Common Questions

Non-Medical Transportation (NMT)

One type is called non-medical transportation (NMT). If you can travel by car, bus, train, or taxi, but do not have a ride to your appointment, NMT services can be set up. You can also use NMT if you need to pick up prescriptions, medical supplies, or equipment. For help with an NMT ride, follow the steps below:

• If you are enrolled in a health plan, call the plan’s Member Services for help with NMT services.
• If you are enrolled in a Medi-Cal Dental Managed Care (DMC) plan, call your DMC plan for help with NMT services.
• If you have trouble getting a ride from a health plan or DMC plan, call the Telephone Service Center at 1-800-322-6384. Your county Medi-Cal office may also be able to help you get an NMT ride.

Need more information about approved NMT providers? You can access the list on the Department of Health Care Services website.

Non-Emergency Medical Transportation (NEMT)

The other type of ride is called non-emergency medical transportation (NEMT). Medi-Cal offers NEMT services to eligible members based on a medical need. Your medical or dental provider can decide if you need NEMT services. NEMT services cover these rides:

• Wheelchair vans
• Litter vans
• Ambulances
• Air transportation

You should ask for a ride as soon as you can before your scheduled appointment. If you have or will have many upcoming appointments, your medical or dental provider can ask for advance transportation to cover future appointments. For help with a NEMT ride, follow the steps below:

• If you are enrolled in a DMC plan, call your Member Services for help with NEMT services. You will need a prescription from a licensed provider.
• If you have Fee-For-Service Medi-Cal, please let your provider know and they will help you get the NEMT ride or call the Medi-Cal San Diego Field Office at 1-858-495-3666.

Can I go to the dentist during COVID-19?

You can go to the dentist during COVID-19. To keep everyone safe, your dental visit will look a little different. Your dental office may ask if you want to schedule a video appointment. When you go to your dental office for an appointment, you may have your temperature taken. You may be asked to wear a face-covering and to keep six feet between yourself and others in the waiting room.

Learn more about returning to the dentist during COVID-19.

Watch this video to learn about what your next dental appointment may look like.

What Is the Medi‑Cal Dental Program?

The Medi‑Cal Dental Program offers free or low-cost dental benefits for enrolled Medi‑Cal members. If your income is more than the Medi‑Cal limit for your family size, a low-cost monthly premium may be required. Learn more about the Medi-Cal Dental Program.

Do I qualify for Medi‑Cal dental services?

The Medi‑Cal program offers a variety of benefits to members including covered dental services. To receive dental coverage through Medi‑Cal, you must be Medi‑Cal eligible. Your eligibility determines the types of benefits you have access to through Medi‑Cal. You do not need to apply separately for dental coverage because it is a part of the Medi‑Cal program.

How do I apply for Medi‑Cal to get dental services?

For information on how to apply for Medi‑Cal, you can go to www.coveredca.com, view a list of county offices, or  call 1‑800‑300‑1506.

Is it harder for me to receive my green card if I receive Medi-Cal?

No, unless you live in a long-term care facility (like a nursing home) and Medi-Cal is covering the costs of your residency.

What dental services am I covered for?

View a list of the dental services you qualify for.

Learn more about your covered dental services.

If I am signed up, do I have to pay for dental services?

Medi‑Cal Dental covers dental services for most Medi‑Cal members. Depending on your income and your family size, dental services may be available at no cost to you (or your child). In some cases, you may have to pay a “Share of Cost (SOC)” and/or a co-pay.

What does the Medi‑Cal Dental Program pay for?

Medi‑Cal Dental covers many services to help keep your gums and teeth strong and healthy. Learn more about services covered by the Medi‑Cal Dental Program.

What is a Share of Cost (SOC)?

In some cases, you may have to pay a Share of Cost (SOC) and/or a co-pay as a Medi‑Cal member. SOC is determined by your monthly income. If you have been told that you have a SOC, this likely means your income is more than the Medi‑Cal limit for your family size, and you have to pay a monthly dollar amount for your medical expenses. Contact Medi‑Cal at 1‑800‑541‑5555 to find out what your share of the cost is. Learn more about SOC.

What is a Co‑Pay?

Your co‑pay is a fixed amount you pay for a service, usually at the same time you receive the service. The co‑pay usually falls outside your covered dental services. The co-pay amount will vary based on the type of service. For example, a dental visit might have a co-pay of $2. The co‑pay for an emergency room visit will usually cost more. For some services, you may have a co-pay and a SOC. These services may have a co‑pay for adults with the Medi‑Cal dental benefit:

• Non-emergency services provided in an emergency room – Co‑pay $5
• Outpatient services – Co‑pay $1

Can I get a copy of my x-rays and records from my dentist?

