Members

Welcome Members

At Gold Coast Health Plan we have a Member-first focus that's geared to maintaining the health of you and your family. We take our role in the community seriously and make every effort to provide the highest quality care and choice for our Members.

Our Member Services Department and call center representatives are skilled at helping you learn about your coverage and how to get the services you need. We can answer your questions in English or Spanish. If your language is not spoken by one of our team members, we'll provide interpreter services in the language you need.

So give us a call at 888.301.1228, and remember: We're more than a managed healthcare system; we're your partner in maintaining good health.

Pending Applicants and Newly Enrolled Medi-Cal Members

The following information is provided by the California Department of Health Care Services (DHCS) for pending applicants and newly enrolled Medi-Cal members.

Information for Applicants and Members

Choose a Provider

Find a provider, make an appointment.

View Our Directory

Change Your Primary Care Provider

Members receive a welcome packet that includes a Provider Directory of Primary Care Providers. The provider selection form can be mailed to Gold Coast Health Plan.

You can select or change a Primary Care Provider (PCP) by calling us at 888.301.1228, TTY 888.310.7347, Monday through Friday, 8:00 a.m. to 5:00 p.m.

Cultural and Linguistic Services

Language Assistance

For help getting an interpreter or understanding something we send you in writing, please call Member Services at 888.301.1228 (for English and Spanish).

American Sign Language Assistance

If you are deaf or speech-impaired and need assistance, please call Member Services at 888.310.7347 (TTY line).

Interpreter Services

Member
If you are a Member and need an interpreter, please call 888.301.1228.

Provider
If you are a Provider and need interpreter services, please call 866.421.3463 and enter your access code. Please call a health educator for an access code.

Face-to-face
If you need an interpreter, please call the Health Education Department at 805.437.5624 or 805-437-5603 for assistance. Advance notice and prior authorization is required for face-to-face interpreters.

C&L Quick Reference Guide
Access the C&L Quick Reference Guide

Contact Us

Lupe Gonzalez, PhD, MPH
Director, Health Education, Outreach and Cultural & Linguistics Services 888.301.1228

Fax: 805.437.5134
healtheducation@goldchp.org

Pharmacy

Gold Coast Health Plan seeks to provide quality pharmacy services to its Members. This page contains important documents and links. Below is a link to the OptumRx web member portal that allows members to review price claims, search for pharmacies that accept GCHP and the ability to pull up medical information about your drugs. Additionally, you’ll be able to view your prescription history.

Provider Directory

Formulary

Direct Member Reimbursement Form (OptumRx)

OptumRx Member Portal Website

Contact OptumRx at 1.855.297.2870; TTY 711

Resources

Access to Protected Health Information

Administrative Member Welcome Letter

Diabetes-Friendly Eating Guide to a Healthy Thanksgiving

Medi-Cal Member Welcome Letter

Member Authorization Form

Member Handbook

Newborn Referral Form

Notice of Privacy Practices-HIPAA

Primary Care Provider (PCP) Selection Form

Provider Directory

Beacon Health Options

Mental Health
Beginning January 1, 2014, your Medi-Cal coverage will now include some Mental Health care benefits. Please refer to your Evidence of Coverage (EOC) for more information regarding these new benefits.

Gold Coast Health Plan (GCHP) will provide these services through Beacon Health Options. If you need mental health services, you can call Beacon Health Options at 855.765.9702, TTY 800.735.2929. If your doctor works with GCHP, you can keep your doctor.

If your doctor doesn't work with GCHP, and you want to keep that doctor, you can call Member Services at 888.301.1228, TTY 888.310.7347 for help. We will let you keep the doctor for up to 12 months, if the doctor agrees to work with us.

EOC Insert

FAQs

Benefit Information

Apply for Medi-Cal and other social service programs

California Children's Services

California Children's Services (CCS) and Gold Coast Health Plan (GCHP) work together for the benefit of children and young adults residing in Ventura County. CCS provides services for children with physical disabilities or conditions that are costly, chronic or catastrophic.

If you have questions about CCS eligibility, GCHP Care Managers may be able to assist you.

Access the CCS website to get information about eligibility, benefits, how to apply and all CCS programs.

CCS website

The CCS office in Ventura County is located at:
2240 East Gonzales Road, Suite 260
Oxnard, CA 93036
Phone: 805.981.5281
Fax: 805.658.4580

Care Management

Care Management is a service that is available to you as a Gold Coast Health Plan member. Your doctor can ask us to assist you, or you can contact us yourself for a health-related concern.

