"The California law that gives Medi-Cal members enforceable rights — and the one health plans hope you never read."
The Knox-Keene Health Care Service Plan Act of 1975 is California's primary law governing managed care health plans — including Medi-Cal plans like L.A. Care, Anthem Blue Cross, and Molina Healthcare. It is enforced by the Department of Managed Health Care (DMHC).
When a member faces an "imminent and serious threat to their health," the plan must provide an expedited grievance resolution within 72 hours. Stalling is a violation.
Health plans must ensure their network of providers is sufficient to provide services in a timely manner. "Ghost networks" are a direct violation of this mandate.
The investigation documented on this site — Case #26AVSC00192 — arose directly from an L.A. Care Health Plan failure to comply with Health & Safety Code § 1368.01(b).