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. Depending on the amount of help you need, Long-Term Care will be provided in a Skilled Nursing Facility, Subacute Facility, or Intermediate Care Facility.

Long-Term Care services require prior authorization. If your doctor is recommending 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 the month after, you become a resident of the Long-Term Care facility. Starting on the third month, you are approved for Long-Term Care and your medical group changes to a new medical network – the SFHP Direct Network (SDN). The change to SDN does not change your benefits. All services stay the same. When 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.

To learn more about Long-Term Care, please call SFHP Customer Service at 1(415) 547-7800 or 1(800) 288-5555 (toll-free) or TTY 1(888) 883-7347 or 711. Monday through Friday 8:30am to 5:30pm.

Benefit information is also available in your SFHP Member Handbook.


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