California PHC

1. 1. What is PHC California?
   2. Who is eligible to be a PHC California Member?
   3. Does PHC California cover services that Regular Medi-Cal does?
   4. What’s the difference between PHC California and other Medi-Cal managed care plans?
   5. How do I enroll in PHC California?
   6. I’m under the care of a specialist or facility that isn’t in PHC California’s network. Can I enroll and finish my treatment?
   7. If I enroll in PHC California and decide that I want another plan, can I leave?
   8. Can my family or household members enroll in PHC California?
   9. Can I change my primary care provider (PCP) when I’m in the plan?
   10. Will PHC California cover me if I travel to other parts of California outside the plan’s service area or other states in the US?
   11. Will PHC California cover prescription drug refills if I fill my medications outside of the plan’s service area or in other states?
   12. If I move, can I stay with PHC California?

PHC California is a California Medi-Cal special needs managed care plan for people who have a prior AIDS diagnosis. PHC California is operated by AIDS Healthcare Foundation and has been in operation since 1995. AIDS Healthcare Foundation has a contract with the California Department of Health Care Services to operate PHC California.

To be eligible for PHC California, a person must:

• Be a Medi-Cal recipient with no share of cost (you have full scope Medi-Cal)
• Have a prior AIDS diagnosis, had an AIDS-defining condition/disease, or had a CD4 count below 200 or 14% or less documented in your medical record
• Live in Los Angeles County
• Are 21 years or older

Yes. The plan covers all of the services Regular Medi-Cal does and more.

PHC California is a Medi-Cal special needs managed care plan for Medi-Cal recipients with HIV and a prior AIDS diagnosis. It offers care coordination. It also has case management services. These specifically address the medical needs of people living with HIV. Each member gets a Registered Nurse. The nurse helps coordinate care with providers. He or she helps the member follow his or her treatment plan. The plan also has a Health and Wellness Benefit that’s designed to keep members healthy and active — a choice of gym membership or up to $200 per year of over-the counter pharmacy items.

Call Member Services at (800) 263-0067 or  email us and ask to enroll. See more information how to enroll.

Yes. If you enroll in PHC California, contact Member Services as soon as possible to tell us. We will work with your treating provider or facility to let you finish your treatment plan.

Yes, you may change plans or enroll in Regular Medi-Cal. Call the Department of Health Care Services’ Health Care Options enrollment broker at (800) 430-4263 or visit the Health Care Options website. (By clicking on this link, you will be taken to the Health Care Options website which is operated by the California Department of Health Care Services and not PHC California.)

Yes, if they meet eligibility rules.

Yes. You may change your PCP for any reason. You can change as often as you like.

Yes. PHC California will cover emergency and urgent care services when you travel outside of Los Angeles County.

We will cover prescription drug refills when you fill your prescription at a network pharmacy anywhere in California. We do not cover medications filled out of the state. The exception is if they are prescribed because of an emergency room or urgent care facility visit.

Depends. If you move within Los Angeles County, you can stay a member in the plan. Just be sure Member Services has your current address. If you move out of Los Angeles County, you will have to choose a new plan. Call the Department of Health Care Services’ Health Care Options enrollment broker at (800) 430-4263 or visit the Health Care Options website. (By clicking on this link, you will be taken to the Health Care Options website which is operated by the California Department of Health Care Services and not PHC California.)