Last Updated: September 19, 2026
Can I Leave My Medi-Cal Health Plan and Return to FFS? Medical Exemption Request (MER) 2026 Guide
“My current doctor only accepts Fee-for-Service Medi-Cal. I am receiving important treatment from this doctor. Can I leave my Medi-Cal Managed Care Plan and go back to FFS Medi-Cal?”
If you are in this situation, you may want to ask about a Medical Exemption Request (MER).
A Medical Exemption Request may allow certain Medi-Cal members who are receiving ongoing treatment from a Fee-for-Service (FFS) Medi-Cal provider to receive a temporary exemption from mandatory Managed Care enrollment.
However, the fact that your doctor only accepts FFS Medi-Cal does not automatically mean that you qualify for an exemption.
A Medical Exemption Request is not simply a way to choose FFS Medi-Cal because you prefer your current doctor.
It may be available when you are currently receiving treatment from an FFS Medi-Cal provider for a complex medical condition that could get worse if you have to change providers, and the provider does not participate in a Medi-Cal Managed Care Plan in your county.
What Is Fee-for-Service Medi-Cal?
Fee-for-Service, or FFS Medi-Cal, is a way Medi-Cal pays participating providers directly for covered services they provide to eligible members.
Under Medi-Cal Managed Care, members generally receive covered health care through a Medi-Cal Health Plan and its provider network.
Because most Medi-Cal members are required to enroll in Managed Care, a member generally cannot simply choose to leave mandatory Managed Care and switch to FFS because they prefer a particular doctor.
What Is a Medical Exemption Request?
A Medical Exemption Request asks Medi-Cal for a temporary medical exemption from mandatory Medi-Cal Managed Care enrollment.
If the request is approved, the member may remain temporarily in FFS Medi-Cal and continue receiving treatment from the current FFS provider until the exemption ends.
Who May Qualify for a Medical Exemption?
A Medical Exemption Request may be appropriate when factors such as the following apply:
- You are currently receiving treatment for a complex medical condition.
- You are currently receiving treatment from an FFS Medi-Cal provider.
- Your treatment or medical monitoring is ongoing.
- Your medical condition could get worse if you have to change providers.
- Your current provider does not participate in a Medi-Cal Managed Care Plan in your county.
Having a particular diagnosis does not automatically guarantee approval. Your current treatment, the complexity of your medical condition, the possible effect of changing providers, the provider's network status, and supporting medical documentation can all be important.
Example: A Patient Receiving Cancer Treatment
Maria has cancer and has been receiving ongoing treatment from an oncologist who accepts FFS Medi-Cal.
Her oncologist has been managing her treatment plan, monitoring test results, and coordinating her cancer care.
Maria is then required to enroll in a Medi-Cal Managed Care Plan. She learns that her current oncologist does not participate in a Medi-Cal Managed Care Plan in her county.
Changing oncologists in the middle of treatment could interrupt her established course of care or delay important treatment.
Maria and her oncologist may want to determine whether she qualifies to submit a Medical Exemption Request so she can temporarily remain in FFS Medi-Cal and continue her current treatment.
Cancer itself does not automatically guarantee approval of a Medical Exemption Request.
The treating provider should explain the current treatment, the complexity of the medical condition, and why changing providers could cause the patient's condition to worsen or disrupt medically necessary treatment.
Is It Enough That My Doctor Only Accepts FFS Medi-Cal?
Generally, no.
A Medical Exemption is not automatically approved simply because:
- You prefer your current doctor.
- You do not want to find another doctor.
- Your doctor only accepts FFS Medi-Cal.
- You prefer FFS Medi-Cal over Managed Care.
The important question is whether you are currently receiving treatment for a complex medical condition and whether changing providers could cause your condition to get worse.
The 90-Day Rule Is Important
Timing can be very important when considering a Medical Exemption Request.
According to DHCS, in most cases, if you have been enrolled in a Medi-Cal Managed Care Health Plan for more than 90 days, you cannot get a medical exemption.
If you are currently receiving important treatment from an FFS Medi-Cal provider and are being required to enroll in Managed Care, contact Medi-Cal Health Care Options and your treating provider as soon as possible.
How Do I Apply for a Medical Exemption?
The Medical Exemption Request uses HCO Form 7101 – Request for Temporary Medical Exemption from Plan Enrollment.
The member completes the member portion of the request, and the treating provider must complete the medical portion.
