What is Medi-Cal?
Medi-Cal is a no-cost or low-cost health coverage program that provides health, dental* and vision** coverage to qualified low-income California residents.
Who Can Apply for Medi-Cal and Join IEHP?
- People who live in our service area (most of Riverside and San Bernardino County)
- People who are adults with or without children, children, seniors and people with disability
- People who meet income guidelines and other program requirements
How Much Will I Pay?
You do not have to pay monthly premium for Medi-Cal coverage. Children with Medi-Cal coverage under the Children’s Health Insurance Program (CHIP) will have a low monthly premium.
What Will I Get with Medi-Cal Through IEHP?
Your plan coverage includes:
- Outpatient (ambulatory) services
- Emergency services
- Hospice and palliative care
- Maternity and newborn care
- Transgender services
- Prescription drugs
- Rehabilitative and habilitative services and devices
- Laboratory services
- Preventive and wellness services and chronic disease management
- Mental health services
- Substance use disorder services
- Pediatric services
- Vision services
- Non-emergency medical transportation (NEMT)
- Non-medical transportation (NMT)
- Long-term services and supports (LTSS)
There are 3 ways to apply:
By clicking on the links below, you will be leaving the IEHP site.
To find out if you're eligible for Medi-Cal, call the IEHP Enrollment Advisors at (888) 860-1298, Monday-Friday, 8am – 5pm, TTY (800) 720-4347.
Important Guides for IEHP Medi-Cal Members
- Medi-Cal Member Handbook (Combined Evidence of Coverage) (PDF): will explain how to get care with IEHP and plan covered benefits like how to find a Doctor, how to get care, benefits and services, and more.
- Medi-Cal Formulary (PDF): will show you what prescription drugs are covered under Medi-Cal
- Medi-Cal Provider and Pharmacy Directory (PDF): will show you our growing network and options to get needed care quickly – day and night.
*Children under 21 are currently eligible for dental coverage under Medi-Cal; Adults will be eligible starting May 2014.
**Children under 21 are eligible for an eye exam and glasses; Adults are eligible for an eye exam only.
What your health plan covers
This page explains your covered services as a member of IEHP. Your covered services are free as long as they are medically necessary and you get the approved services from our Provider network. Care is medically necessary if it is reasonable and necessary to protect life, keeps you from becoming seriously ill or disabled, or reduces pain from a diagnosed disease, illness or injury. For additional information on IEHP benefits and services, read Chapter 4 of the IEHP Medi-Cal Member Handbook (PDF) or contact IEHP Member Services at (800) 440-IEHP (4347), TTY (800) 718-4347.
IEHP offers these types of services:
• Outpatient (ambulatory) services
• Emergency services
• Palliative care
• Hospice care
• Maternity and newborn care
• Transgender services
• Prescription drugs
• Rehabilitative and habilitative services and devices
• Laboratory services
• Preventive and wellness services and chronic disease management
• Mental health services
• Substance use disorder services
• Pediatric services
• Vision services
• Non-emergency medical transportation (NEMT)
• Non-medical transportation (NMT)
• Long-term services and supports (LTSS)
• Care and treatment that falls under EPSDT
The plan covers:
• Eyeglasses for Members under the age of 21 who qualify, as determined by IEHP
• Eyeglasses for pregnant women through postpartum
• Routine eye exam once in 24 months
Your provider can prescribe you drugs that are on the IEHP preferred drug list. This is sometimes called a Formulary. Drugs on the IEHP Formulary are safe and effective. To find out if a drug is on the Formulary or to get a copy of the IEHP Formulary mailed to you, call IEHP Member Services at (800) 440-IEHP (4347), TTY (800) 718-4347.
Sometimes IEHP needs to approve a drug before a provider can prescribe it. IEHP will review and decide on these requests within 24 hours.
• A pharmacist or hospital emergency room may give you a 72-hour emergency supply if they think you need it. IEHP will pay for the emergency supply.
• If IEHP says no to the request, IEHP will send you a letter that lets you know why and what other drugs or treatments you can try.
Exclusions and Limitations
IEHP does not cover the following:
• Drugs or medications prescribed solely for cosmetic purposes
• Over-the-counter medications (unless approved by IEHP)
• Non-FDA approved medications
• Investigational medications
• Medications excluded from the Federal coverage (i.e., erectile dysfunction drugs)
• Medications carved out by Fee-for-Service Medi-Cal
• Therapies and medical equipment excluded from the Federal coverage or carved out by Fee-for-Service Medi-Cal (i.e., erectile dysfunction medical equipment)
PharmaciesIf you are filling or refilling a prescription, you must get your prescribed drugs from a pharmacy that works with IEHP. You can find a list of pharmacies that work with IEHP in the IEHP Provider Directory or use the IEHP Provider Search. You can also find a pharmacy near you by calling IEHP Member Services at (800) 440-IEHP (4347), TTY (800) 718-4347.
