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Health Insurance Plans: Medi-Cal

Medi-Cal is a program that offers health coverage for children and adults with limited income and resources. Find out if you qualify for Medi-Cal.

There are two common ways to receive Medi-Cal benefits:

Medi-Cal which is administered directly by the State. This is usually referred to as Medi-Cal Fee-For-Service (FFS) or traditional Medi-Cal.
Medi-Cal benefits which are administered by a third-party insurance plan that your county has chosen to administer those benefits for its residents. This is referred to as Medi-Cal HMO or Managed Medi-Cal.

Typically, once you sign up for Medi-Cal, you are enrolled in a traditional Medi-Cal FFS plan for the first 30 days, and then the state transitions you to one of the Managed Medi-Cal plans available in your county. Most counties in California are now using Managed Medi-Cal plans.

Medi-Cal HMO or Managed Medi-Cal Plan Options

Stanford Health Care is in-network with the following Medi-Cal options.

Medi-Cal Fee-For-Service/Traditional Medi-Cal

Stanford Health Care accepts Medi-Cal Fee-For-Service for hospital and physician services.

Central California Alliance for Health

Stanford Health Care is in-network for hospital and specialist physician services only. You would not be able to select a Stanford Health Care physician as your primary care physician.

In order to be seen at Stanford Health Care, your primary care physician would need to refer you and your medical group or health plan would need to authorize all services provided at Stanford Health Care or by Stanford Health Care physicians.

Contra Costa Health Plan

Stanford Health Care is in-network for hospital and specialist physician services only. You would not be able to select a Stanford Health Care physician as your primary care physician.

In order to be seen at Stanford Health Care, your primary care physician would need to refer you and your medical group or health plan would need to authorize all services provided at Stanford Health Care or by Stanford Health Care physicians.

Health Plan of San Mateo

Stanford Health Care is in-network for hospital and specialist physician services only. You would not be able to select a Stanford Health Care physician as your primary care physician.

In order to be seen at Stanford Health Care, your primary care physician would need to refer you and your medical group or health plan would need to authorize all services provided at Stanford Health Care or by Stanford Health Care physicians.

Partnership Health Plan

Stanford Health Care is in-network for hospital and specialist physician services only. You would not be able to select a Stanford Health Care physician as your primary care physician.

In order to be seen at Stanford Health Care, your primary care physician would need to refer you and your medical group or health plan would need to authorize all services provided at Stanford Health Care or by Stanford Health Care physicians.

Santa Clara Family Health Plan

Stanford Health Care is in-network for hospital and specialist physician services only. You would not be able to select a Stanford Health Care physician as your primary care physician.

In order to be seen at Stanford Health Care, your primary care physician would need to refer you and your medical group or health plan would need to authorize all services provided at Stanford Health Care or by Stanford Health Care physicians.

All Other Managed Medi-Cal Plans (including Medicaid plans from other states)

If your Medi-Cal plan is not included on the list of in-network plans, that means that Stanford Health Care does not have a contract with your plan. Some Medi-Cal/Medicaid plans are willing to authorize treatment on a case by case basis. It is recommended that you work with your primary care physician to obtain a referral/authorization for treatment at Stanford Health Care. Once your health plan has authorized the care, they will reach out to Stanford Health Care to negotiate a single case agreement with our Managed Care Department.

QUICKLINKS

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Patient Rights and Protections

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Protections Against Surprise Medical Bills (No Surprises Act)

Access More From MyHealth (CURES Act)

Resources

How to Read Your Bill

Billing Process Explained

Tips for Organizing Your Bill

Billing Glossary

Billing FAQs

Insurance FAQs

Guide to Understanding Healthcare Prices

Insurance Glossary

NPI and Tax ID

Assess Your Coverage

Determine the extent of your coverage or any out-of-pocket costs before you receive care.

Contact: Financial Counseling
Phone: 650-498-2900
Mon. – Fri., 8 a.m. – 5 p.m.

Insurance Pre-Authorization

Find out if your insurance carrier has pre-authorized a medical service before you receive care.

Contact: Financial Clearance
Phone: 650-724-4445

Toll Free: 1-877-291-7335