HELPING GOVERNMENTSERVETHE PEOPLE@ - …€¦ · · 2017-08-22... Health Care Options Contract...
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HELPING GOVERNMENTSERVE THE PEOPLE@ April 7, 2010 Ms. Maria Enriquez, Chief Department of Health Care Services Fiscal Intermediary & Contracts Oversight Division MS 4700 P.O. Box 997413 Sacramento, CA 95899-7413 DHCS HCO 10-4672 COPS-17 - DISENROLLMENT SUMMARY REPORT - Effective Date of 4/1/2010 Reference: Health Care Options Contract - 6.5.2.2.F.3-4 C #1009-0646, dated October 30, 2009 Dear Ms. Enriquez: The purpose of this report is to provide a comprehensive view of disenrollments over a reporting period. Volumes are categorized by disenrollment type and reason, while grouping are reported by choice type (medical, dental), county, plan, and language. This is a contractually required report detailed in Health Care Options Contract 07-65829. Note: As of November 2009, volumes categorized by disenrollment type and ZIP Code, as referenced in 6.5.2.2.FA, are available to run on an ad hoc basis from Reporting Services, per DHCS request via C #1009-0646. If you have any questions, please contact Haiyong Li at (916) 364-6656. Sincerely, r=s--flr Benjamin R. Coss Vice President California Health Care Options cc: Reports File Admin File 3130 KILGORE ROAD, SUITE 100 I RANCHO CORDOVA, CALIFORNIA 95670 I 916.364.6610 I 916.364.0289 FAX I WWW.MAXIMUS.COM
Transcript of HELPING GOVERNMENTSERVETHE PEOPLE@ - …€¦ · · 2017-08-22... Health Care Options Contract...
HELPING GOVERNMENTSERVE THE PEOPLE@
April 7, 2010
Ms. Maria Enriquez, ChiefDepartment of Health Care ServicesFiscal Intermediary & Contracts Oversight DivisionMS 4700P.O. Box 997413Sacramento, CA 95899-7413
DHCS HCO 10-4672
COPS-17 - DISENROLLMENT SUMMARY REPORT - Effective Date of 4/1/2010
Reference: Health Care Options Contract #07~65829 - 6.5.2.2.F.3-4C #1009-0646, dated October 30, 2009
Dear Ms. Enriquez:
The purpose of this report is to provide a comprehensive view of disenrollments over a reportingperiod. Volumes are categorized by disenrollment type and reason, while grouping are reportedby choice type (medical, dental), county, plan, and language. This is a contractually requiredreport detailed in Health Care Options Contract 07-65829.
Note: As ofNovember 2009, volumes categorized by disenrollment type and ZIP Code, asreferenced in 6.5.2.2.FA, are available to run on an ad hoc basis from Reporting Services, perDHCS request via C #1009-0646.
If you have any questions, please contact Haiyong Li at (916) 364-6656.
Sincerely,
r=s--flrBenjamin R. CossVice PresidentCalifornia Health Care Options
cc: Reports FileAdmin File
3130 KILGORE ROAD, SUITE 100 I RANCHO CORDOVA, CALIFORNIA 95670 I 916.364.6610 I 916.364.0289 FAX I WWW.MAXIMUS.COM
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 1 of 225Report Created at 4/6/2010 4:54:44 PM
000050000001000
000010302001000
000010000000000
000030000002000
000060010000000
000040000000000
000030000000000
000020000000000
000040000020000
000030000020000
0000110000031000
000000000030000
0000110100101000
0000110000215000
0000110000011000
0000110000000000
000010000000000
94578
94577
94568
94566
94560
94555
94551
94550
94546
94545
94544
94542
94541
94538
94536
94501
93725ALAMEDAMandatory
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
MEDICAL Disenrollment Transactions by Status, County, and ZIP
COPS-17.2 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 12:00:00 AM and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 1 of 26Report Created at 4/7/2010 10:37:02 AM
1
1,339118137745912458
38226817153315
3
24922511162614
175131515494
1461249487
384451522204818
2,2785005512216110499419
2519721824286527
904161552613
44432255
168562413112840
21141251122
11334211041722
35545321052327
1,236209240613754323283
Care 1st Health Plan
County Subtotal
Western Dental Services
SafeGuard Dental, Inc.
Liberty Dental Plan of CA
HealthNet of California
Community Dental Svc, Inc.
Access Dental Plan
County Subtotal
Western Dental Services
SafeGuard Dental, Inc.
Liberty Dental Plan of CA
Health Net
Community Dental Svc, Inc.
Care 1st Health Plan
American Health Guard
Access Dental Plan
SAN BERNARDINO
SACRAMENTO
LOS ANGELESDental
I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Plan Type County Name Plan Name
Disenrollment Transactions by Plan Type (Medical, Dental), County Name, and Plan Name
COPS-17.2 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 12:00:00 AM and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 2 of 26Report Created at 4/7/2010 10:37:02 AM
1
1,8122
496
3
343
235
190
5452
4,54111
512
196
65
340
58
221
497
2,65211
Care 1st Health Plan
County Subtotal
Western Dental Services
SafeGuard Dental, Inc.
Liberty Dental Plan of CA
HealthNet of California
Community Dental Svc, Inc.
Access Dental Plan
County Subtotal
Western Dental Services
SafeGuard Dental, Inc.
Liberty Dental Plan of CA
Health Net
Community Dental Svc, Inc.
Care 1st Health Plan
American Health Guard
Access Dental Plan
SAN BERNARDINO
SACRAMENTO
LOS ANGELESDental
X05X04X03
TotalDisenrollmentTransaction Type Disenrollment Reason Code Plan Type County Name Plan Name
COPS-17.2 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 12:00:00 AM and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 3 of 26Report Created at 4/7/2010 10:37:02 AM
3314
1271191276624261
6
8
2
41
3
4
101
12
293
113711742315191
103
49531397
3,6176186550290169623480
13
2
1
Alameda Alliance For Health
County Subtotal
Santa Clara Family H.P.
San Francisco Health Plan
Molina Healthcare Partner
L.A. Care Health Plan
KP Cal, LLC
Inland Empire Health Plan
Health Plan of San Joaquin
Health Net Comm Solutions
Contra Costa Health Plan
Blue Cross of CA Partnrshp
Anthem Blue Cross Partnrshp
Alameda Alliance For Health
County Subtotal
SafeGuard Dental, Inc.
Health Net
CONTRA COSTA
ALAMEDA
Total
SAN BERNARDINO
Medical
Dental
I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Plan Type County Name Plan Name
COPS-17.2 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 12:00:00 AM and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 4 of 26Report Created at 4/7/2010 10:37:02 AM
38
3752
6
8
2
5
3
4
11
12
32
2011
13
781
6,35713
4
2
1
Alameda Alliance For Health
County Subtotal
Santa Clara Family H.P.