Once you choose a pharmacy, take your prescription to the pharmacy. Give the pharmacy your prescription, along with your IEHP member card. Make sure the pharmacy knows about all medications you are taking and any allergies you have. If you have any questions about your prescription, make sure you ask the pharmacist.
Dental servicesMedi-Cal covers some dental services for children up to age 21, including:
• Diagnostic and preventive dental hygiene (e.g. examinations, x-rays, and teeth cleanings)
• Emergency services for pain control
• Tooth extractions
• Root canal treatments
• Prosthetic appliances
• Orthodontics for children who qualify
Beneficiaries can access dental services through Denti-Cal enrolled providers, who
will advise beneficiaries on the best course of treatment, and under the specific conditions for which some of these services are allowable.
If you have questions or want to learn more about dental services, call Denti-Cal at (800) 322-6384, TTY (800) 735-2922. You may also visit the Denti-Cal website at https://www.denti-cal.ca.gov.
Do you identify as Transgender or Gender Diverse?
You are not alone. The transgender and gender diverse population of the Inland Empire has been estimated at almost 27,000 people. At Inland Empire Health Plan (IEHP), we want you to get all the care you need with the respect you deserve. IEHP covers all medically necessary Medi-Cal covered Gender Health services. IEHP has Doctors and Specialist who have experience in gender health services. Call IEHP Member Services to find out more.
How to Get Started
See your IEHP Primary Care Doctor on a regular basis.
- If you have not seen your Doctor yet or in a long time, set up a visit today. Your Doctor, the key to your overall health care, knows your health history and helps make sure you get the care you need.
- Your Doctor can refer you to Specialists, if needed. This includes any gender health options that meet your medical needs, so share your treatment goals with your Doctor.
- You can change your IEHP Doctor at any time.
Talk to your Doctor about these Gender Health Benefits:
- Behavioral Health Services
- Hormone Replacement Therapy
- Surgeries and Procedures
IEHP has a dedicated team of Care Managers who are familiar with Gender Health services and are ready to help with:
- Referrals to see a specialist
- Getting medical supplies
- Getting medicines
- Connecting you to community resources
IEHP also provides non-clinical resources such as:
- Care Coordination
- Community and Legal Resources
- Demographic updates
- Family Support Groups
For education and training on gender health care, please access the following resources:
Effective July 1, 2018, Behavioral Health Treatment is no longer a covered benefit solely for Members Diagnosed with Autism Spectrum Disorder. The coverage criteria have been expanded to include IEHP members who meet ALL the below:
- Under 21 years of age
- Have a recommendation from a licensed physician and surgeon or a licensed psychologist that evidence-based BHT services are medically necessary.
- Be medically stable
- Not be in need of 24-hour medical/nursing monitoring or procedures provided in a hospital or intermediate care facility for persons with intellectual disabilities.
Behavioral Health Treatment (BHT) is the design, implementation and evaluation of environmental modifications, using behavioral stimuli and consequences, to produce socially significant improvement in human behavior, including the direct observation, measurement and functional analysis of the relations between environment and behavior.
BHT services teach skills through the use of behavioral observation and reinforcement, or through prompting to teach each step of targeted behavior. BHT services are based on reliable evidence and are not experimental. Treatment may or may not include Applied Behavioral Analysis (ABA).
BHT is medically necessary after the Provider has completed a comprehensive developmental surveillance and screening, and have recommended BHT services is clinically warranted to treat persistent developmentally inappropriate behavior and/or diagnoses that may be able to be corrected or ameliorated with BHT services. Aberrant behaviors include but are not limited to self-injury, aggression, and deficits in language skills, daily living skills, and social skills.
Primary Care Physicians will continue to referral a Member directly to IEHP Behavioral Health for any BHT services and/or diagnostic needs regardless of IPA.
If you have any questions or ask your Primary Care Provider for screening, diagnosis and treatment, you can call IEHP Member Services at (800) 440-IEHP (4347), TTY(800) 718-4347, Monday – Friday, 8am to 5pm.
Cost to Member
There is no cost to the Member for these services.
Visit IEHP's Mental Health page for general mental health information.
