Living Healthy A newsletter for the members of Central California Alliance for Health As a Medi-Cal member, you must renew your Medi-Cal each year to keep your health care benefits. This renewal process is called an annual redetermination. The Department of Health Care Services (DHCS) paused this process during COVID-19’s Public Health Emergency (PHE). Since the PHE is ending, the redetermination process is coming back again. You will need to complete your annual redetermination to keep your Medi-Cal coverage. For most members, Medi-Cal is automatically renewed. If your county cannot confirm all of your information to automate the renewal, a packet will be mailed to you. All forms inside this packet must be filled out and returned. Here are some ways you can return this information: ■ Over the phone. ■ By mail or by fax. ■ Going to your county’s Medi-Cal The yearly Medi-Cal eligibility process is back! Merced County 209-385-3000 Monterey County 877-410-8823 Santa Cruz County 888-421-8080 enrollment office and handing in your packet in-person. After you return your forms and requested documentation, the county will send you a letter letting you know if you still qualify to keep your Medi-Cal coverage. Important: If you do not complete this renewal process by the deadline, you could lose your Medi-Cal benefits. You only have 90 days after your Medi-Cal benefits expire to file for renewal. After the 90 days, you will have to submit a brand-new Medi-Cal application. If you have moved and haven’t updated your address with your county’s Medi-Cal enrollment office, you should contact them to update your information. It is important to make sure that your address on file is accurate so you receive your redetermination packet. If you do not hear anything from your county’s Medi-Cal enrollment office, you can contact them to check on the status of your redetermination. The contact information for your county’s enrollment office is below: Standard U.S. Postage PAID Walla Walla, WA Permit No. 44 Central California Alliance for Health 1600 Green Hills Road, Suite 101 Scotts Valley, CA 95066 June 2022 | VOLUME 28, ISSUE 2
Back-to-school immunizations The start of a new school year is almost here, and your child may need to be vaccinated before going back to school. Now is a great time to start planning for the next school year! You can start by calling your child’s doctor. Ask what vaccines your child needs and schedule an appointment. Appointments can be scheduled ahead of time, so call your child’s doctor today. Quality, awardwinning care for your child The Alliance is committed to meeting your child’s health care needs! Almost half of Alliance members are children and youth. We believe it is important to set children up for success so they can be as healthy as possible. The Alliance network offers: ■ High-quality care by your child’s doctor. ■ Excellent customer service. ■ Access to timely and needed care. The Department of Health Care Services (DHCS) recognized the Alliance with an award for outstanding children’s care in 2021. Our award-winning care for kids includes: ■ Well-child visits to check on your child’s overall health, growth and development. ■ Health education and disease-management classes in areas like weight management, diabetes and asthma. ■ Access to our 24/7 Nurse Advice Line. If your child is sick, you can call 844-971-8907 (TTY: Dial 7-1-1) to talk to a nurse. ■ Health andWellness Rewards for taking your child to the doctor for routine care. For example, when your child completes required immunizations, you could be entered into a raffle to win a Target gift card. Want to find out more about health care for your child? Call Member Services Monday through Friday, 8 a.m. to 5:30 p.m., at 800-700-3874 (TTY: Dial 7-1-1). You can also visit our website at www.thealliance.health. FOR MORE INFORMATION and resources, visit shotsforschool.org. 2 Living Healthy
Staying healthy— well-care visits for teens Throughout the COVID-19 pandemic, many families have been doing their best to stay home and help stop the spread of the coronavirus. During this time, many teens got behind on their annual well-care visits and immunizations. The American Academy of Pediatrics and the Centers for Disease Control and Prevention recommend that teens see their doctor at least once a year for their well-care visit. The teen years can be challenging for some, as teens experience many changes physically, mentally and emotionally. Well-care visits allow doctors to review growth, overall health and complete other types of screenings such as screening for depression, anxiety and substance abuse. These visits help prevent future illnesses, identify risky behaviors and ensure that teens are up-to-date with their immunizations. Don’t put off scheduling a well-care visit. Help your teen stay healthy and get routine care. We encourage you to call your teen’s doctor and schedule a visit, especially if it has been more than a year. Our doctors are committed to keeping our members safe and are providing options for getting care. American Sign Language (ASL) interpretation services at no charge to you Did you know that the Alliance offers American Sign Language (ASL) interpretation services at no cost for members who are deaf or hard of hearing? We work hard to make sure that all members can talk to their primary care provider about their health care needs. To learn about these services, please call the Health Education Line at 800-700-3874, ext. 5580. You can also use the California Relay Service’s (CRS) service to contact us at 800-735-2929 (TTY: Dial 7-1-1). 3 Living Healthy