San Francisco Health Plan
Molina Healthcare Partner
L.A. Care Health Plan
KP Cal, LLC
Inland Empire Health Plan
Health Plan of San Joaquin
Health Net Comm Solutions
Contra Costa Health Plan
Blue Cross of CA Partnrshp
Anthem Blue Cross Partnrshp
Alameda Alliance For Health
County Subtotal
SafeGuard Dental, Inc.
Health Net
CONTRA COSTA
ALAMEDA
Total
SAN BERNARDINO
Medical
Dental
X05X04X03
TotalDisenrollmentTransaction Type Disenrollment Reason Code Plan Type County Name Plan Name
COPS-17.2 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 12:00:00 AM and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 5 of 26Report Created at 4/7/2010 10:37:02 AM
192265181614
5
6455442151518336195
61
5
251228517421211
1
21
2
21
6
5
6
91
5153733101
2
10115321011811
12
Health Net Comm Solutions
Contra Costa Health Plan
Blue Cross of CA Partnrshp
Anthem Blue Cross Partnrshp
Alameda Alliance For Health
County Subtotal
Santa Clara Family H.P.
San Francisco Health Plan
Molina Healthcare Partner
L.A. Care Health Plan
KP Cal, LLC
Inland Empire Health Plan
Health Plan of San Joaquin
Health Net Comm Solutions
Contra Costa Health Plan
Community Hlth Grp Partner
Blue Cross of CA Partnrshp
Anthem Blue Cross Partnrshp
FRESNO
CONTRA COSTAMedical
I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Plan Type County Name Plan Name
COPS-17.2 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 12:00:00 AM and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 6 of 26Report Created at 4/7/2010 10:37:02 AM
2631
5
1,7711
7
5
3522
1
21
2
3
6
5
6
10
83
2
1632
12
Health Net Comm Solutions
Contra Costa Health Plan
Blue Cross of CA Partnrshp
Anthem Blue Cross Partnrshp
Alameda Alliance For Health
County Subtotal
Santa Clara Family H.P.
San Francisco Health Plan
Molina Healthcare Partner
L.A. Care Health Plan
KP Cal, LLC
Inland Empire Health Plan
Health Plan of San Joaquin
Health Net Comm Solutions
Contra Costa Health Plan
Community Hlth Grp Partner
Blue Cross of CA Partnrshp
Anthem Blue Cross Partnrshp
FRESNO
CONTRA COSTAMedical
X05X04X03
TotalDisenrollmentTransaction Type Disenrollment Reason Code Plan Type County Name Plan Name
COPS-17.2 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 12:00:00 AM and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 7 of 26Report Created at 4/7/2010 10:37:02 AM
5276352232179621
1
2
64241
143223744191
19
5
24136192143543
6
4631
9115777201626352209
9
2
155
2
7
1915
4
County Subtotal
Santa Clara Family H.P.
Molina Healthcare Partner
L.A. Care Health Plan
Kern Family Health Care
Inland Empire Health Plan
Health Plan of San Joaquin
Health Net Comm Solutions
Contra Costa Health Plan
Blue Cross of CA Partnrshp
County Subtotal
Santa Clara Family H.P.
Molina Healthcare Partner
L.A. Care Health Plan
KP Cal, LLC
Kern Family Health Care
Inland Empire Health Plan
Health Plan of San Joaquin
KERN
FRESNOMedical
I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Plan Type County Name Plan Name
COPS-17.2 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 12:00:00 AM and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 8 of 26Report Created at 4/7/2010 10:37:02 AM
78612
1
2
71
2412
19
5
3911
6
50
2,12011
9
2
20
2
7
25
4
County Subtotal
Santa Clara Family H.P.
Molina Healthcare Partner
L.A. Care Health Plan
Kern Family Health Care
Inland Empire Health Plan
Health Plan of San Joaquin
Health Net Comm Solutions
Contra Costa Health Plan
Blue Cross of CA Partnrshp
County Subtotal
Santa Clara Family H.P.
Molina Healthcare Partner
L.A. Care Health Plan
KP Cal, LLC
Kern Family Health Care
Inland Empire Health Plan
Health Plan of San Joaquin
KERN
FRESNOMedical
X05X04X03
TotalDisenrollmentTransaction Type Disenrollment Reason Code Plan Type County Name Plan Name
COPS-17.2 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 12:00:00 AM and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 9 of 26Report Created at 4/7/2010 10:37:02 AM
1
1
203,8621,4171513677108568187
2
1
104521
151,479465277234314964
8
2621
21610
4
51,9709451595165419122
7
8
1
23
2
13
L.A. Care Health Plan
Inland Empire Health Plan
County Subtotal
Santa Clara Family H.P.
San Francisco Health Plan
Molina Healthcare Partner
L.A. Care Health Plan
KP Cal, LLC
Kern Family Health Care
Inland Empire Health Plan
Health Plan of San Joaquin
Health Net Comm Solutions
Contra Costa Health Plan
Community Hlth Grp Partner
Care1st Partner Plan, LLC
Blue Cross of CA Partnrshp
Anthem Blue Cross Partnrshp
Alameda Alliance For Health
OUT OF STATE
LOS ANGELESMedical
I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Plan Type County Name Plan Name
COPS-17.2 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 12:00:00 AM and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 10 of 26Report Created at 4/7/2010 10:37:02 AM
1
1
6,539171293
2
1
112
2,3965731
8
301
226
4
3,70612552
7
8
1
23
2
13
L.A. Care Health Plan
Inland Empire Health Plan
County Subtotal
Santa Clara Family H.P.
