November 7, 2022
Department of Managed Healthcare
Protection Applies to 23.5 Million Enrollees
(Sacramento) – As other states have created obstacles and restricted access to reproductive health care, the California Department of Managed Health Care (DMHC) issued guidance reminding health plans regulated by the Department of requirements to cover and provide access to emergency and urgent care services when enrollees are out of state. This includes when an enrollee needs emergency or urgent care while in another state that may restrict access to reproductive health care services, like abortion care.
“The Department of Managed Health Care is committed to protecting reproductive health care rights by making sure health plans follow the law,” said DMHC Director Mary Watanabe. “We want all health plan enrollees to know their health care rights, and that health plans must continue to provide access to emergency and urgent care when their California enrollees are in other states, including abortion services.”
California health plans must provide timely access to medically necessary basic health care services to enrollees, even when those enrollees happen to be outside of California when they need the services. This includes covering out-of-area emergency care and urgently needed care for 23.5 million enrollees in DMHC-licensed commercial and Medi-Cal plans.
In some instances, an enrollee may not be able to readily access emergency or urgent care because such care is not available in the area or state where the enrollee is located. For example, a number of states have recently instituted near total or total bans on health care providers’ abilities to provide certain services, including abortion care services, that are “basic health care services” under California law. Health plans also have an obligation to arrange for enrollees to obtain health care services in a timely manner, consistent with California’s timely access standards. This may require the health plan to pay for the enrollee to travel, including travel to another state, to access the needed care. Some insurers or employers may add additional benefits, including coverage of travel costs in a broader set of circumstances.
Under California law, most private health plans in California cover abortion as a basic health care service. All Medi-Cal plans cover abortion. Learn more at www.abortion.ca.gov.
If a health plan enrollee experiences issues with receiving appropriate access to care, they should contact their health plan directly, or the DMHC Help Center for further assistance at 1-888-466-2219 or www.HealthHelp.ca.gov. The DMHC Help Center provides help in all languages and all services are free.
The California Department of Managed Health Care (DMHC) protects the health care rights of 28.4 million Californians and ensures a stable health care delivery system. The DMHC Help Center has assisted 2.6 million Californians to resolve complaints and issues with their health plan. The DMHC Help Center provides assistance in all languages and all services are free. For more information visit www.HealthHelp.ca.gov or call 1-888-466-2219.
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