IEHP covers Long-Term Services and Supports (LTSS) for eligible Members to help them live independently in the community. You may qualify for the following services.
In-Home Supportive Services (IHSS)
If you have a disability, are blind, or over 65 years old and not able to live in your home without help, you may qualify. Get help around the house and other daily care needs. With IHSS, you find your own caregivers to help with:
- Cooking meals and cleaning up
- Personal care services (such as bowel and bladder care, bathing, and grooming)
- Laundry and household cleaning, grocery shopping and errands, rides to Doctors visits
For more information on IHSS:
San Bernardino County In-Home Supportive Services
(909) 252-4703 TTY, Monday-Friday, from 8am – 5pm
Riverside County In-Home Supportive Services
(888) 960-4477 (TTY 711), Monday - Friday, from 8am – 5pm
Multipurpose Senior Services Program (MSSP)
You may qualify for MSSP if you are at least 65 years old, have a disability, and are eligible for nursing care but wish to stay at home. A care manager works with providers to arrange your care. Some of the covered benefits include:
- Case Management
- Minor home modification
- Emergency response system
For more information on MSSP:
San Bernardino County Multipurpose Senior Services Program
(877) 565-2020, 24-Hour Hotline
(909) 891-3900 TTY, Monday-Friday, from 8am – 5pm
Riverside County Multipurpose Senior Services Program
(951) 697-4699 TTY, Monday-Friday, 8am – 5pm
Community Based Adult Services (CBAS)
Get extra help while being more active. If you are at least 18 years old and have health problems that make it hard for you to take care of yourself, you may qualify for CBAS benefits. If so, you need to visit the center 2-5 days a week to get these services:
- Skilled nursing care
- Social services
- Lunch at the center
- Physical, speech and occupational therapy
- Training and support for your family or caregiver
- Transportation to and from the center
Skilled Nursing Facility (SNF)You may qualify for SNF services if you have a physical disability and need a high level of care. SNF services must be prescribed by your Doctor and given in a licensed SNF. Covered benefits:
- Skilled nursing care
- Care management
- Bed and board (daily meals)
- X-ray and laboratory
- Physical, speech and occupational therapy
- Prescribed medicine, medical supplies, and equipment normally given by the SNF
Important – If you think you need CBAS or SNF care, please call your Doctor or IEHP Member Services at: (800) 440-IEHP (4347) or (800) 718-IEHP (4347) TTY Monday-Friday, from 8am – 5pm
For more information about IHSS or MSSP, contact the programs directly. If you need assistance in applying for a program, call IEHP Member Services and ask for the Long-Term Services and Supports (LTSS) Unit.
Caregiver Resources in the Inland Empire
By clicking on any of the links below, you will be leaving the IEHP website.
Inland Caregiver Resource Center
1430 E Cooley Dr.
Colton, CA 92324
Services: Information and referral, family consultation, support groups, short-term counseling, educational workshops, respite and supplemental services.
Alzheimer’s Greater Los Angeles
002 Iowa Ave, Suite 1072
Riverside, CA 92509
Services: information and referral, 24/7 Hotline, Care Counselors, Early Stage Services, Memory Mornings, Support Groups, Community Education, and Advocacy.
600 West Fifth St.
San Bernardino, CA 92410
Senior Companions provide support to family caregivers. They assist with grocery shopping, transportation to medical appointments, meal preparation, encouraging clients to participate in daily activities, reminiscing, providing companionship and love.
San Bernardino County Department of Aging and Adult Services
686 E. Mill St.
San Bernardino, CA 92415
Services: Adult Protective Services, Family Caregiver Support, Long-Term Care Ombudsmen, Nutrition Services, Senior Employment Program, Information and Assistance
Riverside County Office on Aging
6296 River Crest Dr., Suite K
Riverside, CA 92507-0738
Services: Care Coordination, Caregiving Resources, Care Transitions Intervention (CTI), Elder Abuse Education, Health Insurance Counseling and Advocacy Program (HICAP), Fit After 50, Grandparents Raising Grandchildren, Health Promotion, Legal Assistance, Nutrition, Senior Employment, Volunteer Services
Community Access Center
6848 Magnolia Avenue, Suite 150
Riverside, CA, 92506
Services: information, supportive services and independent living skills training.
1955 S. Hunt Street, Suite 101
San Bernardino, CA 92408
Services: disability information and referral, housing, independent living skills training, assistive technology, and advocacy.
