What is Medi-Cal?
Medi-Cal is a no-cost or low-cost health coverage program. It provides health, dental and vision* coverage to qualified low-income California residents.
Who Can Apply for Medi-Cal and Join IEHP?
- People who live in our service area (most of Riverside and San Bernardino counties)
- Adults with or without children, children, seniors, and people with a disability
- People who meet income guidelines and other program requirements
How Much Will I Pay?
Adults pay no monthly premium for Medi-Cal coverage. Children with Medi-Cal coverage under the Children’s Health Insurance Program (CHIP) will have a low monthly premium.
What Care Will I Get with Medi-Cal Through IEHP?
Your plan coverage includes:
How do I apply for Medi-Cal:
Call the IEHP Enrollment Advisors at (888) 860-1298, Monday – Friday, 8am – 5pm. TTY users should call (800) 720-4347.
You may also call Health Care Options at 1-800-430-4263 or visit or visit www.healthcareoptions.dhcs.ca.gov. TTY users should call 1-800-430-7077.
Important Reading for IEHP Medi-Cal Members
- Medi-Cal Member Handbook (PDF): explains how to get care with IEHP and plan covered benefits.
- Medi-Cal Formulary (PDF): lists what prescription drugs are covered under Medi-Cal.
- Medi-Cal Provider and Pharmacy Directory (PDF): lists our growing network and options to get needed care quickly – day and night.
What does my health plan cover?
This page explains your covered services as a Member of IEHP. Your covered services are at no cost if they are medically necessary, and you get the approved services from our Provider network. “Medically necessary” means it is reasonable and needed to protect life, to keep you from becoming seriously ill or disabled, or to reduce pain from a diagnosed disease, illness or injury.
To learn more about IEHP’s benefits and services, read Chapter 4 of the IEHP Medi-Cal Member Handbook (PDF) or contact IEHP Member Services at (800) 440-IEHP (4347), TTY (800) 718-4347.
IEHP offers these types of services:
- Outpatient (ambulatory) services*
- Emergency services
- Transgender services*
- Hospice and palliative care*
- Maternity and newborn care
- Mental health services
- Prescription drugs
- Rehabilitative and habilitative services and devices*
- Laboratory and radiology services, such as X-rays*
- Preventive and wellness services and chronic disease management
- Sensitive services
- Substance use disorder treatment services
- Pediatric services
- Vision services*
- Non-emergency medical transportation (NEMT)
- Non-medical transportation (NMT)
- Long-term services and supports (LTSS)
- Telehealth services
Some of the services listed are covered only if IEHP or your IPA approves first. Covered services that may need an approval from IEHP or your IPA or medical group first are marked by an asterisk (*).
The plan covers:
- Routine eye exam once every 24 months; IEHP may pre-approve (prior authorization) additional services as medically necessary.
- Eyeglasses (frames and lens) once every 24 months; contact lens when required for medical conditions such as aphakia, aniridia and keratoconus
- Single vision lenses only.
- Members under 18 automatically get polycarbonate lenses.
- Contacts in lieu of glasses only if medically necessary.
Your provider can prescribe you drugs that are on the IEHP preferred drug list. This list is also called a Formulary. Drugs on the IEHP Formulary are safe and effective. To find out if a drug is on the Formulary or to get a copy of the IEHP Formulary mailed to you, call IEHP Member Services at 1-800-440-IEHP (4347) / TTY (800) 718-4347.
Sometimes IEHP needs to approve a drug before a provider can prescribe it. IEHP will review and decide on these requests within 24 hours.
- A pharmacist or hospital emergency room may give you a 72-hour emergency supply if they think you need it. IEHP will pay for this supply.
- If IEHP denies to the request, IEHP will send you a letter that tells you why and what other drugs or treatments you can try instead.
Exclusions and Limitations
IEHP does not cover:
- Drugs or medicines prescribed solely for cosmetic reasons
- Over-the-counter medicines (unless approved by IEHP)
- Non-FDA approved medicines
- Investigational medicines
- Medicines excluded from the Federal coverage (i.e., erectile dysfunction drugs)
- Medicines carved out by Fee-for-Service Medi-Cal
- Therapies and medical equipment excluded from the Federal coverage or carved out by
- Fee-for-Service Medi-Cal (i.e., erectile dysfunction medical equipment)
If you fill or refill a prescription, you must get your prescribed drugs from a pharmacy that works with IEHP. You can find a list of these network pharmacies in the IEHP Provider Directory. You can also use the IEHP Provider Search tool on our website or you can call IEHP Member Services at 1-800-440-IEHP (4347) / TTY (800) 718-4347.