The provider should submit the required medical information explaining the condition, current treatment, and why changing providers could cause the condition to worsen.
What Medical Documentation May Be Important?
Supporting medical information may include documentation such as:
- Recent office visit notes
- Current medical history and physical information
- Current treatment plan
- Relevant diagnosis information
- Information explaining the complexity of the condition
- Information explaining why changing providers could cause the condition to worsen
Incomplete forms or missing medical documentation can affect the review. Work with your treating provider to make sure the required portions of the request and supporting records are included.
Where Do I Request a Medical Exemption?
Medical Exemption Requests are handled through Medi-Cal Health Care Options (HCO).
Phone: 1-800-430-4263
TTY: 1-800-430-7077
Monday–Friday, 8 a.m.–6 p.m.
You can say:
What Happens If My Medical Exemption Is Approved?
If your Medical Exemption Request is approved, you may remain temporarily in FFS Medi-Cal and continue seeing your current FFS provider until the exemption ends.
A Medical Exemption may allow you to remain in FFS Medi-Cal for up to 12 months.
For certain medical conditions, an extension may be available. DHCS states that an extension request may be made after at least 11 months from the start date of the existing exemption.
What If My Medical Exemption Is Denied?
If your Medical Exemption Request is denied, carefully review the notice you receive and the options explained in the notice.
Even if you cannot remain in FFS Medi-Cal, you may be able to ask your Medi-Cal Managed Care Plan for Continuity of Care (CoC) so you can continue seeing your existing provider for a period of time.
MER: You request a temporary exemption from mandatory Managed Care enrollment and remain in FFS Medi-Cal during the approved exemption.
Continuity of Care: You remain enrolled in your Medi-Cal Managed Care Plan but request to continue seeing an existing out-of-network provider for a period of time.
Even if your Medical Exemption Request (MER) is not approved, there may be another way to temporarily continue care with your existing provider.
Continuity of Care (CoC) does not return you to Fee-for-Service Medi-Cal. Instead, qualifying members may be able to remain enrolled in their Medi-Cal Managed Care Plan while temporarily continuing care with an existing out-of-network provider.
→ Can I Keep My Doctor After Joining a Medi-Cal Health Plan? Continuity of Care 2026 Guide
What If I Have Medicare and Medi-Cal?
If you have both Medicare and Medi-Cal, there is an important distinction.
DHCS explains that you do not need a Medical Exemption simply to continue seeing your Medicare providers. Enrollment in a Medi-Cal Managed Care Plan does not prevent you from continuing to see Medicare providers for Medicare-covered services.
If your concern involves a doctor who is treating you as a Medi-Cal provider rather than as a Medicare provider, different rules may apply.
Frequently Asked Questions
Can I leave my Medi-Cal Health Plan just because my doctor does not accept it?
Not automatically. A Medical Exemption is based on medical circumstances and other eligibility requirements, not simply on a preference for a particular provider.
Does cancer automatically qualify me for an MER?
No. Cancer can involve complex and ongoing treatment, but the diagnosis itself does not automatically guarantee approval. The individual medical circumstances and the effect of changing providers are important.
Can my doctor help me apply?
Yes. Your treating provider plays an important role because the provider must complete the medical portion of the request and provide supporting medical information.
What if I have already been in my Medi-Cal Health Plan for more than 90 days?
DHCS states that, in most cases, members who have been enrolled in a Medi-Cal Managed Care Health Plan for more than 90 days cannot receive a Medical Exemption. You may still want to ask your plan whether Continuity of Care or another provider-access option applies to your situation.
Key Takeaways
Your doctor accepting only FFS Medi-Cal does not automatically qualify you for an exemption.
The 90-day rule can be very important, so do not wait to ask about an MER if you are receiving ongoing treatment.
Your treating provider must provide medical information supporting the request.
If an MER is not available or is denied, ask your Medi-Cal Health Plan whether Continuity of Care may allow you to keep seeing your current provider temporarily.
Official Resources
- DHCS – Medi-Cal Managed Care Frequently Asked Questions
- DHCS – Medi-Cal Help
- HCO Form 7101 – Request for Temporary Medical Exemption
Disclaimer:
This website provides general information about California public benefit programs and is for informational purposes only. It is not affiliated with or endorsed by any government agency and does not provide legal, medical, or professional advice. Program rules, eligibility requirements, benefits, and procedures may change. For the most current information and guidance about your individual situation, please contact the appropriate government agency, county office, health plan, or program administrator.