January 24, 2023
UnitedHealthcare (UHC) Community Plan has announced that it is no longer providing services to approximately 30,000 Medi-Cal members in San Diego County effective January 1, 2023. According to the notice mailed to Community Plan physicians in October 2022, the California Department of Health Care Services (DHCS) transitioned all UHC Community Plan members in San Diego County to other participating Medi-Cal managed care plans effective January 1.
According to the DHCS, the other currently participating Medi-Cal plans are in San Diego County are:
- Aetna Better Health of California
- Blue Shield of California Promise Health Plan
- Community Health Group Partnership Plan
- Health Net Community Solutions, Inc.
- Kaiser Permanente Health Plan
- Molina Healthcare of California Partner Plan, Inc.
UHC Community Plan first entered the Medi-Cal marketplace in San Diego and Sacramento counties in 2017. However, UHC Community Plan quickly exited Sacramento County in November 2018.
Continuity of Care
Patients may be able to continue to see their physician, even if the physician is not contracted with the patient’s new plan or delegated entity, under California’s continuity of care law.
- Under the continuity of care laws, patients with an acute condition, serious chronic condition, duration of a pregnancy, duration of a terminal illness, care of children between birth and 36 months, or for the performance of a surgery or other procedure that has been authorized, may qualify to request continuity of care.
- Patients may also request up to 12 months of continuity of care with an out-of-network provider if the patient has a pre-existing relationship with that provider, defined as having seen that physician within the previous 12 months, regardless of the patient having a condition under the continuity of care law.
- Prior authorizations obtained prior to the transition remain in effect for 90 days. However, if the treating physician is not in the new Medi-Cal managed care plan network or the patient has not seen that physician within the previous 12 months, the plan can require the patient to see an in-network physician for the approved service. If the treating physician is participating in the new Medi-Cal managed care plan network, the new plan should have the prior authorization on file and should pay claims appropriately.
For More Information
UHC Community Plan enrollees who wish to request continuity of care, need assistance in selecting an alternative Medi-Cal health plan or who have questions about the transition can call Health Care Options at (800) 430-4263.