CalAIM Managed Care Plan (MCP) Grievance/Appeal Process

To file a grievance for the CalAIM Program (e.g., regarding authorization requests, etc.):

Initial Grievances:

Before filing a complaint with the DMHC or CDI, you should first file a grievance with your health plan. 

  • Internal Review:

    Your health plan will have an internal process for reviewing grievances. Allow 30 days for them to respond. 

  • External Review:

    If you're not satisfied with your health plan's decision or if they haven't responded within 30 days, you can then file a complaint with the DMHC or CDI. 

  • Urgent Issues:

    If your situation is urgent, you may be able to seek immediate assistance from the DMHC. 

  • Specifics:

    Be sure to include all relevant details in your complaint, including your health plan's name, your policy number, and the specific issue you're facing. 

Kaiser Grievance/Appeals:
Kaiser CalAIM Appeal Website for Authorization Requests

Health Net Grievance/Appeals:
Health Net

Department of Managed Care:

To file a complaint through the DHCS Department of Managed Medi-Cal:
https://www.dmhc.ca.gov/FileaComplaint.aspx

Medi-Cal Managed Care and Mental Health Office of the Ombudsman
https://www.dhcs.ca.gov/services/MH/Pages/mh-ombudsman.aspx