GCHP Care Managers are Registered Nurses and Social Workers and are ready to work with you should you require assistance with:

  • Understanding and managing your benefits
  • Communicating with your doctors
  • Establishing a Medical Home
  • Learning about Community Resources that may be available to you
  • Setting goals and making plans for improving your health
  • A new diagnosis that is causing you concern
  • Learning about your condition
  • Problems with your pregnancy
  • Organ transplant questions
  • Managing multiple medications

To reach the GCHP Care Management Department, please call 805.437.5656 or email: caremanagement@goldchp.org. If emailing, please include your telephone call back number and GCHP Identification Number for a prompt response. Deaf and hard of hearing members can call our TYY line at 888.310.7347.

Community-Based Adult Services Program (CBAS)

The Community-Based Adult Services Program (CBAS) transitions from a fee-for-service program to a Medi-Cal managed care benefit, on October 1, 2012. CBAS replaces the state’s Adult Day Health Care (ADHC) program and will be managed by Gold Coast Health Plan.

Learn about CBAS

COMMUNITY ADVISORY COMMITTEE (CAC)

The Community Advisory Committee (CAC) gives GCHP information about important issues that affect Medi-Cal members in Ventura County to further enhance the quality of the experience between the members and the Plan. The 10 voting members represent various constituencies served by the Plan. They include:

  • Beneficiaries with chronic medical conditions
  • County Health Care Agency
  • County Human Services Agency
  • Foster children
  • Medi-Cal beneficiaries
  • Persons with disabilities
  • Persons with special needs
  • Seniors

The Health Care Agency and the Human Services Agency are standing seats. With the exception of those positions, each of the appointed members serves a two-year term; however, committee members may reapply for additional terms as there are no term limits. The committee meets at least quarterly.

Rita Duarte-Weaver: Committee Chair, Ventura County Public Health Department

Rita Duarte-Weaver is the Community Advisory Committee (CAC) committee chair. She is the daughter and caretaker of a current Gold Coast Health Plan (GCHP) member. For the last 17 years, Ms. Duarte-Weaver has worked for the Ventura County Public Health Department where she serves as the community services coordinator for the Health Care for All program. Ms. Duarte-Weaver conducts regular presentations on Medi-Cal, the Ventura County Self-Discount Program and Health Care for All. She has extensive knowledge of Medi-Cal and knows how to assist GCHP’s members with their needs.

Ruben Juarez: Vice-Chairperson, Ventura County Health Care Agency, Whole Person Care

Ruben Juarez is the Community Advisory Committee (CAC) vice-chairperson. Mr. Juarez is a community services worker with Ventura County’s Whole Person Care (WPC) program. The program facilitates the coordination of health, behavioral health, and social services. WPC helps all patients with their goals and improvement of their overall health and well-being through more efficient and effective use of resources. In his role with the WPC program, Mr. Juarez supports all Medi-Cal beneficiaries identified as high users of services who continue to be in poor health. He connects members with public and private entities, providing comprehensive care and follow up to help those who are experiencing homelessness.

Estelle Cervantes: Beneficiary Member

Estelle Cervantes is the beneficiary member serving on the Community Advisory Committee (CAC).  Her son is also a Gold Coast Health Plan (GCHP) member. Ms. Cervantes has been a volunteer for the United Way Volunteer Income Tax Assistance program, is currently serving as a Conejo Valley Unified Board District Advisory Council member, and is a Conejo Valley High School council member. In 2016, she was recognized by the “Latino American Who’s Who” for her achievements in advancing the culture of the Latino American business community. As a two-time cancer survivor, her goal is to be an advocate and speak out in support of women.

Norma Gomez: Mixteco / Indígena Community Organization Project (MICOP)

Norma Gomez has worked as an interpreter, educator, and case manager with the Mixteco / Indígena Community Organization Project (MICOP) in Oxnard since 2000. As an educator to the Mixtec community, she leads workshops and group activities to provide information on nutrition, health, and parenting. Ms. Gomez also provides case management and conducts follow-up home visits with the Mixtec community and assists residents with completing applications for disability, unemployment, school, Medi-Cal, Cal-Fresh, passport applications, etc. Ms. Gomez facilitates “Aprendiendo con Mama y Papa” (“Learning with Mom and Dad”) educational workshops for Mixteco and Latino migrant farm worker children.

