Living Healthy A newsletter for the members of Central California Alliance for Health Taking care of your mental health is an important part of your overall health and wellness. The holidays can be a lonely or stressful time. If you are feeling sad, anxious or depressed or you are struggling with substance use, know that you are not alone! We can refer you to resources to help. Alliance Medi-Cal members can get mental health care through our partner, Beacon Health Options. Beacon will help you: ■ Understand your mental health benefits. ■ Find mental health providers in your area. ■ Help you make an appointment. If you or a family member is having a mental health crisis or having thoughts of suicide, call or text the suicide prevention number at 988. This December 2022 | VOLUME 28, ISSUE 4 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 Your mental health matters! service is available in English and Spanish. If you are having a mental health emergency, call 911 or go to the nearest emergency room. Our website has more resources for mental health support at www.thealliance.health/mentalhealth. How to get mental health services Call Beacon Health Options at 855-765-9700. This toll-free number is available 24 hours a day, 7 days a week. For substance use disorder services, contact your county’s Behavioral Health department: Merced County: 888-334-0163 Monterey County: 888-258-6029 Santa Cruz County: 800-952-2335 You can also get help by calling the Alliance’s Member Services at 800-700-3874 (TTY: Dial 7-1-1), Monday through Friday, 8 a.m. to 5:30 p.m.
2 Living Healthy What members like and want from their health care Earlier this year, the Alliance asked members like you what you thought about the care and services you received. This was done through an annual survey called the Population Needs Assessment (PNA). This is a summary of what we heard. You shared that: ■ Your primary care provider (PCP) is good at scheduling appointments with a specialist when you need to see one. ■ You have enough support from us to help your child lose weight. You also shared that you are interested in receiving information or help from us on the following topics: ■ How to use our transportation services. Call the Alliance at 800-700-3874, ext. 5577 (TTY: Dial 7-1-1), Monday through Friday from 8 a.m. to 5:30 p.m. Call at least five business days before your doctor appointment. ■ How to ask the Alliance a question about your health plan. Call Member Services at 800-700-3874, Monday through Friday from 8 a.m. to 5:30 p.m. ■ How to choose a doctor. Our website shows you how to find and choose a doctor at www.thealliance.health/ find-a-doctor. If you need help, you can call Member Services at 800-700-3874, Monday through Friday from 8 a.m. to 5:30 p.m. ■ Who to call at night when you or your child is sick. You can talk to a nurse by calling 844-971-8907 (TTY: Dial 7-1-1). The Nurse Advice Line is available 24 hours a day, 7 days a week at no cost to you. We will continue to improve the ways we share information about the programs and services we offer. If you have questions about the Alliance 2022 PNA, please call the Alliance Health Education Line at 800-700-3874, ext. 5580. If you need language assistance, we have a special telephone line to get an interpreter who speaks your language, available to you at no cost. For the Hearing or Speech Assistance Line, call 800-735-2929 (TTY: Dial 7-1-1). Formulary updates If you are a Medi-Cal member, your prescriptions that are filled at a pharmacy are covered by MediCal Rx, not the Alliance. You can view the formulary for Medi-Cal Rx at www.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/prescriptions. You can request a copy by calling Member Services at 800-700-3874 (TTY: Dial 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.
3 Living Healthy COVID-19 vaccine approved for children ages 6 months through 5 years COVID-19 continues to impact our families and communities. We have learned that one of the best ways to protect ourselves and our families is to get the COVID-19 vaccine. The COVID-19 vaccine helps lower the risk of a person getting very sick, being hospitalized or dying from COVID-19. The COVID-19 vaccine is now available for children ages 6 months through 5 years old. Now our youngest family members can be protected. Children can get vaccinated at their doctor’s office, pharmacies or COVID-19 vaccine clinics available in your community. The Alliance recommends calling your child’s doctor to request the COVID-19 vaccine so you can also check if your child is up-to-date on other vaccines and health check-ups. If your child is not able to see the doctor, visit myturn.ca.gov to find a walk-in location or schedule an appointment for the COVID-19 vaccine, including family appointments. You can protect yourself and your loved ones this holiday season by getting your COVID-19 vaccine! COVID-19 MEDICINE Evusheld™ can help protect immunocompromised people There is a medicine called Evusheld™ that may help prevent immunocompromised people ages 12 years and older from getting COVID-19. “Immunocompromised” means that someone has a weakened immune system. Evusheld™ is given in two injections and is recommended every six months. It is available at no cost to Alliance members. Evusheld™ is for people who have a higher risk for severe COVID-19 disease and complications. You can get Evusheld™ medication if you have not been exposed to COVID-19 recently and you: ■ Are moderately to severely immunocompromised because of a medical condition. ■ Cannot get a COVID-19 primary series or booster because you have a history of a severe reaction to COVID-19 vaccine(s) or COVID-19 vaccine ingredient(s). ■ Have taken medicines or treatments that suppress the immune system. You may not be able to get the Evusheld™ treatment if you: ■ Have allergies. ■ Have a bleeding disorder. ■ Have a low number of platelets. ■ Have a history or risk of heart attack or stroke. ■ Are pregnant or plan to become pregnant. ■ Are breastfeeding. Questions? If you have an immunocompromising condition or are taking immunosuppressing treatment, contact your doctor to see if Evusheld™ is right for you.
