Benefits and Covered Services

Long-Term Care

Medi-Cal has a new benefit called Long-Term Care.

Long-Term Care (also called Custodial Care) is for members who meet specific rules. You cannot live at home on your own because of a health need. You may need long term help with things like bathing, getting dressed, getting in and out of bed, walking, using the toilet, and eating. You get this care in a Long-Term Care facility called a Skilled Nursing Facility.

Custodial Long-Term Care services require prior authorization. If your doctor is recommending Custodial Long-Term Care services, they will contact SFHP and request prior authorization.

When you need this care for longer than the month of admission and month after, you become a resident of the Long-Term Care facility. From the third month, you are approved for Custodial Long-Term Care. Your medical group changes to a new medical network – the SFHP Direct Network (SDN). This does not happen if you are in Kaiser Permanente. Kaiser members stay assigned to Kaiser Permanente medical group. The change to SDN does not change your benefits. All services stay the same. When Custodial Long-Term Care members are reassigned to the SDN, you will receive a letter telling you of the change. You also get a new SFHP Member Identification (ID) Card.