Once you choose a pharmacy, take your prescription there. Give them your prescription, along with your IEHP Member ID card. Make sure they know all the medicines you take and any allergies you have. If you have any questions about your medicines, make sure you ask the pharmacist.
The Medi-Cal Dental Program covers some dental services, such as:
- Diagnostic and preventive dental hygiene (e.g., examinations, x-rays, and teeth cleanings)
- Emergency services for pain control
- Tooth extractions
- Root canal treatments
- Prosthetic appliances
- Orthodontics for children who qualify
Members can access dental services through providers enrolled in the Medi-Cal Dental Program. They will advise you on the best course of treatment and when these services may be attained.
Your Medi-Cal benefits include round trip transportation for plan-covered health services and Medi-Cal-covered services, such as mental health, substance abuse and dental, within San Bernardino and Riverside counties.
The plan covers:
- Visits to your Primary Care Doctor, Specialists and urgent care clinics.
- Visit for dental, mental health, substance abuse and other services.
Exclusions and Limitations
IEHP does not cover:
- One-way trips and non-medical visits.
- Visits to Social Security, Workers Compensation Claims, Personal Injury cases, Courts, Parole or Probation or Social Services Offices.
IEHP offers two types of transportation:
- Bus passes* for Non-Medical Transportation (NMT): approved when you do not have any physical or medical issue that does not allow you to travel by bus, car, taxi or other forms of public transportation.
- Uber for Non-Medical Transportation (NMT): approved when your area doesn’t support bus passes, or you are crossing counties. For this type of transportation, you need to wait for your ride at the curb.
- Non-Emergent Medical Transportation (NEMT): approved when your medical or physical issue does not allow you to travel by bus, car, taxi or other forms of public transportation. For this type of transportation, your Doctor must submit a Physicians’ Certification Statement online.
Effective March 1, 2020, transportation for routine medical visits including Behavioral Health and Substance Use must be scheduled five business days before your appointment. To set up transportation, call IEHP Transportation Department at 1-800-440-4347 (option two), Monday – Friday, 8am – 5pm. TTY users should call 1-800-718-4347 (option two).
*For bus passes, call American Logistics Company at 855-673-3195 selection option 1. Once you get your bus pass, you can use this for all of your health care visits.
Early and Periodic Screening, Diagnostic and Treatment (EPSDT)
Who can get preventive care services?
IEHP Members who are infants, children, and youth up to age 21 can get these services at no cost.
What are preventive care services?
Services that ensure that infants, children, and youth under age 21 get the care they need at the right age. This includes screenings for medical, dental, vision, hearing, mental health, and substance use disorders. You or your child may also get developmental services, specialty care, and needed vaccines to keep you healthy.
IEHP covers screenings (including lead blood-level assessment) any time you need them at no cost to you.
Check-ups and screenings can help Doctors find health issues early. If a physical or behavioral health issue is found during a check-up or screening, IEHP will cover the care needed to address it.
How do I get preventive care services?
Set up a visit for any check-ups, screenings or other preventive care through your or your child’s Doctor.
To learn more about preventive care services, please call IEHP Member Services at 1-800-440-IEHP (4347) (TTY 1-800-718-4347), Monday – Friday from 8am – 5pm.
How to Get Care
New Members must choose a Primary Care Provider (PCP) in the IEHP network. The IEHP network is a group of Doctors, hospitals and other providers who work with IEHP. You must choose a PCP within 30 days from the time you become an IEHP Member. If you do not choose a PCP, IEHP will choose one for you. You may choose the same PCP or other PCPs for all family members in IEHP.
If you have a Doctor you want to keep, or you want to find a new PCP, you can look in the IEHP Provider Directory. To help you choose the right one for you, PCPs listed in the IEHP network include their name, address, phone number, specialty, etc.
If you change PCPs, you will get a new IEHP Member ID card in the mail. It will have the name of your new PCP. To change your PCP, call IEHP Member Services at 1-800-440-IEHP (4347) / TTY (800) 718-4347.
Do you identify as Transgender or Gender Diverse?
You are not alone. The transgender and gender diverse population of the Inland Empire has been estimated at almost 27,000 people. At Inland Empire Health Plan (IEHP), we want you to get all the care you need with the respect you deserve. IEHP covers all medically necessary Medi-Cal covered Gender Health services. IEHP has Doctors and Specialist who have experience in gender health services. Call IEHP Member Services to find out more.