3200 Inland Empire Blvd., Suite 280
Ontario, CA 91764
Palm Desert Office
74020 Alessandro Dr., Suite A
Palm Desert, CA 92260
Rights and Responsibilities as a Member of IEHP Medi-Cal
As an IEHP Member you have the following rights:
- Receive information about your rights and responsibilities as an IEHP Member.
- Be treated with respect and courtesy. IEHP recognizes your dignity and right to privacy.
- Receive information about IEHP, its programs and services, its Doctors, its providers, and health care facilities.
- Receive interpreter services at no cost to you.
- Your IEHP Doctor cannot charge you for covered health care services, except for required co-payments.
- Receive medically necessary covered services without regard to race, religion, age, gender, national origin, mental or physical disability, sexual identity or orientation, genetic information, source of payment, family composition or size, or medical condition or stage of illness.
- Receive family planning services, services at Federally Qualified Health Centers or Indian Health Centers, sexually transmitted disease (STD) services, and emergency services outside the IEHP network as stated in Federal law (Medi-Cal Members).
- If you are under a Doctor’s care for an acute condition, serious chronic condition, pregnancy, terminal illness, newborn care, or a scheduled surgery, you may ask to continue seeing your current Doctor. To make this request, or if you have any concerns about your continuity of care, please call IEHP Member Services at (800) 440-IEHP (4347).
- If you have been receiving care from a health care provider, you may have a right to keep your provider for a designated time period. Please contact IEHP Member Services at (800) 440-IEHP (4347). If you have further questions, you are encouraged to contact the Department of Managed Health Care, which protects HMO consumers, by telephone at its toll free number, (888) HMO-2219, TDD (877) 688-9891, or online at http://www.dmhc.ca.gov/?referral=hmohelp.ca.gov.
- Receive emergency or urgently needed services outside the IEHP Network.
- Receive emergency care whenever necessary and wherever you need it.
- Receive sensitive services, such as family planning or mental health care in a confidential way.
- Access minor consent services (Medi-Cal).
- Choose a primary care Doctor within the IEHP Network.
- If your Primary Care Doctor changes, your IEHP benefits and required co-payments will stay the same.
- Receive information from IEHP that you can understand.
- Receive Member informing materials in alternative formats, including Braille, large print, and audio.
- Make recommendations about IEHP Members’ rights and responsibilities policies.
- Participate with Doctors in decision making about your own health care.
- Talk with your Doctor about your medical condition and appropriate or medically necessary treatment options regardless of the cost or what your benefits are. Members who are not able to talk with their Doctor about decision making have the right to be represented by parents, guardians, family members or other conservators. Receive information on available treatment options and alternatives, presented in a manner appropriate to the Member’s condition and ability to understand.
- Decide about your care, including the decision to stop treatment, services, or stop participating in health management programs.
- Decide in advance how you want to be cared for in case you have a life-threatening illness or injury.
- Be informed by IEHP regarding advance directives, and to receive information from IEHP regarding any changes to that law. The information shall reflect changes in state law regarding advance directives as soon as possible, but no later than 90 days after the effective date of change.
- Review, request corrections to, and receive a copy of your medical records (your Doctor may charge a fee for copies of records and other forms).
- Keep your personal and medical information and records confidential, unless you say differently, and know how IEHP keeps your information confidential.
- Complain about IEHP, its providers, or your care. IEHP will help you with the process. You may appeal decisions made by IEHP or your Medical Group. You have the right to choose someone to represent you during the grievance process and for your complaints and appeals to be reviewed as quickly as possible and be told how long it will take. Medical Members have the right to request a State Fair Hearing or an expedited Fair Hearing for urgent cases. Member’s have the right to have benefits continue pending the resolution of the appeal and receive how to request benefits continue. Call the Department of Social Services Public Inquiry and Response Unit at (800) 952-5253, TTY (800) 952-8349.
- Have IEHP act as your patient advocate.
- Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience, or retaliation.
- Medical recipients can stop being IEHP Members (disenroll) at anytime, for any reason. If you want to disenroll, call IEHP Member Services at (800) 440-4347 or Health Care Options at (800) 430-4263 8am – 6pm (PST), Monday – Friday, TTY/TDD (800) 430-7077 to get disenrollment information.
- IEHP will honor authorization for services already approved for you. If you have any authorization pending approval, if you are in the middle of treatment, or if specialty care has been scheduled for you by your current Doctor, contact IEHP to help you coordinate your care during this transition time. Call IEHP Member Services at (800) 440-IEHP (4347)
- Request a second opinion about a medical condition.
- File a grievance with IEHP if your linguistic needs are not met
- Request an Independent Medical Review from the Department of Managed Health Care (DMHC) if you disagree with IEHP’s decision to deny, delay, or modify a service that your Doctor requests.
