Glossary

Many of the terms on this site may be new to you. To help guide you, we’ve partnered with the World Institute on Disability to provide the glossary below with commonly used terms.

You can also access the Disability Benefits 101 Glossary.

Appeal — If a health plan denies or reduces services, you have the right to appeal, which is a request for a review of the health plan decision. For help with appeals, contact the Ombudsman at 1-855-501-3077.

Beneficiary — A person who receives Medicare and/or Medi-Cal benefits.

Cal MediConnect Health Plans — Health plans that combine Medicare and Medi-Cal benefits into a single health plan.

Care Coordination — Making sure that your doctors, specialists, pharmacists, caregivers, case managers, and other providers all work together with you to take care of your health.

Choice Form — The form you fill out to choose or change your health plan. To get a choice form, contact Health Care Options at 1-844-580-7272.

Community-Based Adult Services (CBAS) — CBAS centers provide daytime health care, such as: nursing, therapy, activities and meals for people with certain chronic health conditions.

Coordinated Care Initiative (CCI) — A program to improve health outcomes and quality of life for beneficiaries with Medi-Cal as well as new options for those who are eligible for both Medicare and Medi-Cal. There are two parts to the CCI: Cal MediConnect and Medi-Cal Managed Long-Term Services and Supports (see those definitions for more information). CCI is currently in seven counties in California: Los Angeles, Orange, Riverside, San Bernardino, Santa Clara, San Diego, and San Mateo.

Copayment (Copay) — A fixed amount you may have to pay for a health care service, usually when you receive the service. The amount can vary by the type of service. You may also have a copay when you get a prescription filled.

Dual-Eligible Beneficiaries — People who receive both Medicare and Medi-Cal benefits and may be eligible for Cal MediConnect.

Enrollee — A person enrolled in a health plan.

Fee-for-Service (FFS) — When Medicare or Medi-Cal directly pays for the services you receive. Under Fee-for-Service, you do not have a health plan.

Grievance — A way to file a complaint about how a health plan has served you.

Health Plan — A group of doctors, specialists, clinics, pharmacies, hospitals, and long-term care providers that work together to meet your needs. Health plans are also called managed care plans. People enrolled in the health plan are called “members” and have a primary care provider who helps guide their health care.

Home and Community Based Services (HCBS) — Services and other supports that people with Medi-Cal can receive to help them stay in their home or community independently. HCBS includes: In-Home Supportive Services, the Multipurpose Senior Services program, and Community-based Adult Services.

In-Home Supportive Services (IHSS) — The IHSS program provides in-home care for people who cannot safely remain in their own homes without assistance. Caregivers can assist with meal preparation, house cleaning, personal care services (such as bathing), accompaniment to medical appointments, and other medical tasks (like injections or assistance with taking medications). Your county assesses your IHSS needs. Contact your county or health plan for more information.

Long-Term Services and Supports (LTSS) — Some people need LTSS to help them with activities of daily living. This help is called LTSS and can be provided in a facility or in the community. LTSS include a range of home and community based services such as In-Home Supportive Services (IHSS), Community-Based Adult Services (CBAS), and Multipurpose Senior Services Program (MSSP), in addition to care in nursing facility services when needed.

Medi-Cal — California’s Medicaid program. Medi-Cal offers health coverage for low-income Californians.

Medicare — The federal health program that provides health coverage for people aged 65 and older, people younger than 65 with certain disabilities, and people with certain diseases. You may hear about the different parts of Medicare, including:

  • Medicare Part A covers medical care while you are at the hospital or during a short-term stay in a nursing facility.
  • Medicare Part B covers routine medical services such as doctor visits and preventative services. It also covers some home health care, durable medical equipment (such as walkers), and laboratory services and supplies (like insulin pumps).
  • Medicare Part C is often called Medicare Advantage. It is a private health plan that provides both Medicare Part A and Part B coverage.
  • Medicare Part D provides coverage for most prescription drugs through a private plan.

Multipurpose Senior Services Program (MSSP) — This program provides both social and health care coordination services for Medi-Cal recipients aged 65 or older who meet the eligibility criteria for a skilled nursing facility. In addition to the care coordination services, each MSSP site has funds to help a person stay in the community after all other public or private program options have been exhausted; such as transportation and meal services.

Preferred Drug List — A list of medications covered by a health plan offering prescription drugs.

Primary Care Provider — Your main health care provider. This may be a doctor, nurse practitioner, nurse midwife, or physician’s assistant. They help connect you to all the services you need, including care from specialists.

Nursing Facilities — Nursing facilities encompass nursing homes and rehabilitation facilities and provide nursing, rehabilitative, and medical care.