Does my child have asthma? Learn the signs and symptoms As a parent, you know that a child’s cough can mean many things. It could be something as simple as a cold. But did you know it also could be asthma? Asthma is a common chronic disease in children. Although it usually starts before age 5, kids can be diagnosed with asthma at any age. And while any child (or adult) can have asthma, it is more likely in kids with risk factors, such as allergies or a family history of allergies or asthma. More than a cough In addition to coughing, the most common asthma warning signs and symptoms include: ■ Shortness of breath, especially with exercise. ■ Wheezing, a whistling sound from the chest when your child breathes out. ■ Chest tightness. Children may say their chest hurts. ■ Feeling tired or weak. With asthma, coughing and other signs and symptoms may be worse at certain times, such as at night or early in the morning; after laughing or crying; and when your child is around substances that may trigger their asthma, such as plant pollen, dust or pets. What’s more, kids with asthma may have trouble sleeping, playing or taking part in sports because of their breathing problems. So that’s something to watch for, too. Speak up If your child has signs and symptoms of asthma, let your child’s primary care provider know. Asthma is a serious disease. It puts kids at risk for asthma attacks. Severe asthma attacks can cause trips to the emergency department. And children can die from a severe attack. Fortunately, asthma can be controlled, and kids can feel better with the right treatment plan. That usually means taking asthma medicines and avoiding asthma triggers. We can help! The Alliance offers the Healthy Breathing for Life program for adults and children diagnosed with asthma. This program will help you and your child learn new ways to manage asthma. You will also learn how to avoid asthma attacks and how to best use your asthma medicine. Please call the Alliance Health Education Line for more information at 800-700-3874, ext. 5580. If you need language assistance, please call the Hearing or Speech Assistance Line at 800-735-2929 (TTY: Dial 7-1-1). This number is a special telephone line to get an interpreter who speaks your language, at no cost to you. Sources: American Academy of Allergy, Asthma & Immunology; American College of Allergy, Asthma & Immunology 4 Living Healthy
We are committed to your satisfaction! We want you to be happy with your health care and our services. But sometimes you might not be. When that is the case, we want to hear about it. If you are not happy with a doctor or the doctor’s office, it is best to talk to them first. Let someone in the office know what happened. Ask them for help to fix the problem. If you are not happy with your experience in a hospital or other facility, you can ask to speak with a nurse, social worker or patient advocate. If you are getting a bill for services covered by the Alliance, call the billing department at the number on your statement. Let them know you have the Alliance as your insurance and ask them to bill us directly. If you would rather talk to the Alliance about the problem, we are here to help. You may file a complaint (also called a grievance) if you are not happy with: ■ The care your doctor is providing or how you were treated in the office. ■ Being able to get the care you need. ■ The services you get from the Alliance. There are other reasons you might file a complaint with us. These are listed in your Member Handbook. You may file an appeal with us if you are not happy with: ■ A decision we have made to change or deny services. You can file a complaint or an appeal by calling Member Services at 800-700-3874. You can also file a complaint or appeal in writing or through our website at www.thealliance.health/for-members/member-services/ file-a-grievance. Once you let us know about your complaint or appeal, we will look into it. We will do all we can to help you. The information you share also helps us improve as an organization and helps our health partners. If you are still unhappy after we try to resolve your case, we will tell you what steps you can take next. 5 Living Healthy