How to Get Started
See your IEHP PCP on a regular basis.
- If you have not seen your Doctor yet or in a long time, set up a visit today. Your Doctor, the key to your overall health care, knows your health history and helps make sure you get the care you need.
- Your Doctor can refer you to Specialists, if needed. This includes any gender health options that meet your medical needs, so share your treatment goals with your Doctor.
- You can change your IEHP Doctor at any time.
Talk to your Doctor about these Gender Health Benefits:
- Behavioral Health Services
- Hormone Replacement Therapy
- Surgeries and Procedures
IEHP has a dedicated team of Care Managers who are familiar with Gender Health services and are ready to help with:
- Referrals to see a specialist
- Getting medical supplies
- Getting medicines
- Connecting you to community resources
IEHP also provides non-clinical resources such as:
- Care Coordination
- Community and Legal Resources
- Demographic updates
- Family Support Groups
For education and training on gender health care, please access the following resources:
Behavioral Health Treatment
Effective July 1, 2018, Behavioral Health Treatment is no longer a covered benefit solely for Members Diagnosed with Autism Spectrum Disorder. The coverage criteria have been expanded to include IEHP Members who meet ALL the below:
- Under 21 years of age
- Have a recommendation from a licensed physician and surgeon or a licensed psychologist that evidence based BHT services are medically necessary.
- Be medically stable
- Not need 24-hour medical/nursing monitoring or procedures provided in a hospital or intermediate care facility for persons with intellectual disabilities.
Behavioral Health Treatment (BHT) is the design, implementation and evaluation of environmental modifications, using behavioral stimuli and consequences, to produce socially significant improvement in human behavior, including the direct observation, measurement and functional analysis of the relations between environment and behavior.
BHT services teach skills using behavioral observation and reinforcement, or through prompting to teach each step of targeted behavior. BHT services are based on reliable evidence and are not experimental. Treatment may or may not include Applied Behavioral Analysis (ABA).
BHT is medically necessary after the Provider has completed a comprehensive developmental surveillance and screening, and have recommended BHT services is clinically warranted to treat persistent developmentally inappropriate behavior and/or diagnoses that may be able to be corrected or ameliorated with BHT services. Aberrant behaviors include but are not limited to self-injury, aggression, and deficits in language skills, daily living skills, and social skills.
PCPs will continue to referral a Member directly to IEHP Behavioral Health for any BHT services and/or diagnostic needs regardless of IPA.
If you have any questions or ask your PCP for screening, diagnosis and treatment, you can call IEHP Member Services at 1-800-440-IEHP (4347) / TTY (800) 718-4347, Monday – Friday, 8am – 5pm.
Cost to Member
There is no cost to the Member for these services.
Visit IEHP's Mental Health page for general mental health information.
Long Term Services and Supports (LTSS)
IEHP covers Long-Term Services and Supports (LTSS) for eligible Members to help them live independently in the community. You may qualify for the LTSS services listed below.
In-Home Supportive Services (IHSS)
If you have a disability, are blind, or over 65 years old and not able to live in your home without help, you may qualify. Get help around the house and other daily care needs. With IHSS, you find your own caregivers to help with:
- Cooking meals and cleaning up
- Personal care services (such as bowel and bladder care, bathing, and grooming)
- Laundry and household cleaning, grocery shopping and errands, rides to Doctors visits
To learn more about IHSS:
San Bernardino County In-Home Supportive Services
(909) 252-4703 TTY, Monday-Friday, from 8am – 5pm
Riverside County In-Home Supportive Services
(888) 960-4477 (TTY 711), Monday - Friday, from 8am – 5pm
Multipurpose Senior Services Program (MSSP)
MSSP is a case management program that provides Home and Community-Based Services to Medi-Cal eligible individuals.
To be eligible, you must be 65 years of age or older, live within a site’s service area, be able to be served with MSSP’s cost limitations, be appropriate for care management services, currently eligible for Medi-Cal, and certified or certifiable for placement in a nursing facility.
- Adult day care/support center
- Housing assistance
- Chore and personal care assistance
- Protective supervision
- Care management
- Meal Services
- Social Services
This benefit is covered up to $4,285 per year.
To learn more about MSSP:
San Bernardino County Multipurpose Senior Services Program
(877) 565-2020, 24-Hour Hotline
(909) 891-3900 TTY, Monday-Friday, from 8am – 5pm
Riverside County Multipurpose Senior Services Program
(951) 697-4699 TTY, Monday-Friday, 8am – 5pm
Community Based Adult Services (CBAS)
CBAS is an outpatient, facility-based service program where people attend based on a schedule. It offers skilled nursing care, social services, therapies (including occupational, physical, and speech), personal care, family/caregiver training and support, nutrition services, transportation, and other services. We will pay for CBAS if you meet the eligibility criteria.