You may obtain a copy of your x-rays or records from your dentist, but your dentist may charge you a reasonable fee for their reproduction.

How do I find a Medi-Cal dentist?

You can find a dentist by visiting the Medi‑Cal Dental provider website, or you can call the Telephone Service Center Phone Line at 1‑800‑322‑6384.

What if I want a second opinion?

As Medi‑Cal member, you can ask to see another dentist or specialist before making a decision about your primary dentist’s treatment plan for you. This is also an option for you if you are enrolled in a Dental Managed Care plan.

If I do not have a ride, are there other options to get to the dentist’s office?

Medi‑Cal provides non-emergency and non-medical transportation services to eligible members. You can qualify for transportation if your appointment is medically necessary. To request transportation assistance, call the Telephone Service Center Phone Line at  1‑800‑322‑6384. The transportation must be used only for necessary health care covered by the Medi-Cal program. Call your county social services office for help if you need a ride to your appointment, but you do not qualify for medically necessary non-emergency transportation services.

What if I need an interpreter during my dental appointment?

Medi-Cal provides language interpretation assistance and American Sign Language (ASL) translation services to Medi-Cal members at no cost. Language interpreters are available in over 250 languages and dialects. You, or your dental office can call the Telephone Service Center (TSC) at 1‑800‑322‑6384 Monday through Friday, between 8 a.m. and 5 p.m. to ask for language assistance over the telephone during your dental appointment. Language assistance cannot be scheduled ahead of time. If you are a member with hearing or speaking limitations, you can call the Teletext Typewriter (TTY) line at 1‑800‑735‑2922, Monday through Friday, 8 a.m. to 5 p.m.; at all other times, you should call the California Relay Service TDD/TTY at 711 for help. For assistance scheduling ASL translation services during your dental appointment, please have the operator call the toll-free member line at 1‑800‑322‑6384.

What do I need to bring to my dental appointment?

Show your Medi‑Cal Benefits Identification Card (BIC) to your dentist’s office at your appointment. Your dentist will match the name and signature on your BIC with another form of identification, such as:

• Your Social Security Number (SSN)
• A valid California driver’s license
• Any identification card issued by the Department of Motor Vehicles (DMV)
• Or any other document which appears to prove your identity

In some cases, you can still be seen for dental services without a BIC. If your dentist does not know you, they must make a good faith effort to verify your identity.

What happens if I miss an appointment?

It is important to show up to your dental appointments, but if you know you will not be able to make it, call your dentist at least 24 hours before to cancel and reschedule. Missing a dental appointment can have a big impact on the health of your mouth. It is best to make all arrangements (transportation, babysitting, time off work) when you schedule your appointment to make sure you can keep it.

Can I get a copy of my x-rays and records from my dentist?

You may obtain a copy of your x-rays or records from your dentist; however, your dentist may charge you a reasonable fee for their reproduction

Can I change dentists in the middle of treatment?

If services were prior authorized to one dentist and you wish to change your dentists, it is necessary that you write a letter indicating your change and have your new dentist submit that letter to the Medi-Cal Dental Program with his/her Treatment Authorization (TAR) form. The Medi-Cal Dental Program will contact your previous dentist to verify if any of the prior authorized services have been performed and will issue a new Notice of Authorization (NOA) as applicable.

What if I am denied services requested for prior authorization?

If you are denied services that your dentist has requested prior authorization for, please contact your dentist to determine if a re-evaluation of the request could be made. You may also file a request through the Department of Social Services for a Fair Hearing by calling toll-free (800) 952-5253. You may also write to: The Department of Social Services State Hearings Division P.O. Box 944243 MS 19-37 Sacramento, CA 94244-2430 To expedite your request, please include the Document Control Number (DCN). The DCN references the denied services.

What do I need to bring to my dental visit?

Show your Medi-Cal Benefits Identification Card (BIC) to your dentist’s office at your appointment. Your dentist will match the name and signature on your BIC with another form of identification, such as:

• Your Social Security Number (SSN)
• A valid California driver’s license
• Any identification card issued by the Department of Motor Vehicles (DMV)
• Or any other document which appears to prove your identity

If your photo ID has expired, the dental office will accept it up to six months from the expiration date.

In some cases, you can still be seen for dental services without a BIC. If your dentist does not know you, they must make a good faith effort to verify your identity.

What happens if I miss an appointment?

