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UnitedHealthcare Community Plan of California Medi-Cal

Medicaid

UnitedHealthcare Community Plan of California includes a range of benefits. Children, pregnant women, families, adults and seniors and people with disabilities may qualify based on income. View the benefits below to see what our plan covers.

If you have Medi-Cal benefits, your coverage will need to be renewed every year. The county will send you a Medi-Cal renewal form. Complete this form and return it to your local county human services agency. You can also visit or call your local human services agency. To find an office near you, visit the San Diego Health & Human Service Agency website.

If you lose Medi-Cal coverage, you may enroll in health insurance coverage through Covered California in the special-enrollment period due to a loss of coverage.

Has your contact information changed in the past two years? Give your county office your updated contact information so you can stay enrolled. Find your local county office.

Benefits & Features

Well and Sick Care

Get the assistance you need to be at your best — or to get better if you are injured or sick. That includes:

  • Well Visits. Annual checkups to help keep you healthy. 
  • Choice of Doctor. Find a doctor you trust in our network. 
  • Shots and Vaccines. Routine shots to help protect against illness. 
  • Urgent Care. Convenient care for a sudden illness or injury. 
  • NurseLine. Speak with a registered nurse 24/7. Call 1-866-270-5785.
  • Lab and X-Rays. Lab tests, x-rays and diagnostic imaging are covered. 

Nothing is more important than the health and well-being of a mother and your baby. That's why our plan benefits include:

  • Choice of Doctor. Find a doctor or OB/GYN you trust in our network. 
  • Prenatal Visits. Care for you before your baby is born.
  • Healthy First Steps®. Get extra support and rewards to keep you and your baby healthy.
  • Text4Baby. Receive text messages with helpful tips and reminders.

Medical questions and situations sometimes happen at inconvenient times. When you have questions about your health, you can call a nurse 24 hours a day, 7 days a week: 1-855-366-5032.

Our NurseLine will:

  • Listen to the symptoms.
  • Help with self-care.
  • Advise you about getting care at a doctor visit or an urgent care center.
  • Help you know when to go to the emergency room.

If you have a life threatening emergency, go immediately to the emergency room or call 911.

If you have asthma, diabetes or another long-term condition, you can depend on us. Our plan makes sure you get the care and services you need. Benefits include:

  • Care Manager. If you qualify, get personal help managing health conditions. 
  • Disease Management. Focused care for those with chronic health needs, like asthma and diabetes. 
  • Mental Health. Counseling and other treatments are covered. 
  • Residential Care. Brief stay at a care facility while you recover from sickness or injury.

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. 

If you are recovering from a serious illness or surgery, you may need extra support. Our plan includes the care and equipment needed to recover safely at home. Some benefits include:

  • Equipment and Supplies. In-home medical and safety equipment. 
  • Home Health Care. Medical and personal care in your home, if medically needed.

Sometimes members need a little extra help using their health plan. For those times, you can rely on:

  • Transportation. Get rides to and from doctor appointments and more. 
  • Language Help. Translated materials and interpreters who are ready to help you 24/7. 
  • Member Services. Available 7 a.m. to 7 p.m. PT, Monday – Friday. 
  • Member Advocate. Local advocates to get you information, services and care. 
  • NurseLine℠. Speak with a registered nurse 24/7. Call 1-866-270-5785.


UnitedHealthcare Community Plan of California, Inc. has health education programs, services and materials to help you improve your health and manage illness at no cost to you. 

  • Health Education Resource Library: Many of the materials are offered in different languages and/or in formats for the hard of hearing and visually impaired.
  • Health Education Classes: UnitedHealthcare is partnering with Champions for Health to sponsor virtual health education classes about multiple topics such as Chair Yoga, Childhood Health, Cooking Demo, Women’s Health, and Diabetes. The classes will be offered to our members and the community at no cost in English and Spanish.

To enroll in a class, download the Health Education Class Schedule in English or Spanish or visit championsforhealth.org/virtual-health-education-classes to register.
For questions about our health education programs, please call 866-782-2037 or email uhchealthed@uhc.com.

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.  

Community supports

California Advancing and Innovating Medi-Cal (CalAIM) establishes the framework to address social determinants of health and improve health equity statewide.

A key feature of CalAIM is the introduction of a menu of in lieu of Community Supports.

What Are Community Supports?
Community Supports are services or settings that the Plan may offer in place of services or settings covered under the California Medicaid State Plan and that are medically appropriate, cost-effective alternatives to a State Plan covered service.
Community Supports are optional for the Plan to offer and for Members to utilize. The Plan will not require Members to use Community Supports instead of a service or setting.

Community Supports that may be offered are:

  • Housing Transition and Navigation Services
  • Housing Deposits
  • Housing Tenancy and Sustaining Services
  • Short-Term Post-Hospitalization Housing
  • Recuperative Care (Medical Respite)
  • Respite Services
  • Medically Supportive Food/ Meals/Medically Tailored Meals
  • Sobering Centers

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:

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

 

 

Enhanced Care Management

UnitedHealthcare Community Plan of California, Inc. covers Enhanced Care Management (ECM) services for members with highly complex needs. ECM is a benefit that provides extra services to help you get the care you need to stay healthy. It coordinates the care you get from different doctors. ECM helps coordinate primary care, acute care, behavioral health, developmental, oral health, community-based long-term services and supports (LTSS), and referrals to available community resources.

If you qualify, you may be contacted about ECM services. You can also call UnitedHealthcare Community Plan of California, Inc. to find out if and when you can receive ECM. Or talk to your health care provider who can find out if you qualify for ECM and when and how you can receive it.

Covered ECM services

If you qualify for ECM, you will have your own care team, including a care coordinator. This person will talk to you and your doctors, specialists, pharmacists, case managers, social services providers and others to make sure everyone works together to get you the care you need. A care coordinator can also help you find and apply for other services in your community. ECM includes:

  • Outreach and engagement
  • Comprehensive assessment and care management
  • Enhanced coordination of care
  • Health promotion
  • Comprehensive transitional care
  • Member and family support services
  • Coordination and referral to community and social supports

To find out if ECM may be right for you, talk to your UnitedHealthcare Community Plan of California, Inc. representative or health care provider. 

Call Member Services at 1-866-270-5785 (TTY 711).

UnitedHealthcare Community Plan of California, Inc. is here 7:00 a.m. to 7:00 p.m. PST, Monday through Friday, except State holidays. The call is toll free. Or call the California Relay Line at 711. Visit online at myuhc.com/CommunityPlan.

 

 

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.

 

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

    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.
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