San Francisco Health Plan
Molina Healthcare Partner
L.A. Care Health Plan
KP Cal, LLC
Kern Family Health Care
Inland Empire Health Plan
Health Plan of San Joaquin
Health Net Comm Solutions
Contra Costa Health Plan
Community Hlth Grp Partner
Care1st Partner Plan, LLC
Blue Cross of CA Partnrshp
Anthem Blue Cross Partnrshp
Alameda Alliance For Health
OUT OF STATE
LOS ANGELESMedical
X05X04X03
TotalDisenrollmentTransaction Type Disenrollment Reason Code Plan Type County Name Plan Name
COPS-17.2 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 12:00:00 AM and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 11 of 26Report Created at 4/7/2010 10:37:02 AM
7112
4375791461910436
32
372486335445224319
13714144519203213
813122
3
52
215237129192115
3
6815
1722
153
81
1
1
1
2
Blue Cross of CA Partnrshp
Anthem Blue Cross Partnrshp
Alameda Alliance For Health
County Subtotal
Molina Healthcare Partner
L.A. Care Health Plan
KP Cal, LLC
Kern Family Health Care
Inland Empire Health Plan
Health Plan of San Joaquin
Health Net Comm Solutions
Community Hlth Grp Partner
Blue Cross of CA Partnrshp
Anthem Blue Cross Partnrshp
Alameda Alliance For Health
County Subtotal
Anthem Blue Cross Partnrshp
County Subtotal
SACRAMENTO
RIVERSIDE
PLACER
OUT OF STATEMedical
I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Plan Type County Name Plan Name
COPS-17.2 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 12:00:00 AM and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 12 of 26Report Created at 4/7/2010 10:37:02 AM
74
64232
32
1,043293
55132
98
3
7
258261
3
74
21
18
9
1
1
1
2
Blue Cross of CA Partnrshp
Anthem Blue Cross Partnrshp
Alameda Alliance For Health
County Subtotal
Molina Healthcare Partner
L.A. Care Health Plan
KP Cal, LLC
Kern Family Health Care
Inland Empire Health Plan
Health Plan of San Joaquin
Health Net Comm Solutions
Community Hlth Grp Partner
Blue Cross of CA Partnrshp
Anthem Blue Cross Partnrshp
Alameda Alliance For Health
County Subtotal
Anthem Blue Cross Partnrshp
County Subtotal
SACRAMENTO
RIVERSIDE
PLACER
OUT OF STATEMedical
X05X04X03
TotalDisenrollmentTransaction Type Disenrollment Reason Code Plan Type County Name Plan Name
COPS-17.2 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 12:00:00 AM and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 13 of 26Report Created at 4/7/2010 10:37:02 AM
2
921641
5
4
14
1
51,083153801845154902
11
93
24120435162122
251
292512
12
9
13
123652232102429
19
1
Health Plan of San Joaquin
Health Net Comm Solutions
Community Hlth Grp Partner
Care1st Partner Plan, LLC
Blue Cross of CA Partnrshp
Anthem Blue Cross Partnrshp
County Subtotal
Santa Clara Family H.P.
San Francisco Health Plan
Molina Healthcare Partner
L.A. Care Health Plan
KP Cal, LLC
Kern Family Health Care
Inland Empire Health Plan
Health Plan of San Joaquin
Health Net Comm Solutions
Contra Costa Health Plan
Community Hlth Grp Partner
SAN BERNARDINO
SACRAMENTOMedical
I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Plan Type County Name Plan Name
COPS-17.2 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 12:00:00 AM and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 14 of 26Report Created at 4/7/2010 10:37:02 AM
2
104
5
4
14
1
1,64082
11
12
3713
26
39
12
9
13
3792
19
1
Health Plan of San Joaquin
Health Net Comm Solutions
Community Hlth Grp Partner
Care1st Partner Plan, LLC
Blue Cross of CA Partnrshp
Anthem Blue Cross Partnrshp
County Subtotal
Santa Clara Family H.P.
San Francisco Health Plan
Molina Healthcare Partner
L.A. Care Health Plan
KP Cal, LLC
Kern Family Health Care
Inland Empire Health Plan
Health Plan of San Joaquin
Health Net Comm Solutions
Contra Costa Health Plan
Community Hlth Grp Partner
SAN BERNARDINO
SACRAMENTOMedical
X05X04X03
TotalDisenrollmentTransaction Type Disenrollment Reason Code Plan Type County Name Plan Name
COPS-17.2 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 12:00:00 AM and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 15 of 26Report Created at 4/7/2010 10:37:02 AM
18534322254615
1211
14141534
5
513
31
2061131616106581
8
1107107156625181
942431232015
5
6
6773102354625486346
12975214111415739
175518331
1
1
518344827765
Molina Healthcare Partner
L.A. Care Health Plan
KP Cal, LLC
Kern Family Health Care
Inland Empire Health Plan
Health Plan of San Joaquin
Health Net Comm Solutions
Contra Costa Health Plan
Community Hlth Grp Partner
Care1st Partner Plan, LLC
Blue Cross of CA Partnrshp
Anthem Blue Cross Partnrshp
County Subtotal
Molina Healthcare Partner
L.A. Care Health Plan
KP Cal, LLC
Kern Family Health Care
Inland Empire Health Plan
SAN DIEGO
SAN BERNARDINO
Medical
I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Plan Type County Name Plan Name
COPS-17.2 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 12:00:00 AM and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 16 of 26Report Created at 4/7/2010 10:37:02 AM
31732
14
32
5
54
4
51663
8
294242
1901
5
6
1,1561101
5411
2061
1
1
27719
Molina Healthcare Partner
L.A. Care Health Plan
KP Cal, LLC
Kern Family Health Care
Inland Empire Health Plan
Health Plan of San Joaquin
Health Net Comm Solutions
Contra Costa Health Plan
Community Hlth Grp Partner
Care1st Partner Plan, LLC
Blue Cross of CA Partnrshp
Anthem Blue Cross Partnrshp
County Subtotal
Molina Healthcare Partner
L.A. Care Health Plan
KP Cal, LLC
Kern Family Health Care
Inland Empire Health Plan
SAN DIEGO
SAN BERNARDINO
Medical
X05X04X03
TotalDisenrollmentTransaction Type Disenrollment Reason Code Plan Type County Name Plan Name
COPS-17.2 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 12:00:00 AM and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 17 of 26Report Created at 4/7/2010 10:37:02 AM
1
5
6
318343642
1741
2
16051417861619
16
221
1001412173
2342111
1
2
5
8
611062
1
169628088430251611325
Molina Healthcare Partner
L.A. Care Health Plan
KP Cal, LLC
Health Plan of San Joaquin
Health Net Comm Solutions
Contra Costa Health Plan
Blue Cross of CA Partnrshp
Anthem Blue Cross Partnrshp
Alameda Alliance For Health
County Subtotal
San Francisco Health Plan
Molina Healthcare Partner
Health Plan of San Joaquin
Health Net Comm Solutions
Contra Costa Health Plan
Blue Cross of CA Partnrshp
Anthem Blue Cross Partnrshp
County Subtotal
SAN JOAQUIN
SAN FRANCISCO
SAN DIEGOMedical
I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Plan Type County Name Plan Name
COPS-17.2 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 12:00:00 AM and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 18 of 26Report Created at 4/7/2010 10:37:02 AM
1
5
6
621
22
2
281
16
23
13011
3411
1
2
5
8
79
1
1,4452138
Molina Healthcare Partner
L.A. Care Health Plan
KP Cal, LLC
Health Plan of San Joaquin
Health Net Comm Solutions
Contra Costa Health Plan
Blue Cross of CA Partnrshp
Anthem Blue Cross Partnrshp
Alameda Alliance For Health
County Subtotal
San Francisco Health Plan
Molina Healthcare Partner
Health Plan of San Joaquin
Health Net Comm Solutions
Contra Costa Health Plan
Blue Cross of CA Partnrshp
Anthem Blue Cross Partnrshp
County Subtotal
SAN JOAQUIN
SAN FRANCISCO
SAN DIEGOMedical
X05X04X03
TotalDisenrollmentTransaction Type Disenrollment Reason Code Plan Type County Name Plan Name
COPS-17.2 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 12:00:00 AM and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 19 of 26Report Created at 4/7/2010 10:37:02 AM
1
14
601232113
2
455112245
911
12093811131146022
581934324
4
7
1
6
141
1
110319710742818
153
270649218922232
101
Kern Family Health Care
Health Plan of San Joaquin
Health Net Comm Solutions
Contra Costa Health Plan
Blue Cross of CA Partnrshp
Alameda Alliance For Health
County Subtotal
Santa Clara Family H.P.