It is important to show up to your dental appointments. If you know you will not be able to make it, call your dentist at least 24 hours before to cancel and reschedule. Missing a dental appointment can have a big impact on the health of your mouth. It is best to plan ahead (transportation, babysitting, time off work) when you make your appointment to make sure you can keep it.

What if I need an interpreter during my dental appointment?

Medi-Cal provides language interpretation assistance and American Sign Language (ASL) translation services to Medi-Cal members at no cost. Language interpreters are available in over 250 languages and dialects. You, or your dental office, can call the Telephone Service Center (TSC) at 1‑800‑322‑6384 Monday through Friday, between 8 a.m. and 5 p.m. to ask for language assistance over the telephone during your dental appointment. Language assistance cannot be scheduled ahead of time. If you are a member with hearing or speaking limitations, you can call the Teletext Typewriter (TTY) line at 1‑800‑735‑2922, Monday through Friday, 8 a.m. to 5 p.m.; at all other times, you should call the California Relay Service TDD/TTY at 711 for help. For assistance scheduling ASL translation services during your dental appointment, please have the operator call the toll-free member line at 1‑800‑322‑6384.

What is a dental emergency?

The American Dental Association recognizes these examples as dental emergencies:

• Bleeding that doesn’t stop
• Painful swelling in or around your mouth
• Severe pain
• Facial trauma, such as injury to jawbone and face
• Gum infection with pain or swelling
• After surgery treatment (dressing change, stitch removal)
• Broken or knocked-out tooth
• Snipping or adjusting wires in braces that hurt your cheeks or gums

A routine dental visit is not an emergency. This includes:

• Regular visits for exams, cleanings and x-rays
• Regular visit for braces
• Removal of teeth that aren’t painful
• Treatment of cavities that aren’t painful
• Teeth whitening

When should my child have their first dental appointment?

You should make an appointment for your child’s first dental visit as soon as their first tooth comes in or by their first birthday, whichever comes first. Many kids get cavities as early as age 2. See the dentist as soon as possible to prevent problems.

Learn more about your child’s first dental visit. 

How often should I go to the dentist?

If you are under the age of 21, you are covered for free or low-cost check-ups twice a year. If you are 21 or over, you are covered for free or low-cost check-ups once a year. Regular dental visits are important for your oral health and your overall health.

Is it safe to go to the dentist while I’m pregnant?

It is safe and important to see the dentist while pregnant. When you are pregnant, your oral health is a big part of making sure your baby is healthy.

Learn more about oral health care and pregnancy.

Watch this video to learn more about visiting the dentist while pregnant.

What if I only have restricted scope Medi-Cal?

If you have restricted scope Medi-Cal, sometimes called “emergency Medi-Cal” you may qualify for Medi-Cal coverage for emergency and pregnancy-related services. Learn more about your Medi-Cal eligibility.

What is the difference between Medi-Cal Dental (Fee-For-Service) and Dental Managed Care (Sacramento County and Los Angeles County)?

The Medi-Cal Dental Program is made up of two delivery systems: Medi-Cal Dental (Fee-For-Service) and Dental Managed Care (Sacramento County and Los Angeles County). Fee-For-Service is a way Medi-Cal pays doctors and other health care providers. Medi-Cal Dental Fee-For-Service is the program in most California counties. Dental Managed Care (DMC) is an organized system to help you get high-quality care and stay healthy. If you live in Sacramento County you will be enrolled in DMC. As a DMC member you will be assigned to a dental provider in your DMC plan’s network. If you live in Los Angeles County you can choose to enroll in DMC or stay in Medi-Cal Dental. If you enroll in DMC the plan you choose will send you a dental card and your benefit information. Please visit the Dental Managed Care Members webpage for information about DMC.

How can I get information about my benefits if I have a dental managed care plan?

If you live in Sacramento County, you will need to enroll in Dental Managed Care (DMC) and will see a dentist through a dental managed care plan. If you live in Los Angeles County, you can choose to stay in Medi‑Cal Dental or you can enroll in DMC. If you enroll in DMC, the plan you choose will send you information about your benefits. Learn more about Dental Managed Care (DMC).

I am currently enrolled in a prepaid health plan/managed care plan; how do I change plans?

Call MAXIMUS, the State’s Health Care Options Contractor at toll-free (800) 430-4263.

What is a Medi-Cal Fair Hearing?

