will give you a care coordinator and care team that will work with you and your health care providers, such as your doctors, specialists, pharmacists, case managers, and others, to coordinate your care. UnitedHealthcare Community Plan of California provides HHP services, which include:

• Comprehensive Care Management
• Care Coordination
• Health Promotion
• Comprehensive Transitional Care
• Individual and Family Support Services
• Referral to Community and Social Supports

Cost to Member:

There is no cost to the Member for HHP services.

Healthy First Steps®

Build a healthy future for you and your baby and earn great rewards with Healthy First Steps. Our program will help you take the right steps to keep you and your baby healthy. Plus you can earn $20 just for signing up. 

We will help you:

• Choose a pregnancy provider and a pediatrician (child’s doctor).
• Schedule visits and exams and arrange rides to your visits.
• Earn rewards for going to visits throughout your pregnancy and baby’s first 15 months of life.
• Get supplies, including breast pumps for nursing moms.
• Connect with community resources such as Women, Infants and Children (WIC) services.

Home Health Care

After surgery or a serious illness, you may need extra help with day-to-day tasks. You may even need an in-home medical visit to check on how well you are healing. With approval from your doctor, our plan covers:

• In-home medical visits.
• Medical equipment like hospital beds, walkers or wheelchairs.
• Disposable medical supplies.
• Help with personal care.

Hospitalization

This plan pays for all expenses related to a hospital stay - the member will never be changed. Our plan covers:

• Room and board.
• Supplies and equipment.
• Treatment and therapies.  
• Diagnostic tests and exams.

And after leaving the hospital, you are not alone. We make sure the follow-up care is available to continue healing at home.

Interpreters

UnitedHealthcare offers services to help you talk with your doctor or other health care workers. You can get this service if you do not speak English or have hearing and speech barriers. You do not need a referral from your doctor to get these services.

Interpreter services are offered free of charge.

Labs and X-Rays

Knowing what’s wrong and finding it early can make all the difference. Our plan covers:

• Labs and testing.
• X-rays, scans and other imaging.

We’ll help you get the information needed to improve your health or be at your best.

Language Help

You may be able to receive information in your preferred language or format, including Braille. Just ask. We also have people at our member service centers who speak more than one language. Chances are, we have someone who speaks your language. All languages required by the State of California are covered, plus more.

Medicines

Prescriptions and certain over-the-counter items are covered by our plan.

You may receive a prescription from a UnitedHealthcare doctor or specialist. You can fill your prescription at any UnitedHealthcare contracted pharmacy. Just show your State Benefit Identification Card (BIC) and your UnitedHealthcare Identification card to the pharmacy when you get your prescriptions filled. 

Member Advocates

We’re looking out for you. Our local member advocates can help solve problems, provide training and education, and work on issues that concern you.

They can:

• Answer your questions about your benefits.
• Help with doctor issues or complaints.
• Help you clarify your health care benefits.

Member Services

Sometimes you might need a little help understanding your health care options. With us, you have someone you can call. We’ll answer your questions simply and completely.

We can also help you find:

• Find a doctor.
• Change your primary care physician.
• Questions on benefits.

Just call 1-866-270-5785, TTY: 711 Monday - Friday, 7:00 am – 7:00 pm PT.

 

No Copays

You pay nothing for covered services.

While your health care is low-cost or free, the care quality is high. You get: 

• Care from highly skilled and compassionate doctors.
• Treatments at respected hospitals and clinics.
• Prescription drugs and over-the-counter medicines.

On My Way

UnitedHealthcare OMW™ (On My Way) is a mobile-friendly website aimed at helping young adults through the process of transitioning into adulthood. This interactive website also makes it fun to learn as you go. Register at www.uhcomw.com and begin the journey.

Outpatient Mental Health

Mental Health is as important as physical health. That’s why we have coverage for both.

Mental Health Screening:

• A mental health screening will be completed to determine if you are in mild or moderate distress or have acute impairment of mental, emotional or behavioral functioning.
• This screening can be completed by a PCP, UnitedHealthcare Community Plan of California, Inc. or county mental health plan.
  