L.A. Care Health Plan
KP Cal, LLC
Kern Family Health Care
Health Plan of San Joaquin
Health Net Comm Solutions
Contra Costa Health Plan
Blue Cross of CA Partnrshp
Alameda Alliance For Health
County Subtotal
Santa Clara Family H.P.
STANISLAUS
SANTA CLARA
SAN JOAQUINMedical
I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Plan Type County Name Plan Name
COPS-17.2 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 12:00:00 AM and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 20 of 26Report Created at 4/7/2010 10:37:02 AM
1
14
921
2
83
11
369
120
4
7
1
6
15
1
197
18
4291
11
Kern Family Health Care
Health Plan of San Joaquin
Health Net Comm Solutions
Contra Costa Health Plan
Blue Cross of CA Partnrshp
Alameda Alliance For Health
County Subtotal
Santa Clara Family H.P.
L.A. Care Health Plan
KP Cal, LLC
Kern Family Health Care
Health Plan of San Joaquin
Health Net Comm Solutions
Contra Costa Health Plan
Blue Cross of CA Partnrshp
Alameda Alliance For Health
County Subtotal
Santa Clara Family H.P.
STANISLAUS
SANTA CLARA
SAN JOAQUINMedical
X05X04X03
TotalDisenrollmentTransaction Type Disenrollment Reason Code Plan Type County Name Plan Name
COPS-17.2 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 12:00:00 AM and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 21 of 26Report Created at 4/7/2010 10:37:02 AM
3713,7583,5581611,0545515032,3291,3753112
3710,1412,9401555042613341,7068953112
3138710102131174731
52
4
7
15
3
1
1302281933
3
71
142651221397441
3
148181432358
13
3
1
County Subtotal
Santa Clara Family H.P.
Molina Healthcare Partner
L.A. Care Health Plan
Kern Family Health Care
Inland Empire Health Plan
Health Plan of San Joaquin
Health Net Comm Solutions
Contra Costa Health Plan
Community Hlth Grp Partner
Blue Cross of CA Partnrshp
Anthem Blue Cross Partnrshp
County Subtotal
Santa Clara Family H.P.
Molina Healthcare Partner
L.A. Care Health Plan
Total
TULARE
STANISLAUS
Total
Medical
I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Plan Type County Name Plan Name
COPS-17.2 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 12:00:00 AM and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 22 of 26Report Created at 4/7/2010 10:37:02 AM
23,5672517921
17,2102417918
603
7
4
7
15
3
1
185
3
8
367
3
2201
13
3
1
County Subtotal
Santa Clara Family H.P.
Molina Healthcare Partner
L.A. Care Health Plan
Kern Family Health Care
Inland Empire Health Plan
Health Plan of San Joaquin
Health Net Comm Solutions
Contra Costa Health Plan
Community Hlth Grp Partner
Blue Cross of CA Partnrshp
Anthem Blue Cross Partnrshp
County Subtotal
Santa Clara Family H.P.
Molina Healthcare Partner
L.A. Care Health Plan
Total
TULARE
STANISLAUS
Total
Medical
X05X04X03
TotalDisenrollmentTransaction Type Disenrollment Reason Code Plan Type County Name Plan Name
COPS-17.2 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 12:00:00 AM and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 23 of 26Report Created at 4/7/2010 10:37:02 AM
284211142
1785641
33,6176186550290169623480
4518124
113
11,802309538119060346296
906741618
321
52
3910
42
21,58827011589399252156
15374
41
84121
13
Armenian
Arabic
Total
Vietnamese
Tagalog
Spanish
Russian
No Valid Data
Korean
Hmong
Farsi
English
Chinese
Cambodian
Armenian
Arabic
Medical
Dental
X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Plan Type Language
Disenrollment Transactions by Plan Type (Medical, Dental) and Language
COPS-17.2 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 12:00:00 AM and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 24 of 26Report Created at 4/7/2010 10:37:02 AM
88
140
6,3571
70
5
3,390
141
6
7
49
6
2,6201
29
5
16
13
Armenian
Arabic
Total
Vietnamese
Tagalog
Spanish
Russian
No Valid Data
Korean
Hmong
Farsi
English
Chinese
Cambodian
Armenian
Arabic
Medical
Dental
X05
TotalDisenrollment
Transaction Type Disenrollment Reason Code Plan Type Language
COPS-17.2 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 12:00:00 AM and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 25 of 26Report Created at 4/7/2010 10:37:02 AM
179213713,7583,5581611,0545515032,3291,3753112
179183710,1412,9401555042613341,7068953112
3115463311293
18315
491143,2841,0035811984724992202
1121372548
2321932109
1112
1103112
53953273
189333
11917216,2481,622943651672431,047624319
312717321116141
1281131
Total
Vietnamese
Tagalog
Spanish
Russian
No Valid Data
No Response, Client declined to state
Korean
Hmong
Farsi
English
Chinese
Cambodian
Total
Medical
X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Plan Type Language
COPS-17.2 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 12:00:00 AM and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 26 of 26Report Created at 4/7/2010 10:37:02 AM
23,56725
17,21024
204
18
5,41510
196
781
5
18
1821
36
10,59212
194
44
Total
Vietnamese
Tagalog
Spanish
Russian
No Valid Data
No Response, Client declined to state
Korean
Hmong
Farsi
English
Chinese
Cambodian
Total
Medical
X05
TotalDisenrollment
Transaction Type Disenrollment Reason Code Plan Type Language
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 2 of 225Report Created at 4/6/2010 4:54:44 PM
6
7
1
5
7
4
3
2
6
5
15
3
14
19
13
11
1
94578
94577
94568
94566
94560
94555
94551
94550
94546
94545
94544
94542
94541
94538
94536
94501
93725ALAMEDAMandatory
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 3 of 225Report Created at 4/6/2010 4:54:44 PM
000030400000000
000000000010000
000010000000000
000010000000000
0000150010000000
000020000000000
000010000000000
000040100000000
000030010001000
000010000000000
000082000000000
0000172000001000
0000130030103000
000012000000000
0000193000101000
000040000000000
000070100000000
000040110000000
94706
94705
94703
94702
94621
94619
94612
94609
94608
94607
94606
94605
94603
94602
94601
94588
94587
94580ALAMEDAMandatory
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 4 of 225Report Created at 4/6/2010 4:54:44 PM
7
1
1
1
16
2
1
5
5
1
10
20
20
3
24
4
8
6
94706
94705
94703
94702
94621