Nursing Facility (NF)
A NF is a place that provides care for people who cannot get care at home but who do not need to be in a hospital.
- Nursing care
- Care management
- Bed and board (daily meals)
- X-ray and laboratory
- Physical, speech and occupational therapy
- Drugs given to you as part of your plan of care.
To learn more about these programs, call IEHP Member Services and ask for the Long-Term Services and Supports (LTSS) Unit.
Caregiver Resources in the Inland Empire
By clicking on any of the links below, you will be leaving the IEHP website.
Inland Caregiver Resource Center
1430 E Cooley Dr.
Colton, CA 92324
Services: Information and referral, family consultation, support groups, short-term counseling, educational workshops, respite and supplemental services.
Alzheimer’s Greater Los Angeles
002 Iowa Ave, Suite 1072
Riverside, CA 92509
Services: information and referral, 24/7 Hotline, Care Counselors, Early Stage Services, Memory Mornings, Support Groups, Community Education, and Advocacy.
600 West Fifth St.
San Bernardino, CA 92410
Senior Companions provide support to family caregivers. They assist with grocery shopping, transportation to medical appointments, meal preparation, encouraging clients to participate in daily activities, reminiscing, providing companionship and love.
San Bernardino County Department of Aging and Adult Services
686 E. Mill St.
San Bernardino, CA 92415
Services: Adult Protective Services, Family Caregiver Support, Long-Term Care Ombudsmen, Nutrition Services, Senior Employment Program, Information and Assistance
Riverside County Office on Aging
6296 River Crest Dr., Suite K
Riverside, CA 92507-0738
Services: Care Coordination, Caregiving Resources, Care Transitions Intervention (CTI), Elder Abuse Education, Health Insurance Counseling and Advocacy Program (HICAP), Fit After 50, Grandparents Raising Grandchildren, Health Promotion, Legal Assistance, Nutrition, Senior Employment, Volunteer Services
Community Access Center
6848 Magnolia Avenue, Suite 150
Riverside, CA, 92506
Services: supportive services and independent living skills training.
1955 S. Hunt Street, Suite 101
San Bernardino, CA 92408
Services: disability information and referral, housing, independent living skills training, assistive technology, and advocacy.
3200 Inland Empire Blvd., Suite 280
Ontario, CA 91764
Palm Desert Office
74020 Alessandro Dr., Suite A
Palm Desert, CA 92260
Rights and Responsibilities as a Member of IEHP Medi-Cal
As an IEHP Member you have the following rights:
- To be treated with respect, giving due consideration to your right to privacy and the need to maintain confidentiality of your medical records.
- To be given information about the plan and its services, including Covered Services, Practitioners, Providers, and Member rights and responsibilities.
- To be able to choose a PCP within IEHP’s network.
- To take part in decisions about your health care, including the right to refuse treatment.
- To voice grievances, verbally or in writing, about the organization or the care given.
- To provide feedback about the organization’s Member rights and responsibilities policies.
- To get care coordination.
- To request an appeal of decisions to deny, defer or limit services or benefits.
- To get oral interpretation services for their language.
- To get free legal help at your local legal aid office or other groups.
- To create advance directives.
- To have access to family planning services, Federally Qualified Health Centers, Indian Health Service Facilities, sexually transmitted disease services and Emergency Services outside IEHP’s network pursuant to federal law.
- To request a State Hearing, including instructions on how an expedited hearing is possible.
- To have access to, and where legal and appropriate, get copies of, amend or correct your Medical Record.
- To disenroll upon request. Members who can request expedited disenrollment include, but are not limited to, those getting services under the Foster Care or Adoption Assistance Programs and those with special health care needs.
- To access Minor Consent Services.
- To get written Member-informing materials in other formats (such as braille, large-size print and audio) upon request and in a timely fashion appropriate for the format being requested and in accordance with Welfare & Institutions Code Section 14182 (b)(12).
- To be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation.
- To learn about and discuss available treatment options and alternatives with regard to cost or benefit coverage, presented in a manner appropriate to your condition and ability to understand.
- To get a copy of your medical records, and request amendments or corrections, as specified in 45 Code of Federal Regulations §164.524 and 164.526.