Outpatient Mental Health Services- Covered by UnitedHealthcare Community Plan of California:

• If your mental health screening results determine you are in mild to moderate distress, UnitedHealthcare Community Plan of California covers the following outpatient mental health services:
  • Outpatient mental health services
  • Individual and group mental health evaluation and treatment (psychotherapy)
  • Psychological testing when clinically indicated to evaluate a mental health condition
    Psychiatric consultation for medical management
  • Screening and Brief Intervention (SBI)
  • Outpatient laboratory, supplies and supplements
  • Drugs (excluding anti-psychotic drugs which are covered by Medi-Cal fee-for-service)
  • Family Counseling
  • Neuro behavioral testing
  • Neuro psychological testing
• Outpatient mental health services do not require a referral from your PCP.
• For help finding more information on mental health services provided by UnitedHealthcare Community Plan of California, Inc., call 1-866-270-5785, TTY 711.

Specialty Mental Health Services- Covered by County Mental Health Plan

• If your mental health screening results determine you have acute impairment of mental, emotional or behavioral functioning, you may be eligible for specialty mental health services.
• Your PCP or UnitedHealthcare Community Plan of California, Inc. can refer you to the county mental health plan to receive an assessment.
• County mental health plans cover specialty mental health services for Medi-Cal beneficiaries who meet criteria.
• Specialty mental health services may include the following inpatient and outpatient services:
  • Outpatient specialty mental health services:
    • Mental health services (assessments, plan development, therapy, rehabilitation, and collateral)
    • Medication support services
    • Day treatment intensive services
    • Day rehabilitation services
    • Crisis intervention services
    • Crisis stabilization services
    • Targeted case management services
    • Therapeutic behavioral services
    • Intensive care coordination (ICC)
    • Intensive home-based services (IHBS)
    • Therapeutic foster care (TFC)
  • Residential services:
    • Adult residental treatment services
    • Crisis residental treatment services
  • Inpatient services:
    • Acute psychiatric inpatient hospital services.
    • Psychiatric inpatient hospital professional services.
    • Psychiatric health facility services.

• For help finding more information on specialty mental health services provided by the county mental health plan, call the county at 1-888-724-7240.

Personal Care

Sometimes the basics are hard to do yourself after an illness or injury. If needed, we provide help with:

• Dressing.
• Bathing.
• Feeding.

Prenatal Visits

Your pregnancy is a journey you'll want to make with the help of friends, family and a pregnancy doctor, or OB-GYN. 

All recommended prenatal clinical visits and tests are covered by our plan.

At these visits, the clinic will:

• Make sure both you and your baby are healthy.
• Explain what to expect at each stage of your pregnancy.
• Answer your questions.

Quitting Tobacco

Most people know the bad health effects of smoking. And they know they need to quit. We support our members to help them quit. The only thing they won’t get from us is a lecture.

Text4Baby

Text4baby can help new and expecting mothers keep themselves and their babies healthy.

You’ll get text messages each week throughout your pregnancy and your baby’s first year. Each text contains health and safety tips for topics like:

Prenatal care.

Labor and delivery.

Breastfeeding.

Safe sleep.

Nutrition.

Car seat safety.

So you and your baby can make a great start on life.

Therapy Services

Physical, occupational and speech therapy can help members recover from a serious injury or illness, or simply reach their full potential.
Our plan covers limited visits for:

• Occupational therapy.
• Physical therapy.
• Speech therapy.
• In-home therapy.

Transportation

• Members can schedule a ride at 844-772-6623
• Hours: Monday - Friday, 7 a.m. – 7 p.m.
• TTY 711 or 844-488-9724
• Website: http://bit.ly/uhc-ca-members

Rides can be scheduled at least 30 days in advance, and no later than 3 business days before your appointment. Scheduling your ride at least 3 business days in advance will help you to have the best experience. Urgent care and other urgent types of trips, like dialysis or chemotherapy, can be scheduled on the same day.

Members can get round trip transportation to and from health care locations as needed, including rides to:  

• Doctor or therapy visits
• Pickup prescription drugs that cannot be mailed directly to the member
• Pickup medical supplies, prosthetics, orthotics and other equipment
• Specialty mental health services
• Substance use disorder services
• Dental and any other benefits covered through Medi-Cal  

Vision Services

The plan covers: 

• Routine eye exam once every 24 months; UnitedHealthcare Community Plan of California, Inc. 
  may pre-approve (prior authorization) additional services as medically necessary. 
• Eyeglasses (frames and lens) once every 24 months; contact lens when required for medical 
  conditions such as aphakia, aniridia and keratoconus. 

Well Visits

Well visits with your doctor can help keep you and your family healthy. These visits can catch health problems early, so they can be treated. Preventive services include:

Checkups for adults and children.

Well-baby care.

Care for women expecting a baby.

Routine shots and tests.

Mammograms.