Specialist Referral Form - Health Plan of San Joaquin 2026

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Emergency medical service and care performed by a hospital emergency department (ED) for evaluation, treatment and stabilization of an emergent medical condition, meeting the definition stated above, will be covered and do not require an prior authorization. This applies to both in-network and out of network providers.
HPSJ is a health plan that provides Medi-Cal services to residents in San Joaquin and Stanislaus Counties. HPSJ offers a range of medical benefits and services to its members, ensuring they receive high-quality healthcare.
Individuals who are potentially eligible for Medi-Cal include those who are: A United States Citizen or Legal Resident, and. A California Resident, and. In a household with Modified Adjusted Gross Income (MAGI) below 138% of the Federal Poverty Level (FPL) for adults and 250% FPL for children.
Electronic Funds Transfer (EFT) is a great way to receive your payments from Health Plan faster. Visit .changehealthcare.com/support/customer-resources/enrollment-services to enroll in EFT, or download and send completed forms via email to EFTenrollment@ChangeHealthcare.com or fax to (615) 238-9615.
Please create or log into your member account by visiting the Members page or contact Customer Service at our Toll Free number 1-888-936-PLAN (7526) or 1-209-942-6320.
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Medi-Cal is the name for the Federal Medicaid Program in California. If you have limited income, the Medi-Cal Program provides comprehensive health coverage to you and your family for free or low-cost.

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