Covered California Certified Enroller Practice Exam

If a consumer in a Medi-Cal managed care plan has a service or plan problem, which entity should they contact?

1. California Department of Insurance

2. Medi-Cal Managed Care Ombudsman

3. California Department of Social Services

4. Department of Health and Human Services

The correct answer is: Medi-Cal Managed Care Ombudsman

The Medi-Cal Managed Care Ombudsman is the correct entity for consumers to contact regarding service or plan problems within a Medi-Cal managed care plan. This ombudsman is specifically designated to assist Medi-Cal beneficiaries by providing information and guidance on their rights and responsibilities, as well as helping to resolve issues related to the managed care plans. The Ombudsman plays a crucial role in advocating for the interests of consumers and ensuring they receive the services they are entitled to under Medi-Cal. In contrast, other entities listed do not focus specifically on the issues arising from Medi-Cal managed care plans. For instance, the California Department of Insurance primarily oversees insurance companies and brokers, addressing issues related to various types of insurance, but not specifically for Medi-Cal problems. The California Department of Social Services manages public assistance programs and social services, but it does not handle the grievances related to managed care within Medi-Cal. The Department of Health and Human Services covers a broader range of health-related services at the state and federal levels but lacks the specific focus and advocacy role that the Medi-Cal Managed Care Ombudsman has for beneficiaries experiencing service or plan-related problems.