Internal and External Review: Medi-Cal Managed Care Plans Managed Care in California Series Issue No. 4 (Revised October, 2019)

Executive Summary

Federal and state law and the state and federal Constitutions require that enrollees in Medi-Cal managed care plans receive notice, and grievance and appeal rights when they are denied access to medically necessary services. Frequently, however, enrollees fail to receive the required notice, get an inadequate notice, or do not understand their right to appeal the plan’s decision. This issue brief will provide an overview of the rules and processes for notice, grievances, and appeals that apply to Medi-Cal plans.

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