Frisa Herrera: Casa Pacifica

Frisa Herrera has been employed at Casa Pacifica since March 1999 as both the clinic manager and Medi-Cal biller. Casa Pacifica serves abused, neglected, and severely emotionally disturbed children and adolescents from the tri-county region of Southern California. Ms. Herrera has a unique understanding and familiarity with the needs of foster children and is deeply committed to serving this population. Her goal is to “be the voice for the foster community in Ventura County.”

Laurie Hall Jordan: Rainbow Connection Family Resource Center

Laurie Hall Jordan works for the Rainbow Connection Family Resource Center at Tri-Counties Regional Center. She has been with Rainbow Connection for nearly 30 years providing information, training and support for children and adults with developmental disabilities and their families. Ms. Jordan serves as a community representative on the Improving State Systems subcommittee for the state Interagency Coordinating Council on Early Intervention. She is currently chairwoman of the Community Advisory Committee for the Special Education Local Plan Area. She also serves on the Behavioral Health Advisory Board Youth & Family Committee. Ms. Jordan’s son and granddaughter are Gold Coast Health Plan (GCHP) members.

Paula Johnson: The Arc of Ventura County

Paula Johnson is the director of clinical services at The Arc of Ventura County. She has many years of experience working with individuals and families of adults with intellectual and developmental disabilities. Her educational background includes a master’s degree in education and a bachelor’s degree in behavioral psychology. Ms. Johnson is a certified instructor for the Crisis Prevention Institute and American Heart Association.

Curtis Updike: Ventura County Human Services Agency

Curtis Updike currently serves as the deputy director of the Ventura County Human Services Agency (HSA) where he oversees Medi-Cal and CalFresh eligibility determination. Prior to his selection as deputy director in 2005, he served as manager of the county's East County Intake and Eligibility Center (IEC) from 2002 to 2005. The East County IEC processes intake and continuing cases in Medi-Cal and CalFresh. Before joining HSA, he served as chief of staff for former Ventura County Supervisor Kathy Long and field deputy for former Supervisor Maggie Kildee. Mr. Updike holds an associate degree in business administration, a bachelor's degree in mass communications, and a master's degree in public administration.

Pablo Velez: Amigo Baby, Inc.

Pablo Velez is the CEO / President / Founder of Amigo Baby, Inc. He has a medical doctoral degree from Colombia where he developed several county-based services. Upon moving to the U.S., he began working with special needs children, lectured in several community organizations and, in 2004, created Amigo Baby, Inc. to serve the Ventura County community. Mr. Velez brings more than 20 years of medical and special needs experience to infants and children with developmental delays.

COMMUNITY ADVISORY COMMITTEE MEETINGS

Contracted Hospitals

Los Robles Hospital and Medical Center
215 W. Janss Road
Thousand Oaks, CA 91360
805.497.2727
Visit their Website

Ojai Valley Community Hospital (CMH)
1306 Maricopa Highway
Ojai, CA 93023
805.646.1401
Visit their Website

Santa Paula Hospital (VCMC)
825 N. 10th St.
Santa Paula, CA 93060
805.933.8600
Visit their Website

Simi Valley Hospital and Health Care Services
2975 N. Sycamore Drive
Simi Valley, CA 93065
805.955.6000
Visit their Website

St. John's Pleasant Valley Hospital
2309 Antonio Ave.
Camarillo, CA 93010
805.389.5800
Visit their Website

St. John's Regional Medical Center
1600 N. Rose Ave.
Oxnard, CA 93030
805.988.2500
Visit their Website

Ventura County Medical Center (VCMC)
3291 Loma Vista Road
Ventura, CA 93003
805.652.6000
Visit their Website

Denti-Cal Program

Dental Services for Medi-Cal beneficiaries under 21 years of age are currently provided as a carved out benefit through the Denti-Cal Program. Search for dentists in your local area and throughout the State if you are a Denti-Cal beneficiary or contact the Denti-Cal Service Center for additional help at 800.322.6384.

Search for Dentists in Your Area

Starting May 1, 2014, certain adult dental benefits will be restored in accordance with Assembly Bill 82. Note: these services are not a benefit for beneficiaries 21 years of age and over until May 1, 2014.

Full description of restored services and procedures

Dialysis Transportation

Do you need a ride to your dialysis appointment?

Members who need dialysis can get free rides to and from appointments. Gold Coast Health Plan (GCHP) offers Non-Emergency Medical Transportation (NEMT) for eligible members. Call your doctor and ask about these services.