94619
94612
94609
94608
94607
94606
94605
94603
94602
94601
94588
94587
94580ALAMEDAMandatory
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 5 of 225Report Created at 4/6/2010 4:54:44 PM
000000003000000
0000100000020000
000051000002000
000042012000000
0000200004051000
000001000001000
000010000000000
000040000000000
000020000111000
000080000000000
000030000000000
000010100000000
000020013010000
0000211000000000
00001979117251318000
000020000000000
000020000000000
000010000000000
94563
94561
94553
94547
94531
94530
94525
94523
94521
94520
94519
94518
94513
94509
Total
95821
95817
94710
CONTRA COSTA
ALAMEDAMandatory
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 6 of 225Report Created at 4/6/2010 4:54:44 PM
3
12
8
9
30
2
1
4
5
8
3
2
7
22
262
2
2
1
94563
94561
94553
94547
94531
94530
94525
94523
94521
94520
94519
94518
94513
94509
Total
95821
95817
94710
CONTRA COSTA
ALAMEDAMandatory
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 7 of 225Report Created at 4/6/2010 4:54:44 PM
000010000000000
000031000060000
000050000010000
000020416651521418000
0000302010112000
000020000000000
0000170010032000
000012000000000
0000212201001000
000010000000000
000020000000000
000001000000000
000030000000000
000011000000000
000040202000000
000060000010000
0000320110008000
000033000000000
93277
93234
93210
Total
94806
94805
94804
94803
94801
94605
94601
94598
94597
94583
94582
94572
94565
94564
FRESNO
CONTRA COSTA
Mandatory
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 8 of 225Report Created at 4/6/2010 4:54:44 PM
1
10
6
280
37
2
23
3
27
1
2
1
3
2
8
7
42
6
93277
93234
93210
Total
94806
94805
94804
94803
94801
94605
94601
94598
94597
94583
94582
94572
94565
94564
FRESNO
CONTRA COSTA
Mandatory
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 9 of 225Report Created at 4/6/2010 4:54:44 PM
000034000003000
0000510000066000
000010000000000
00002010000015000
00001970000100000
000030000000000
000051000032000
000014000000000
000010000010000
000033000050000
000070000053000
000030000020000
000023290019324000
0000123000056000
000010000000000
000011000000000
000030000000000
000010000000000
93650
93648
93647
93646
93640
93631
93630
93625
93624
93622
93619
93616
93612
93611
93609
93606
93602
93306FRESNOMandatory
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 10 of 225Report Created at 4/6/2010 4:54:44 PM
10
27
1
36
36
3
11
5
2
11
15
5
98
26
1
2
3
1
93650
93648
93647
93646
93640
93631
93630
93625
93624
93622
93619
93616
93612
93611
93609
93606
93602
93306FRESNOMandatory
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 11 of 225Report Created at 4/6/2010 4:54:44 PM
000080000010000
00001514000031000
00001511010061000
0000111000001212000
000054640231309000
0000762800162014000
000025100000105000
000044350000171000
000099500100208000
000018130130133000
000001000000000
000000000020000
000016121000133000
000060000000000
00002827000143000
000001000000000
000020120000929000
000001000000000
93721
93720
93711
93710
93706
93705
93704
93703
93702
93701
93675
93667
93662
93660
93657
93656
93654
93652FRESNOMandatory
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 12 of 225Report Created at 4/6/2010 4:54:44 PM
9
33
34
45
163
145
50
97
178
51
1
2
45
6
63
1
70
1
93721
93720
93711
93710
93706
93705
93704
93703
93702
93701
93675
93667
93662
93660
93657
93656
93654
93652FRESNOMandatory
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 13 of 225Report Created at 4/6/2010 4:54:44 PM
000055030000000
0000451110200000
000020010000000
0000122000000000
000010000000000
00007765012141123315173000
000010000000000
000010000000000
000000000010000
000020000000000
000010000000000
000010000000000
0000198100079000
0000555403012014000
0000443200102413000
000029190123111000
000031000000000
000064340502168000
93240
93215
93206
93203
90044
Total
95828
95206
94145
93776
93745
93744
93728
93727
93726
93725
93723
93722
KERN
FRESNOMandatory
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 14 of 225Report Created at 4/6/2010 4:54:44 PM
13
50
3
14
1
1,815
1
1
1
2
1
1
44
147
114
66
4
129
93240
93215
93206
93203
90044
Total
95828
95206
94145
93776
93745
93744
93728
93727
93726
93725
93723
93722
KERN
FRESNOMandatory
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 15 of 225Report Created at 4/6/2010 4:54:44 PM
000000000001000
000050000000000
0000200010010000
000041000000000
000040100000000
0000192000284000
0000195000248000
000052130005714000
0000402032242000
0000315260174000
00004011041176000
000070000000000
0000120010060000
000091100182000
000081000040000
0000160000000000
0000100000000000
0000120000020000
93385
93314
93313
93312
93311
93309
93308
93307
93306
93305
93304
93301
93280
93268
93263
93250
93249
93241KERNMandatory
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 16 of 225Report Created at 4/6/2010 4:54:44 PM
1
5
22
5
5
35
38
91
55
56
70
7
19
22
13
16
10
14
93385
93314
93313
93312
93311
93309
93308
93307
93306
93305
93304
93301
93280
93268
93263
93250
93249
93241KERNMandatory
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 17 of 225Report Created at 4/6/2010 4:54:44 PM
0000222000021000
0000223000150000
0000216010001000
000090000100000
00003219121243000
00003210010010000
00003810010361000
0000397525213166545000
000010000000000
000020000000000
000030000000000
000032000040000
000020000000000
000000010000000
000001000000000
0000110000020000
000000000003000
000020000011000
90007
90006
90005
90004
90003
90002
90001
Total
93706
93615
93581
93561
93534
93527
93516
93505
93504
93501
LOS ANGELES
KERNMandatory
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 18 of 225Report Created at 4/6/2010 4:54:44 PM
27
31
29
10
64
44
59
604
1
2
3
9
2
1
1
13
3
4
90007
90006
90005
90004
90003
90002
90001
Total
93706
93615
93581
93561
93534
93527
93516
93505
93504
93501
LOS ANGELES
KERNMandatory
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 19 of 225Report Created at 4/6/2010 4:54:44 PM
000041000000000
0000100000100000
0000307000004000
000004000000000
000010000000000
000012258020010000