- Request an External Independent Review if a service or therapy was denied on the basis that it was considered experimental or investigational. If you have any questions about these procedures, call IEHP Member Services at (800) 440-IEHP (4347), TTY (800) 718-4347
- If you are a Native American Indian, you have the right to not enroll in a plan, not be restricted by a plan in your right to access Indian Health Facilities, and to disenroll from a plan without cause.
As a Member of IEHP, you have the responsibility to:
- Be familiar with and ask questions about your health plan options, your health plan coverage limitations and exclusions, rules about the use of network providers, coverage and exclusions, rules, appropriate process to obtain addition information and process to appeal coverage decisions. If you have a question about your coverage, call IEHP Member Services at (800) 440-IEHP (4347), TTY (800) 718-4347.
- Follow the advice and care procedures indicated by your doctor and IEHP. If you have a question about these procedures, call IEHP Member Services at (800) 440-IEHP (4347), TTY (800) 718-4347.
- Request interpreter services at least 5 working days before a scheduled appointment.
- Call your Doctor or pharmacy at least 3 days before you run out of medicine.
- Cooperate with your Doctor and staff and treat them and other patients with respect. This includes being on time for your visits or calling your Doctor if you need to cancel or reschedule an appointment.
- Understand that your Doctor’s office may have limited seating for patients and caregivers only.
- Give accurate information to IEHP, your Doctor, and any other provider. This helps you receive better care.
- Understand your health care needs and be part of your health care decisions. Ask your doctor questions if you do not understand.
- Work with your Doctor to make plans for your health care.
- Follow the plans and instructions for care that you have agreed on with your Doctor.
- Notify IEHP and your Doctor if you want to stop the plans and instructions you have agreed on or want to stop participating in health management programs.
- Immunize your children by age 2 years and always keep your children’s immunization up to date.
- Call your Doctor when you need routine or urgent health care.
- Care for you own health. Live a healthy lifestyle, exercise, eat a good diet, and don’t smoke.
- Avoid knowingly spreading disease to others.
- Use IEHP’s grievance process to file a complaint. Call IEHP Member Services at (800) 440-IEHP (4347), TTY (800) 718-4347 to file a complaint (grievance or appeal).
- Report any wrongdoing or fraud to IEHP by calling the Compliance Hotline at (866) 355-9038 or the proper authorities.
- Understand that there are risks in receiving health care and limits to what can be done for you medically.
- Understand that it is a health care provider’s duty to be efficient and fair in caring for you as well as other patients.
- Make a good –faith effort to pay your health care bills (Premiums, co-pays and non-covered services where applicable).
- Follow administrative and operational procedures at IEHP, its providers and Government health benefits programs.
Open Access Program
If you’re a foster parent, IEHP applauds you. By reaching out, you’re giving a child a chance at a better life, and a better future. Many children enter foster care with a list of physical or behavioral health concerns. Due to changing placements, these concerns often go untreated. By speeding up the process to see a Doctor the Open Access Program makes it simple for your child to receive ongoing medical care. No matter where you live in the Inland Empire, your child can see any Doctor in the network. Plus, our program gives your child many services you won’t find with the Regular Medi-Cal system.
How Open Access makes it simpler for your child to get healthcare:
- Save time looking for a Doctor, your child can see any Primary Care Doctor in our large network.
- You can switch Doctors anytime for any reason, we will help you find one. Call (800) 440-4347, TTY (800) 718-4347.
- The Program gives your Doctor a record of your child’s health history (shots, medicines, checkups) so there’s no guesswork.
- If you misplaced your IEHP Member ID Card or Beneficiary Identification Card (BIC), an Open Access Doctor can go online and quickly confirm your child’s eligibility.
You and your child get extra services at no cost:
- Keep your child feeling well with free Wellness Programs like asthma or diabetes.
- Keep your child safe and healthy and get extras a parent can appreciate like an infant car seat, children’s vitamins, and a bicycle helmet.
- A team helps you care for your child with a chronic illness. Working with your child’s Doctor, we call you, making sure your child gets the right care. We even lend a hand if things like Doctor visits, lab tests or medicine pile up.
Get Health Advice at Night
When you can’t reach your Doctor after hours, call the IEHP 24-Hour Nurse Advice Line. You’ll get the advice you need – until you can see your child’s Doctor.
Find out more about the Open Access Program by calling an IEHP Foster Care Specialist at (800) 706-4347, Monday–Friday, 8am-5pm.