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​​​Consumer Assistance at the Department of Health Care Services

The California Department of Health Care Services (DHCS) administers Medi-Cal and other programs that provide medical and other services and support to Californians with a low income or disability. The following DHCS consumer assistance service centers provide guidance and referrals for Medi-Cal program issues.

 

Service Center Phone Number Website
Office of the Ombudsman Main line: 1-888-452-8609

TTY/TDD: California Relay Service (711)

Hours of operation: Monday-Friday, 8:00 a.m. – 5:00 p.m. (except state holidays)

www.dhcs.ca.gov/services/medi-cal/Pages/MMCDOfficeoftheOmbudsman.aspx
Medi-Cal Telephone Service Center Main line: 1-800-541-5555

TTY/TDD: 916-635-6491

Hours of operation: Monday-Friday, 8:00 a.m. – 5:00 p.m. (except state holidays)



www.medi-cal.ca.gov
Medi-Cal Dental Telephone Service Center Main line: 1-800-322-6384

TTY/TDD: 1-800-735-2922

Other lines: 1-866-290-6310 (for patients new to the program)

Hours of operation: Monday-Friday, 8:00 a.m. – 5:00 p.m. (except state holidays)

Some automated services available through the phone system 7 days a week, 24 hours a day. Voicemail checked daily.



https://dental.dhcs.ca.gov/​

Complaint Data Highlights

The highlights below are based on information DHCS reported to OPA about its consumer assistance service centers and about its 2019 State Fair Hearings. State Fair Hearings conducted by the California Department of Social Services (CDSS) are an avenue for Medi-Cal members and applicants to address complaints about the program. More details can be found in the DHCS section of the full Annual Complaint Data Report or on OPA’s webpage about how to file Medi-Cal Complaints.

Consumer assistance volume in 2019:

1,246,505 requests for assistance, including State Fair Hearings and inquiries made to the Office of the Ombudsman, Medi-Cal Telephone Service Center, and Medi-Cal Dental Telephone Service Center

Complaint volume in 2019: 4,978 (State Fair Hearings conducted by CDSS)

Complaint review time in 2019:

51 days on average

Complaint review times ranged from 0-448 days.

  • The above statistics include re-opened cases with durations counted from the time of the first hearing request filing.
  • Most State Fair Hearings must be conducted no later than 90 days from the date the hearing request was filed.
  • There is a faster hearing process for certain cases involving consumers with urgent clinical issues.

Top ten reasons for complaints:

  1. Pharmacy Benefits (38% of complaints)
  2. Medical Necessity Denial (20%)
  3. Dis/Enrollment (14%)
  4. Billing/Reimbursement Issue (7%)
  5. Denied Services (6%)
  6. Quality of Care (6%)
  7. Scope of Benefits (4%)
  8. Claim Denial (2%)
  9. Rehabilitative/Habilitative Care (1%)
  10. Other (1%)

Top results of the complaint review:

  1. Complaint Withdrawn (45% of complaints)
  2. Health Plan Position Substantiated (38%)
  3. No Action Requested/Required (10%)
  4. Health Plan Position Overturned (6%)
  5. Compromise Settlement/Resolution (2%)