00007857020212000
000011000000000
0000101000000000
0000135000002000
0000191000000000
000093000000000
000011010001000
0000161000000000
000000000010000
000074000000000
000015615000441000
0000112000030000
90028
90027
90026
90025
90024
90023
90022
90021
90020
90019
90018
90017
90016
90015
90014
90012
90011
90008LOS ANGELESMandatory
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 20 of 225Report Created at 4/6/2010 4:54:44 PM
5
11
41
4
1
183
142
2
11
20
20
12
4
17
1
11
180
16
90028
90027
90026
90025
90024
90023
90022
90021
90020
90019
90018
90017
90016
90015
90014
90012
90011
90008LOS ANGELESMandatory
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 21 of 225Report Created at 4/6/2010 4:54:44 PM
000010000000000
0000125010021000
000040000000000
000010010000000
000010734221091000
0000126020210000
0000228000150000
000041000150000
000082000050000
000040000100000
0000140000000000
00004820060040000
000000000010000
0000102000002000
000093370000153000
0000189000030000
0000383000144000
0000143010020000
90048
90047
90046
90045
90044
90043
90042
90041
90040
90039
90038
90037
90035
90034
90033
90032
90031
90029LOS ANGELESMandatory
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 22 of 225Report Created at 4/6/2010 4:54:44 PM
1
21
4
2
156
23
36
11
15
5
14
78
1
14
148
30
50
20
90048
90047
90046
90045
90044
90043
90042
90041
90040
90039
90038
90037
90035
90034
90033
90032
90031
90029LOS ANGELESMandatory
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 23 of 225Report Created at 4/6/2010 4:54:44 PM
000031000001000
00001890000155000
00005012020322000
00002811000152000
000000001000000
000001010000000
00006924001232000
000010000000000
000001000000000
000061000000000
0000140000070000
000000000010000
00006250030037000
0000112020020000
000099020170000
00002150210102000
000011000010000
0000215000040000
90230
90222
90221
90220
90212
90211
90201
90077
90068
90066
90065
90064
90063
90062
90061
90059
90058
90057LOS ANGELESMandatory
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 24 of 225Report Created at 4/6/2010 4:54:44 PM
5
47
71
47
1
2
101
1
1
7
21
1
125
17
28
41
3
30
90230
90222
90221
90220
90212
90211
90201
90077
90068
90066
90065
90064
90063
90062
90061
90059
90058
90057LOS ANGELESMandatory
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 25 of 225Report Created at 4/6/2010 4:54:44 PM
000010000000000
000020000000000
0000438000065000
000030000000000
000060000000000
0000115010050000
000000010000000
00004180340171000
000084000052000
00003380420150000
00003440002150000
000060010020000
000043000020000
000010000000000
000048000020000
000055000001000
000021002010000
000000001000000
90292
90291
90280
90278
90277
90270
90266
90262
90260
90255
90250
90249
90247
90245
90242
90241
90240
90232LOS ANGELESMandatory
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 26 of 225Report Created at 4/6/2010 4:54:44 PM
1
2
62
3
6
22
1
74
19
62
55
9
9
1
14
11
6
1
90292
90291
90280
90278
90277
90270
90266
90262
90260
90255
90250
90249
90247
90245
90242
90241
90240
90232LOS ANGELESMandatory
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 27 of 225Report Created at 4/6/2010 4:54:44 PM
0000829000120000
0000310000411000
000002000000000
0000829010200000
000045010000000
000040000000000
000080000200000
000003000000000
000010000001000
0000145012010000
000020000010000
000030000000000
000010000000000
000040000020000
00001430000160000
000042000080000
000084000020000
0000141040080000
90605
90604
90603
90602
90601
90505
90504
90503
90502
90501
90405
90404
90401
90305
90304
90303
90302
90301LOS ANGELESMandatory
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 28 of 225Report Created at 4/6/2010 4:54:44 PM
40
19
2
40
10
4
10
3
2
23
3
3
1
6
33
14
14
27
90605
90604
90603
90602
90601
90505
90504
90503
90502
90501
90405
90404
90401
90305
90304
90303
90302
90301LOS ANGELESMandatory
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 29 of 225Report Created at 4/6/2010 4:54:44 PM
00001810041154000
000010002000000
000073011000000
000010000000000
000006000010000
000010000000000
000066000010000
0000197000041000
000020000000000
000021000100000
000062000000000
00002512000033000
0000218012120000
00004317000032000
000093000000000
000000010000000
000001000000000
0000108010010000
90723
90717
90716
90715
90713
90712
90710
90706
90703
90701
90670
90660
90650
90640
90638
90637
90631
90606LOS ANGELESMandatory
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 30 of 225Report Created at 4/6/2010 4:54:44 PM
43
3
12
1
7
1
13
31
2
4
8
43
35
65
12
1
1
20
90723
90717
90716
90715
90713
90712
90710
90706
90703
90701
90670
90660
90650
90640
90638
90637
90631
90606LOS ANGELESMandatory
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 31 of 225Report Created at 4/6/2010 4:54:44 PM
000012010000000
000010000002000
000051130021100000
0000234000032000
000011000000000
000051000023000
0000168021094000
000034212510157000
00002211000030000
000000003000000
000082010021000
000000000010000
000012000001000
000021000000000
0000126000011000
00002220110133000
000030000000000
0000132000051000
90815
90814
90813
90810
90808
90807
90806
90805
90804
90803
90802
90801
90755
90746
90745
90744
90732
90731LOS ANGELESMandatory
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 32 of 225Report Created at 4/6/2010 4:54:44 PM
4
3
77
32
2
11
40
85
36
3
14
1
4
3
20
42
3
21
90815
90814
90813
90810
90808
90807
90806
90805
90804
90803
90802
90801
90755
90746
90745
90744
90732
90731LOS ANGELESMandatory
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 33 of 225Report Created at 4/6/2010 4:54:44 PM
000020000000000
000010000000000
000061000002000
0000020000100000
000020000000000
000034000020000
000030000000000
000070001010000
000000010000000
000031000100000
000040000000000
000010000000000
00002200020100000
0000714000030000
000055000000000
000001000010000
000010000000000
000031000000000
91204
91203
91202
91201
91115
91107
91106
91104
91103
91101
91042
91040
91016
91010
91007
91006
91003
91001LOS ANGELESMandatory
