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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.dhcs.ca.gov/individuals/Pages/Medi-CalMemberHelpline.aspx |
| 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 2020 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 2020:
1,247,642 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 2020: 4,959 (State Fair Hearings conducted by CDSS)
Complaint review time in 2020:
47 days on average
Complaint review times ranged from 0-528 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 reasons for complaints (Medi-Cal Managed Care, Fee-for-Service, Dental, and other delivery systems combined):
- Scope of Benefits (27% of complaints)
- Pharmacy Benefits (25%)
- Medical Necessity Denial (22%)
- Dis/Enrollment (8%)
- Claim Denial (4%)
- Denied Services (4%)
- Billing/Reimbursement Issue (4%)
- Quality of Care (3%)
- Rehabilitative/Habilitative Care (1%)
- Other (1%)
- Hospitalization (1%)
Top results of the complaint review:
- Complaint Withdrawn (39% of complaints)
- Health Plan Position Substantiated (38%)
- Compromise Settlement/Resolution (12%)
- No Action Requested/Required (6%)
- Health Plan Position Overturned (4%)