Navigating MediCal Part II


A very long and frustrating day.   And another day of learning.

After completing enrollment (with the help of a Covered California consultant) for Kaiser Managed Health Care plan, the MediCal ombudsman’s office was kind enough to agree to expedite the activation of the insurance once we faxed them a “permission letter” from Kaiser accepting his enrollment. Enrollment in KP is possible  because I (as an immediate family member) am already a Kaiser member.  Three different MediCal people I spoke with at different offices/departments told us the same thing.   It’s the only way KP will take MediCal managed care plans.  Very true …. BUT the MediCal beneficiary must be 21 or under …. no one we talked to at MediCal was aware of this.  We found this out when we were at KP to pick up the permission letter from the membership services folks.

Go straight back to square one.

It literally took us four hours to get back in touch with a real person on the phone at the ombudsman’s office.  Oh yes, this new person says …. that would be true.  Only “adults” under 21 can be covered ….  BUT my over 21 child IS fully covered on “regular” (or straight, depending on where you read it or who you talk to) MediCal – he can go to an urgent clinic or a doctor who takes “regular” and get an interim/emergency script for his meds until he gets in to see a psychiatrist through ACCESS, county mental health agency that will refer him to a psychiatrist for medication evaluation.  The,n simply go to a pharmacy that fills MediCal  prescriptions and he will get his meds FREE OF CHARGE! Isn’t that awesome?

GREAT!  That’s easy!  We then spent a minimum of two more hours trying to locate an urgent care clinic that takes “regular” or “straight” MediCal.  They don’t exist.  None of them accept regular MediCal.  There is a non-profit medical clinic downtown – but it’s neither a walk-in clinic or an urgent clinic – you go in, fill out paperwork and they will make an appointment for you.  When we talked to them on the phone about their recovery programs a few days ago, they weren’t even taking phone calls till May 16.

S0 tomorrow will be Day 3 – getting him enrolled in Anthem/Blue Cross MediCal Managed Care insurance after which he will be able to CHOOSE a doctor from the participating providers.  Hopefully I will be able to get BACK in touch with the ombudsman office so they can expedite his plan activation and we can get an appointment with a doctor early next week.

Unless, of course, we find another stone wall waiting around the corner.  I started working on this at 7:30 am this morning – it’s now 7:30 pm – I have just finished dinner – and that is about all I did today.  I am exhausted (didn’t sleep last night worrying about all this and finding a source for his meds and treatment – now going on 39 hours with no sleep) and have another day to go at least.

Don’t get me wrong, the MediCal people I have talked to have been awesome!  They have readily assisted me by expediting a process that under normal circumstances takes about two months.  I am truly grateful!

And it’s ok – I’d walk to the moon for my kids – he is participating and I want to keep him engaged in his recovery whatever it takes.

Namaste – today I honor all those souls who have no one to advocate for them and, as my hubby said tonight, it’s no wonder they live on the streets.

Itty Bitty

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3 thoughts on “Navigating MediCal Part II

    1. Julie, it’s showing signs of an upward trend for now – at least until the court thing rears it’s head. We are praying that by then he will have firmly established the need for long-term intensive mental health care rather than the alternative. Love to you – enjoy your “time out”!

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