Eligibility
CenCal Health strives to make processes as easy as possible for providers. A member’s Medi-Cal and CenCal CareConnect eligibility with CenCal Health can change.
It’s important to verify eligibility at every visit. Learn more on this page.
It's Important to Verify Eligibility Every Visit
Eligibility can change monthly
Reinforces care coordination
Prevents referral, authorization, & claim denials
Identifies member misrepresentation
Eligibility Criteria
Health Plan Eligibility Criteria
Review the requirements to determine who qualifies for CenCal Health’s Medi-Cal and CenCal CareConnect programs.
CenCal Health Medi-Cal Eligibility
CenCal Health is the first Medicaid Managed Care Plan of its kind in the nation, providing essential Medicaid coverage (referred to as Medi-Cal in California) to low-income individuals and families in Santa Barbara and San Luis Obispo counties.
✔Who Qualifies for Medi-Cal
Older adults, adults with disabilities, children and families, pregnant individuals, and other qualifying populations.
✔Who Determines Eligibility
Eligibility for Medi-Cal is determined by the Department of Social Services (DSS) and the Social Security Administration (SSA). Not CenCal Health.
CenCal CareConnect Eligibility
CenCal CareConnect is a Medicare Advantage Dual Special Needs Plan (D-SNP) for individuals who qualify for both Medicare and Medi-Cal.
✔Medicare Coverage
Must have Medicare Parts A and B.
✔Medi-Cal Eligibility
Must be eligible in CenCal Health Medi-Cal.
✔Residency
Must live in Santa Barbara County or San Luis Obispo County.
✔Medicare Eligibility
65+ or qualifying disability or End-Stage Renal Disease.
Enrollment Info
How to enroll a patient in a Health Plan
Review enrollment information for CenCal Health’s Medi-Cal and CenCal CareConnect programs.
Medi-Cal Enrollment Options
CenCal Health does not handle Medi-Cal enrollment. Individuals who want to enroll in Medi-Cal must apply through the State of California using one of the options below.
Enroll Online
Apply for Medi-Cal online through the California Department of Health Care Services.
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https://benefitscal.com/
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https://www.cencalhealth.org/health-plans/medi-cal/how-to-apply/
Phone | In Person | Mail
Anyone can apply for Medi-Cal by phone, in person, or by mail.
CenCal CareConnect (D-SNP) Enrollment Options
Enroll by Phone
📞 1-877-227-3051
TTY: CA Relay at 711
Monday–Friday, 8 a.m. to 5 p.m. PT
Enroll by Mail
✉ CenCal CareConnect
Attn: Enrollment
4050 Calle Real
Santa Barbara, CA 93110
Checking ID Cards
How do I know if a member has CenCal Health Medi-Cal or CenCal CareConnect?
Review key details on the member’s ID card to confirm whether they are enrolled in a health plan. Member cards are not proof of eligibility. Verify eligibility prior to each visit to prevent referral, authorizations, and claims issues.
CenCal Health Medi-Cal ID Cards
✔Two ID cards
Members receive a CenCal Health ID card and a State Medi-Cal Benefits Identification Card (BIC).
✔Matching member numbers
The numeric portion of the BIC matches the CenCal Health Medi-Cal member ID number.
✔Alpha character
A member’s Medi-Cal member ID number ends with an alpha character.
CenCal CareConnect ID Cards
✔One combined card
CenCal CareConnect members receive one combined Medicare + Medi-Cal ID card.
✔Member ID format
A CenCal CareConnect Medicare member ID number begins with “CC” followed by numeric characters.
Verify Eligibility
How to Verify Member Eligibility
Review the steps to check member eligibility for CenCal Health Medi-Cal or CenCal CareConnect.
Provider Portal
Medi-Cal & CenCal CareConnect
web.cencalhealth.org
Enter PortalVerify
- Monthly Eligibility Status
- PCP Assignment
- Special Class
- Non-contracted providers will not be granted access to the CenCal Health Provider Portal Restricted Website.
Call Member Services
Medi-Cal & CenCal CareConnect
1-877-814-1861
Call NowVerify
- Monthly Eligibility Status
- PCP Assignment
- Special Class
- Available for third party biller member eligibility assistance.
For additional support, please contact Provider Relations at 805-562-1676.
Provider Resources
Helpful tools and guides for providers
Access helpful tools, forms, and information to support quality care and efficient provider services.
Health Plan Overview & Eligibility Quick Reference Guide
Quickly access key information about plan types, eligibility, and enrollment criteria.
CenCal Health Provider Portal Check Eligibility Micro-Training Video
Learn to confidently verify and manage eligibility for CenCal Medi-Cal and CareConnect.
CenCal Health Provider Manual
Review policies, procedures, and resources in the official Provider Manual.
Provider Portal User Guide
Learn how to navigate the Provider Portal for claims, authorizations, and member eligibility.
Provider Training & More!
Explore upcoming trainings, webinars, and educational materials for providers.
Learn About CenCal Health Medi-Cal
Find out how Medi-Cal through CenCal Health supports eligible residents in Santa Barbara and San Luis Obispo Counties.
Learn About CenCal CareConnect (HMO D-SNP)
Discover our Medicare-Medicaid Plan designed for members eligible for both Medi-Cal and Medicare.