To find out if you qualify or to get more information, contact your local county office: Merced County: Ca ll 855-421-6770 or visit www.co.merced.ca.us/458/Medi-Cal. Monterey County: Call 866-323-1953 or visit www.co.monterey.ca.us/ government/departments-i-z/social-services/community-benefits#medi-cal. Santa Cruz County: Call 888-421-8080 or visit www.santacruzhumanservices.org/ EmploymentBenefits/MediCalHealthBenefits. YOU AND YOUR HEALTH are important to us! Please call us at 800-700-3874 (TTY: 800-735-2929 or 7-1-1) if you have questions, need help or have concerns about your care. We’re here to help! 4 Living Healthy On July 1, 2022, Medi-Cal raised the asset limit for people who are 65 or older and people with disabilities. These changes apply to things you own that can be counted for Medi-Cal eligibility. Under the new asset limits, you can own up to $130,000 in assets and still get Medi-Cal insurance. For each family member, you can own an additional $65,000 in assets and still qualify for Medi-Cal. If you qualify for Medi-Cal in Merced, Monterey or Santa Cruz counties, the Alliance will be your health plan! Service with a smile! Have you ever wondered who is on the other end of the phone when you call Member Services? Our representatives are caring, dedicated professionals. They are here to answer your calls Monday through Friday from 8 a.m. to 5:30 p.m. Our representatives are ready to: ■ Help you understand how your health plan works. ■ Answer questions about your benefits. ■ Explain how you can get medical care and services. ■ Let you know which doctors and clinics you can go to. ■ Help you choose or change your primary care provider (PCP). ■ Offer interpreter services if you do not speak English. ■ Help arrange transportation if you do not have ways to get to your doctor appointment. ■ Send you a new Alliance Member ID card if you lose yours. ■ Assist you with concerns or complaints. We have representatives in Merced, Monterey and Santa Cruz counties who live and work in the communities we serve. They care about our members and are here to help. Medi-Cal members can keep more assets because of limit changes
5 Living Healthy Update your Medi-Cal! Have you moved? Did you have Medi-Cal coverage during the pandemic? If so, you will need to update the Medi-Cal office in your county with any changes to your information. Here is what you need to know: Your county may check to see if you can renew your Medi-Cal coverage. Don’t wait for your county to contact you. If there have been any changes to your circumstances or contact information, your local office in Merced, Monterey or Santa Cruz County needs to know. You can report changes to the county by phone, mail, online or in person. Report any of the following changes: ■ Your income. ■ Disability status. ■ Phone number. ■ Mailing address. ■ If someone in your household becomes pregnant. ■ If someone moves into your home. ■ Anything else that may affect your Medi-Cal eligibility. Here is the office to contact for each county. Make sure your county has your current information: Merced County Department of Human Services Phone: 855-421-6770 Monterey County Department of Social Services Phone: 877-410-8823 Santa Cruz County Human Services Department Phone: 888-421-8080 You can also update your contact information online at www.CoveredCA.com or www.BenefitsCal.com. Workshops for healthier living! Living with a chronic condition like diabetes, depression or high blood pressure can be hard. Join a Healthier Living Program (HLP) workshop and learn skills to better manage your health. The Alliance HLP workshops are health and wellness sessions where members learn how to manage pain, fatigue, stress, anxiety and sleep loss. Members also learn about healthy eating, staying active, building relationships and improving their quality of life. The Alliance offers HLP workshops in three different ways: ■ In person at locations in your community. Join us at an HLP workshop! Call the Alliance’s Health Education Line at 800-700-3874, ext. 5580 to sign up. Here’s what our members are saying about the HLP workshops: “I learned something huge…I learned that I need to do selfcare. I have never stopped to take care of my own needs.” “Attending this workshop has helped me get ideas on how to better communicate with my doctor about my health concerns.” “I learned different ways to deal with stress and anxiety. It was also nice meeting other people in the class and getting advice from them.” ■ Over the phone with weekly phone call meetings. ■ Virtually with weekly online meetings.