Once you have your ride scheduled, it is important to call the transit company if your appointment changes or if you need to cancel.  To plan a ride or to cancel an appointment, call 1-855-628-7433 or TTY 711 (California Relay Services).

Click the link below for some helpful tips when scheduling your next ride.

Dialysis Transportation Brochure

Disease Management

Gold Coast Health Plan (GCHP) cares about you and your family! That’s why the Plan offers a Disease Management Program for Diabetes. The program is for members with diabetes and their families. It can also be helpful for those at risk of developing diabetes. The program is a free GCHP benefit. It offers resources and educational materials in both English and Spanish.

The Disease Management Program for Diabetes can connect you with a nurse coach to:

  • Answer your specific questions.
  • Help you create a plan of action for you and your family.

GCHP can connect you with English and Spanish classes in Ventura County near your home or work. The classes can help you learn ways to stay healthy and be active. Classes include information about managing many chronic conditions.

The classes can also teach you ways to keep your family healthier and more active.

For members with asthma, your doctor can create or change an Asthma Action Plan (AAP) for you. An AAP can help you keep your asthma controlled. If you do not have an AAP, click the link below for a sample to show your doctor. Your doctor may use this sample or your doctor may have a preferred AAP. Bring the sample below to your next doctor visit if you need a plan.

Sample asthma action plans in English and Spanish from the National Heart, Lung, and Blood Institute (NHLBI).

Asthma Action Plan
Plan de acción para el control del asma

Partnering with GCHP is easy. All you need to do is call 1-805-437-5588/TTY 1-888-310-7347 and tell us how we can help you and the best way to reach you. You can stop the program at any time.

Learn more about disease management

Grievance & Appeals (G&A)

Gold Coast Health Plan's grievance & appeals (G&A) process provides a mechanism for members to report complaints regarding their health care benefits. Please use the Member Grievance & Appeals Form to submit your complaint.

Member Grievance & Appeal Form

Submit your completed forms to:
Gold Coast Health Plan
Attn: Member Grievance & Appeals
P.O. Box 9176
Oxnard, CA 93031

Human Services Agency

The County of Ventura Human Services Agency (HSA) provides a broad array of services that include the protection of children and vulnerable adults and support for those needing assistance with food, housing, health care and employment.

Access the Medi-Cal site

Member Rewards

Gold Coast Health Plan (GCHP) values the health of its members. To encourage healthy behavior, GCHP is offering rewards to members who complete these preventive care exams:

  • Postpartum Care Exam
    New mothers who complete a postpartum care exam within 3 to 8 weeks after delivery can receive a large pack of diapers.

Apply for the member reward. (Updated October 29, 2018)

  • Annual Well-Child Exam
    (3- to 6-Year Old Children)
 GCHP wants to give your child a $15 gift card for getting a well-child check-up in 2019. The child must have a well-child exam between January 1, 2019 and December 31, 2019.

Download the form

Member Services Information and Resource Guide

Gold Coast Health Plan (GCHP) has a brochure to help you answer some questions about Medi-Cal and GCHP benefits.
 
This brochure has important phone numbers and information about services. It also talks about member rights and responsibilities.

Click here to view the brochure.

Staying Healthy Assessment Tool

Download the Staying Healthy Assessment Tool

Tri-Counties Regional Center (TCRC)

Tri-Counties Regional Center helps people with developmental disabilities of any age with services and support for living, working, learning and recreating in our community.

If you are receiving TCRC services and need help with getting care for a medical problem, talk to your primary care doctor (PCP). Your PCP can ask Gold Coast Health Plan’s Care Management nurses to work with TCRC and the PCP to help get your care needs met.

TCRC offices in Ventura County:
Oxnard
2401 East Gonzales Road, Suite 100
Oxnard, CA 93036
805.485.3177 or 800.664.3177
Fax: 805.988.9521

Simi Valley
1900 E. Los Angeles Ave. Second Floor
Simi Valley, CA 93065
805.522.8030 or 800.517.2524
Fax: 805.522.8142

Access the Tri-Counties Regional Center website

Urgent Care Services

Gold Coast Health Plan (GCHP) offers urgent care services to members at no cost. If you need to see the doctor and it is not a life-threatening condition, go to a contracted urgent care center near you. GCHP members may go to any contracted urgent care center. If you think it’s an emergency, call 911 or call your doctor to receive medical care.

For a list of contracted urgent care centers, click here.

Vision Services

Find a vision services provider near you.

VSP Provider Directory

Behavioral Health Services

View the member materials.

Beacon Member Materials