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 34 of 225Report Created at 4/6/2010 4:54:44 PM
2
1
9
12
2
9
3
9
1
5
4
1
34
24
10
2
1
4
91204
91203
91202
91201
91115
91107
91106
91104
91103
91101
91042
91040
91016
91010
91007
91006
91003
91001LOS ANGELESMandatory
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 35 of 225Report Created at 4/6/2010 4:54:44 PM
0000293020043000
0000121020000000
0000348000300000
0000365010023000
000030000000000
000033000000000
000021000020000
000040001000000
000013000000000
000020000000000
0000210000161000
000032000010000
000013000000000
000001000000000
000000010000000
000020000000000
000040000100000
000040000040000
91342
91340
91335
91331
91326
91325
91324
91321
91311
91307
91306
91304
91303
91214
91208
91207
91206
91205LOS ANGELESMandatory
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 36 of 225Report Created at 4/6/2010 4:54:44 PM
41
15
45
47
3
6
5
5
4
2
29
6
4
1
1
2
5
8
91342
91340
91335
91331
91326
91325
91324
91321
91311
91307
91306
91304
91303
91214
91208
91207
91206
91205LOS ANGELESMandatory
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 37 of 225Report Created at 4/6/2010 4:54:44 PM
0000157000002000
0000132000002000
000010010000000
0000114000110000
000031010020000
000004000000000
000060001000000
000022000000000
000022000000000
000060020000000
000020000000000
000010000000000
0000104001030000
000041002000000
000020000000000
000020000000000
000022000100000
0000144030122000
91406
91405
91403
91402
91401
91390
91387
91367
91364
91355
91354
91353
91352
91351
91350
91345
91344
91343LOS ANGELESMandatory
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 38 of 225Report Created at 4/6/2010 4:54:44 PM
24
17
2
17
7
4
7
4
4
8
2
1
18
7
2
2
5
26
91406
91405
91403
91402
91401
91390
91387
91367
91364
91355
91354
91353
91352
91351
91350
91345
91344
91343LOS ANGELESMandatory
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 39 of 225Report Created at 4/6/2010 4:54:44 PM
000060010100000
000040000410000
0000120000000000
000060000000000
0000372000123000
0000186000020000
000000000010000
000091000010000
0000221010020000
000020000002000
000010000000000
000000000010000
000010010010000
000030000000000
000032000010000
000020000000000
000020000000000
0000110000000000
91724
91723
91722
91711
91706
91702
91607
91606
91605
91601
91506
91505
91504
91502
91501
91423
91412
91411LOS ANGELESMandatory
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 40 of 225Report Created at 4/6/2010 4:54:44 PM
8
9
12
6
45
26
1
11
26
4
1
1
3
3
6
2
2
11
91724
91723
91722
91711
91706
91702
91607
91606
91605
91601
91506
91505
91504
91502
91501
91423
91412
91411LOS ANGELESMandatory
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 41 of 225Report Created at 4/6/2010 4:54:44 PM
0000449020010000
000010000000000
0000252000200000
0000308100110000
0000216000020000
000060000001000
000052000010000
000080000100000
000021000000000
000060000000000
0000151000040000
000050012020000
0000285010422000
000032000000000
000022000000000
0000395000102000
00003110010140000
000073100001000
91770
91769
91768
91767
91766
91765
91755
91754
91750
91748
91746
91745
91744
91741
91740
91733
91732
91731LOS ANGELESMandatory
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 42 of 225Report Created at 4/6/2010 4:54:44 PM
56
1
29
41
29
7
8
9
3
6
20
10
42
5
4
47
47
12
91770
91769
91768
91767
91766
91765
91755
91754
91750
91748
91746
91745
91744
91741
91740
91733
91732
91731LOS ANGELESMandatory
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 43 of 225Report Created at 4/6/2010 4:54:44 PM
000010000000000
000020000000000
000010000000000
000020000000000
000010000000000
000010000000000
000010000000000
00001610000302000
0000203000091000
000010000000000
000022000110000
000022000000000
000092000001000
000072000000000
000012000000000
0000227010210000
000050000000000
000012000000000
92882
92543
92505
92392
92376
92335
92308
91803
91801
91793
91792
91791
91790
91789
91780
91776
91775
91773LOS ANGELESMandatory
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 44 of 225Report Created at 4/6/2010 4:54:44 PM
1
2
1
2
1
1
1
31
33
1
6
4
12
9
3
33
5
3
92882
92543
92505
92392
92376
92335
92308
91803
91801
91793
91792
91791
91790
91789
91780
91776
91775
91773LOS ANGELESMandatory
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 45 of 225Report Created at 4/6/2010 4:54:44 PM
00003,1151,16391005879461134000
000030000000000
000030000000000
000010000000000
000020000000000
000010000000000
000059000021000
000010000000000
00002017010183000
0000184200030000
000070800411461000
000001000000000
0000013001000000
000021000000000
0000159005010000
00004823021033000
00002514000152000
000040000000000
Total
95826
94606
94537
93702
93630
93591
93553
93552
93551
93550
93544
93543
93539
93536
93535
93534
93510LOS ANGELESMandatory
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 46 of 225Report Created at 4/6/2010 4:54:44 PM
5,119
3
3
1
2
1
17
1
50
27
176
1
14
3
30
80
47
4
Total
95826
94606
94537
93702
93630
93591
93553
93552
93551
93550
93544
93543
93539
93536
93535
93534
93510LOS ANGELESMandatory
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 47 of 225Report Created at 4/6/2010 4:54:44 PM
000010000000000
0000131040010000
000020000000000
000031000000000
000010000000000
000000000030000
000010000000000
0000120020001000
0000241040400000
0000110101002000
0000182110200000
0000240110000000
000051000001000
000030000000000
000040000000000
0000151033101000
000010000000000
0000130002300000
92264
92262
92260
92254
92253
92248
92241
92240
92236
92234
92223
92220
92211
92203
92202
92201
92115
91752RIVERSIDEMandatory
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 48 of 225Report Created at 4/6/2010 4:54:44 PM
1
19
2
4
1
3
1
15
33
15
24
26
7
3
4
24
1
18
92264
92262
92260
92254
92253
92248
92241
92240
92236
92234
92223
92220
92211
92203
92202
92201
92115
91752RIVERSIDEMandatory
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 49 of 225Report Created at 4/6/2010 4:54:44 PM
0000141000000000
0000121000210000
000060000000000