Formulary updates If you are a Medi-Cal member, your prescriptions that are filled at a pharmacy are covered by Medi-Cal Rx, and not the Alliance. You can view the formulary for Medi-Cal Rx at medi-calrx.dhcs.ca.gov, or you can request a copy by calling 800-977-2273 (TTY: Dial 7-1-1), 24 hours a day, 7 days a week. If you are an IHSS member, pharmacy services are managed by MedImpact. You can view the formulary on the Alliance website at www.thealliance .health/for-providers/manage-care/ pharmacy-services/pharmacy -formulary. You can request a copy by calling Member Services at 800-700-3874 (TTY: 7-1-1), Monday through Friday, 8 a.m. to 5:30 p.m. If you have questions about a medication, call MedImpact at 800-788-2949. Medi-Cal older adult expansion Starting May 1, 2022, full-scope Medi-Cal is now available to adults 50 years and older, regardless of immigration status. Individuals applying for Medi-Cal will still have to meet all other eligibility rules. Full-scope Medi-Cal covers these health care services andmore: ■ Medical care. ■ Dental care. ■ Emergency care. ■ Mental health care. ■ Family planning. ■ Alcohol and drug use treatment. ■ Medicines and tests your doctor orders. ■ Medical supplies. If you were enrolled with restricted-scope Medi-Cal before May 1, 2022, and you are now 50 years of age or older, and live in Merced, Monterey or Santa Cruz counties, you are now eligible for full-scope Medi-Cal. This change will update automatically and you will be enrolled with the Alliance! For information on benefits provided by the Alliance, please refer to the Member Handbook located at www.thealliance .health/health-plan/medi-cal/medi-cal-member-handbook. You can also talk to someone in Member Services by calling 800-700-3874. If you have questions about your eligibility for benefits, please contact your county enrollment office at one of the numbers below. Merced County 209-385-3000 Monterey County 877-410-8823 Santa Cruz County 888-421-8080 6 Living Healthy
You have dental benefits! Your Medi-Cal plan offers dental benefits for both children and adults. The services are covered by the Medi-Cal Dental Program and not by the Alliance. You will need to show your Medi-Cal Benefits Identification Card (BIC) to your dental provider to receive dental services. For more information, or to find a dentist near you, you can: ■ Call the Medi-Cal Dental Program at 800-322-6384 (TTY: 800-735-2922). ■ Visit the Medi-Cal Dental website at dental.dhcs.ca.gov. Adverse childhood experiences (ACEs) and toxic stress Adverse childhood experiences (ACEs) are traumatic events in a child’s or teenager’s life. They are very common, and most adults have experienced at least one. ACEs can happen to anyone. Toxic stress is something that overwhelms you and can leave you feeling powerless and hopeless. These stressors are also considered to be ACEs. This is different from everyday stress, and too much can be unhealthy. This stress can affect the way a child’s body and mind grows, leading to health problems such as asthma, diabetes and heart disease. It can also affect behavior, learning and mental health. At your child’s next doctor appointment, the doctor may ask questions about your child’s exposure to these events or stressors. The doctor will ask about the following history: ■ Abuse (physical, emotional, sexual). ■ Neglect (physical, emotional). ■ Household instability (mental illness, incarcerated relative, substance abuse, divorce, sudden loss of a loved one). ■ Violence, bullying. These may be difficult questions to answer, but you only need to answer with a “yes.” The doctor may wish to talk to you more about some of the questions. This helps determine if you or your child is at an increased health risk. It also helps your doctor take better care of your child and to recommend additional services to make sure your child grows up healthy. 7 Living Healthy
Offices are open for member visits You can speak to an Alliance staff member in person. Merced County Office 530 West 16th Street, Suite B Merced, CA 95340 Monterey County Office 950 East Blanco Road, Suite 101 Salinas, CA 93901 Santa Cruz County Office 1600 Green Hills Road, Suite 101 Scotts Valley, CA 95066 Our hours for members to visit our offices may change. You can find our current hours on our website at www .thealliance.health/about-the-alliance/contact-us. You can also call us to ask about our hours or any other questions about your health plan. Call Member Services at 800-700-3874 (TTY: Dial 7-1-1) Monday through Friday, 8 a.m. to 5:30 p.m. The Alliance follows public health guidelines to keep members and staff healthy and safe. If you are feeling sick, stay home and call us instead. Follow us on Facebook! Find us at facebook.com/TheAllianceForHealth. Stay up-to-date with: ■ Tips and services for Medi-Cal members. ■ Local community information. ■ COVID-19 updates. LIVING HEALTHY is published for the members and community partners of CENTRAL CALIFORNIA ALLIANCE FOR HEALTH, 1600 Green Hills Road, Suite 101, Scotts Valley, CA 95066, telephone 831-430-5500 or 800-700-3874, ext. 5505, website www.thealliance.health. Information in LIVING HEALTHY comes from a wide range of medical experts. If you have any concerns or questions about specific content that may affect your health, please contact your health care provider. Models may be used in photos and illustrations. 2022 © Coffey Communications, Inc. All rights reserved. Communications Project Specialist Randi Motson Quality and Health Programs Supervisors Desirre Herrera and Mao Moua www.thealliance.health Living Healthy
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