- To freely exercise these rights without adversely affecting how you are treated by IEHP, Providers or the State.
- To have access to family planning services, Freestanding Birth Centers, Federally Qualified Health Centers, Indian Health Service Facilities, midwifery services, Rural Health Centers, sexually transmitted disease services and Emergency Services outside IEHP’s network pursuant to the federal law.
- If you have been getting care from a health care provider, you may have a right to keep him or her for a certain time period. Please contact IEHP Member Services, and if you have more questions, please contact the Department of Managed Health Care, which protects HMO consumers, by telephone at its toll-free number, 1-888-466-2219 (TTY) 1-877-688-9891, or online at https://www.dmhc.ca.gov/.
As a Member of IEHP, you are responsible to:
- Be familiar with and ask questions about your health plan options, your health plan coverage limitations and exclusions, rules about the use of network providers, coverage and exclusions, rules, appropriate process to obtain information and process to appeal coverage decisions. If you have a question about your coverage, call IEHP Member Services at 1-800-440-IEHP (4347) / TTY (800) 718-4347.
- Follow the advice and care procedures requested by your Doctor and IEHP. If you have a question about these procedures, call IEHP Member Services at (1-800-440-IEHP (4347) / TTY (800) 718-4347.
- Request interpreter services at least 5 working days before a scheduled appointment.
- Call your Doctor or pharmacy at least 3 days before you run out of medicine.
- Cooperate with your Doctor and staff and treat them and other patients with respect. This includes being on time for your visits or calling your Doctor if you need to cancel or set up a new appointment.
- Understand that your Doctor’s office may have limited seating for patients and caregivers only.
- Give accurate data to IEHP, your Doctor, and any other provider. This helps you get better care.
- Understand your health care needs and be part of your health care decisions. Ask your Doctor questions if you do not understand.
- Work with your Doctor to make plans for your health care.
- Follow the plans and instructions for care that you have agreed on with your Doctor.
- Notify IEHP and your Doctor if you want to stop the plans and instructions you have agreed on or no longer want to participate in health management programs.
- Immunize your children by age 2 years and always keep your children’s vaccines up to date.
- Call your Doctor when you need routine or urgent health care.
- Care for your own health. Live an active life, exercise, have a good diet, and don’t smoke.
- Avoid knowingly spreading disease to others.
- Use IEHP’s grievance process to file a complaint. Call IEHP Member Services at 1-800-440-IEHP (4347) / TTY (800) 718-4347 to file a complaint (grievance or appeal).
- Report any fraud, waste or abuse to IEHP by calling the Compliance Hotline at (866) 355-9038 or the proper authorities.
- Understand that there are risks in getting health care and limits to what can be done for you medically.
- Understand that it is a health care provider’s duty to be efficient and fair in caring for you as well as other patients.
Open Access Program
If you’re a foster parent, IEHP applauds you. You’re giving a child a chance at a better life, and a better future. Many children enter foster care with a list of physical or behavioral health concerns. Due to changing placements, these concerns often go untreated. By speeding up the process to see a Doctor, the Open Access Program makes it simple for your child to get ongoing medical care. No matter where you live in the Inland Empire, your child can see any Doctor in the network. Plus, our program gives your child many services you won’t find with the Regular Medi-Cal system.
How Open Access makes it simpler for your child to get healthcare:
- Your child can see any PCP in our large network.
- You can switch Doctors any time, for any reason. IEHP will help you find one. Call 1-800-440-IEHP (4347) / TTY (800) 718-4347.
- The Program gives your Doctor a record of your child’s health history (shots, medicines, checkups) so there’s no guesswork.
- If you misplaced your IEHP Member ID Card or Beneficiary Identification Card (BIC), an Open Access Doctor can go online and quickly confirm your child’s eligibility.
You and your child get extra services at no cost:
- Keep your child feeling well with no-cost Wellness Programs like asthma or diabetes.
- Keep your child safe and healthy and get extras a parent enjoy like an infant car seat, children’s vitamins, and a bicycle helmet.
- A team helps you care for your child with a chronic illness. Working with your child’s Doctor, we call you, making sure your child gets the right care. We even lend a hand if things like Doctor visits, lab tests or medicine pile up.
Get Health Advice at Night
When you can’t reach your Doctor after hours, call the IEHP 24-Hour Nurse Advice Line. You’ll get the advice you need – until you can see your child’s Doctor.
Find out more about the Open Access Program by calling an IEHP Foster Care Specialist at (800) 706-4347, Monday–Friday, 8am-5pm.