If you have applied for, have received, or are currently receiving benefits/services from Medi-Cal AND you have a complaint about how your benefits/services are/were handled, or your services have been denied or modified, you may:

• Discuss your complaint with a representative of the County Welfare department in the county in which you live (or where you lived when you received the benefits/services).
• File a discrimination complaint – see the information under Non-Discrimination Policy and Language Access.
• Request a hearing – see the information under How to File a Hearing Request

You must file your request within 90 days of receiving the Notice of Action (NOA). You may be able to file after 90 days if you have a good reason, like illness or a disability.

* DHCS received federal Section 1135 approval to temporarily extend the 90 days to up to an additional 120, for a total of up to 210 days after the date of this notice. This temporary extension is effective March 1, 2020 and will terminate upon termination of the public health emergency.

* = An extension in the time that a member has to file for a Fair Hearing has been granted via the 1135 waiver because of the COVID-19 public health emergency.

Your benefits will continue pending review (Aid Paid Pending) if the hearing is filed within 10 days of receiving the NOA. This process allows you to continue receiving services while the case is being reviewed.

Your Hearing Rights

Requesting a state hearing:

You may complete the “Request for State Hearing” on the back of the NOA. Please provide all requested information such as your full name, address, telephone number, the name of the county that took the action against you, the aid program(s) involved, and a detailed reason why you want a hearing. If you have trouble understanding English, be sure to tell us your language (and dialect) so we can arrange for you to have language assistance at the hearing. If you have chosen an authorized representative, be sure to tell us his/her name and address. Please try to write as neatly as possible. If you wish, you may attach a letter to explain why you believe the county action is not correct. It is always a good idea to keep a copy of your hearing request. For more information, please visit the page on Your Hearing Rights.

Then you may submit your request one of these ways:

• To the county welfare department at the address shown on the Notice of Action.
• To the California Department of Social Services
  State Hearings Division
  P.O. Box 944243, Mail Station 21-37
  Sacramento, California 94244-2430.

• To the State Hearings Division by fax to (833) 281-0905.
• To the California Department of Social Services at the online hearing request page.

OR

You can make a toll-free call to request a State Hearing. Please note—due to a high volume of calls, phone lines are very busy.

California Department of Social Services
Public Inquiry and Response
Phone (800) 743-8525 (Voice)
(800) 952-8349 (TDD)

NOTE: The State Hearings Division cannot accept requests for a State Hearing via e-mail.

For additional information, visit the State Hearings Requests with the Department of Social Services.

Accessing Your Personal Health Information

You have the right to inspect, review, and receive a copy of your personal health information (PHI). You must be the individual, or the parent, guardian, or personal representative of the individual for whom you seek documentation. To request copies of your PHI documents, please see the Privacy Forms page or use the link below to download the request form.

• Special Process for Requests for Information Related to temporary medical exemption request (MER) from managed care enrollment

The Medi-Cal Program provides medical services to qualified beneficiaries in California through managed care health plans that contract with the Department Health Care Services (DHCS) or individual providers on a fee-for-service (FFS) basis. With a few exceptions, Medi-Cal beneficiaries are required to enroll in a managed care plan for their health care services. Beneficiaries that have pre-existing complex medical conditions and are currently undergoing an active course of medical treatment from a FFS provider can request a temporary medical exemption (MER) from managed care enrollment by submitting HCO Form 7101. DHCS reviews all documentation submitted with a MER and approves or denies all MERs, in accordance with Title 22, California Code of Regulations, Section 53887.

Members have the right to examine all documents DHCS considers to determine whether a MER should be granted or denied. Members can contact DHCS to request their documentation or ask questions about their MER or the MER process. To request documents related to a medical exemption request, please visit the Medical Exemption Request Documentation page.

Filing a discrimination complaint

If you think discrimination has affected your benefits or services, you may file a discrimination complaint with the DHCS Office of Civil Rights below:

Office of Civil Rights
Department of Health Care Services
P. O. Box 997413, MS 0009
Sacramento, CA 95899-7413
Phone: (​916) 440-7370
Email: CivilRights@dhcs.ca.gov.

You may use the ADA Title VI Discrimination Complaint form to submit your complaint to DHCS Office of Civil Rights. The form also contains additional information about your rights. A complaint should be filed as soon as possible or within 180 days of the last act of discrimination. If your complaint involves matters that occurred longer ago than this and you are requesting a waiver of the time limit, you will be asked to show good cause why you did not file your complaint within the 180-day period.

You may also submit a discrimination complaint to United States Department of Health and Human Services, Office of Civil Rights. Additional information on filing discrimination complaints is available on the Non-Discrimination Policy and Language Access webpage.​