A real-life example Recently, an Alliance member called the Nurse Advice Line for their 4-yearold child with COVID-19 symptoms. The member called the Nurse Advice Line instead of going to the Emergency Department because it was not a medical emergency. The member told us that the nurse from the Nurse Advice Line listened to their concerns, was caring and helped them with what to do next. 6 Living Healthy If you or your child is sick or have questions about your health, you can call the Nurse Advice Line 24 hours a day, 7 days a week. The Nurse Advice Line is a service available to all Alliance members at no cost to you. When do I call the Nurse Advice Line? Call the Nurse Advice Line when: ■ You or your child is sick, and you can’t reach or get an appointment with your doctor. ■ You are not sure if you should go to the emergency room. ■ You have questions about your health or your child’s health. ■ You are under 18 years old and want to talk in private about your health concerns. A registered nurse will give you advice on what to do next. The nurse can also help you: ■ Make an appointment with your primary care provider (PCP). ■ Make decisions on when and how to seek medical care for an urgent need. Call 844-971-8907 (TTY: Dial 7-1-1) to talk to a nurse. When you call: If you have your Alliance Member ID card with you, have it ready to tell the nurse your ID number. Members who provide their ID number will be entered into a monthly raffle. You could win a $50 Target gift card. What is the Nurse Advice Line? Remember: If you are having a medical emergency, call 911 or go to the nearest emergency room.
You don’t have time for the flu By getting your flu vaccine, you can help prevent yourself from getting the flu. You can also decrease your chance of spreading the flu to others. Everyone 6 months of age and older can get the flu vaccine, unless their doctor advises otherwise. People under age 19 need to get the flu vaccine at their doctor’s office. Children 7 to 24 months old who get their two flu vaccines between September 2022 and May 2023 will be entered into a monthly raffle for a $100 Target gift card! Alliance members can get a flu vaccine at no cost. Make a flu vaccine appointment or get a flu vaccine at a walk-in location today. For more information, visit www.thealliance.health/flu/. 7 Living Healthy Where should I get care? Whether you need a simple check-up or have a medical emergency, there are many places where you can get care. It is important to choose the best option so you can get healthy and stay healthy. If you are sick or have a small injury: Go see your primary doctor. You should always call your doctor first for an appointment. They may have video appointments or available times that may work best for you. Your doctor is listed on your Alliance Member ID Card. If you are not sure who your doctor is, please call Alliance Member Services at 800-700-3874 (TTY: 800-735-2929 or 7-1-1), Monday through Friday from 8 a.m. to 5:30 p.m. If you can’t see your doctor: Some conditions can be treated right away. The emergency room does not need to be your first option. You can: ■ Call the Nurse Advice Line: Call the Alliance Nurse Advice Line for help with what to do next for you or your child. Call 844-971-8907 (TTY: Dial 7-1-1). ■ Go to urgent care: Go to urgent care when you are sick or have an injury that does not appear to be life-threatening but can’t wait until the next day. This can be for fevers and colds, vomiting and nausea, pain with urination, mild asthma, or minor cuts. Life-threatening emergencies If you do have a life-threatening condition, such as shortness of breath, chest pain, seizures, severe allergic reactions, slurred speech, or sudden numbness and weakness, go to the emergency room.
FOR A COMPLETE LIST of services that do not need a referral, see your Evidence of Coverage or Member Handbook. The Member Handbook is available to view on our website: www.thealliance.health/memberhandbook. Confused by referrals and authorizations? We can help! We want to make sure you know how to get services that are covered by your health insurance. Below are some important words and what they mean. Referral: If you are assigned to an Alliance primary care provider (PCP), you must have a referral to see another doctor. ■ If your primary care provider thinks you need to see another doctor, they will fill out a Referral Consultation Form. ■ If we don’t have a referral, we can’t pay the bill or claim from the other doctor. Authorized referral: Our service areas are Merced, Monterey and Santa Cruz counties. If your PCP refers you to a doctor out of our service area, they will need to get approval from the Alliance ahead of time. This is called an authorized referral. ■ This means that we need to approve the referral before you can see the other doctor. ■ If you are an Alliance In-Home Supportive Services (IHSS) member, you will also need an authorized referral if your primary care provider is referring you to a doctor who doesn’t work with the Alliance—even if the doctor is in our service area. ■ Alliance members who are enrolled in the California Children’s Services (CCS) Program will also need an authorized referral for specialty care. Prior authorization: The Alliance must approve some services, procedures, medications and equipment before you get them. This is called prior authorization. ■ The provider who is going to perform the service must send us a request to let us know what you need and the reason why. ■ If the service, procedure, medication or equipment is medically necessary and a covered benefit, we will approve the request. ■ If we deny a request, you will be able to file an appeal if you disagree with our decision. Living Healthy Follow us on Facebook! Find us at www.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
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