000000000010000
0000200000131000
0000455172020000
000031000000000
00001793111000000
000083000000000
0000110203120000
000063040000000
0000224032000000
000062010000000
000030000000000
000010000000000
000010000000000
0000140030000000
000010023000000
92544
92543
92539
92532
92530
92509
92508
92507
92506
92505
92504
92503
92501
92392
92374
92276
92274
92270RIVERSIDEMandatory
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 50 of 225Report Created at 4/6/2010 4:54:44 PM
15
16
6
1
25
62
4
41
11
19
13
31
9
3
1
1
17
6
92544
92543
92539
92532
92530
92509
92508
92507
92506
92505
92504
92503
92501
92392
92374
92276
92274
92270RIVERSIDEMandatory
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 51 of 225Report Created at 4/6/2010 4:54:44 PM
000010000010000
000032013000000
000020002000000
0000100000000000
000050020000000
0000231010130000
0000120000003000
0000180042012000
00001812020030000
000020000010000
000062000000000
000041000010000
0000110300300000
0000120000000000
0000293102100000
000070000100000
000060000000000
0000200101030000
92592
92591
92587
92585
92584
92583
92582
92571
92570
92567
92563
92562
92557
92555
92553
92551
92548
92545RIVERSIDEMandatory
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 52 of 225Report Created at 4/6/2010 4:54:44 PM
2
9
4
10
7
29
15
27
35
3
8
6
17
12
36
8
6
25
92592
92591
92587
92585
92584
92583
92582
92571
92570
92567
92563
92562
92557
92555
92553
92551
92548
92545RIVERSIDEMandatory
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 53 of 225Report Created at 4/6/2010 4:54:44 PM
000090040000000
000050000010000
0000130000000000
000010000021000
0000172041211000
0000101000401000
000070000000000
0000382020121000
0000121000224000
000020000000000
000058463184737213111000
000030200000000
0000170000000000
000080000100000
000065200000000
0000131000030000
000010010000000
000060000020000
95632
95630
95628
95626
95624
95621
95611
95610
95608
91344
Total
92883
92882
92881
92880
92879
92596
92595
SACRAMENTO
RIVERSIDEMandatory
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 54 of 225Report Created at 4/6/2010 4:54:44 PM
13
6
13
4
28
16
7
46
21
2
812
5
17
9
13
17
2
8
95632
95630
95628
95626
95624
95621
95611
95610
95608
91344
Total
92883
92882
92881
92880
92879
92596
92595
SACRAMENTO
RIVERSIDEMandatory
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 55 of 225Report Created at 4/6/2010 4:54:44 PM
0000291033051000
00004710030150000
000040000003000
000031031000000
0000130040100000
000010000000000
0000202020410000
000041010000000
000010000000000
000030000010000
0000201021000000
00001512041002000
000030000043000
0000213001140000
000050000111000
0000247000184000
000030000000000
000010000000000
95821
95820
95819
95818
95817
95816
95815
95814
95812
95811
95758
95757
95673
95670
95662
95660
95641
95638SACRAMENTOMandatory
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 56 of 225Report Created at 4/6/2010 4:54:44 PM
42
66
7
8
18
1
29
6
1
4
24
34
10
30
8
44
3
1
95821
95820
95819
95818
95817
95816
95815
95814
95812
95811
95758
95757
95673
95670
95662
95660
95641
95638SACRAMENTOMandatory
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 57 of 225Report Created at 4/6/2010 4:54:44 PM
000050000011000
00002630100111000
00003270204140000
0000143010063000
00006040210145000
0000170000001000
0000192000305000
0000264020402000
0000113000100000
0000102000021000
000070000160000
000059120100041000
0000320000123000
0000173021010000
0000257020043000
00005311003055000
0000748072166000
0000286020010000
95864
95843
95842
95841
95838
95835
95834
95833
95832
95831
95829
95828
95827
95826
95825
95824
95823
95822SACRAMENTOMandatory
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 58 of 225Report Created at 4/6/2010 4:54:44 PM
7
42
59
27
86
18
29
38
15
15
14
86
38
24
41
77
104
37
95864
95843
95842
95841
95838
95835
95834
95833
95832
95831
95829
95828
95827
95826
95825
95824
95823
95822SACRAMENTOMandatory
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 59 of 225Report Created at 4/6/2010 4:54:44 PM
000084130200000
000072000010000
0000112000000000
0000254030843000
0000130060002000
000010100000000
0000267113000000
0000116000002000
0000279003000000
0000225010001000
000010000000000
000010000000000
000030003101000
0000104000060000
000030003901000
0000131000000000
000020000000000
0000846119063153311459000
92316
92308
92307
92301
91786
91784
91764
91763
91762
91761
91759
91739
91737
91730
91710
91709
91701
Total
SAN BERNARDINO
SACRAMENTOMandatory
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 60 of 225Report Created at 4/6/2010 4:54:44 PM
18
10
13
47
21
2
38
19
39
29
1
1
8
20
16
14
2
1,249
92316
92308
92307
92301
91786
91784
91764
91763
91762
91761
91759
91739
91737
91730
91710
91709
91701
Total
SAN BERNARDINO
SACRAMENTOMandatory
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 61 of 225Report Created at 4/6/2010 4:54:44 PM
0000342020043000
0000140400011000
000000000010000
0000361411151000
000060010010000
0000287011044000
000061000451000
000020010000000
000010000000000
000043020300000
0000103000061000
0000512033020000
000030000004000
000054030000000
0000212240230000
0000424020844000
000011000000000
0000178000021000
92395
92394
92393
92392
92377
92376
92374
92373
92359
92354
92346
92345
92344
92337
92336
92335
92329
92324SAN BERNARDINO
Mandatory
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 62 of 225Report Created at 4/6/2010 4:54:44 PM
45
20
1
50
8
45
17
3
1
12
20
61
7
12
34
64
2
28
92395
92394
92393
92392
92377
92376
92374
92373
92359
92354
92346
92345
92344
92337
92336
92335
92329
92324SAN BERNARDINO
Mandatory
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 63 of 225Report Created at 4/6/2010 4:54:44 PM
000011000000000
000032000022000
000000020000000
0000194001201000
0000163001132000
000020000000000
0000100000000000
000014000000000
000058788134318435334000
000010000000000
000010000000000
000070000001000
0000190010110000
000090010000000
0000201000102000
0000130001221000
0000475070110000
000050000000000
91915
91913
91912
91911
91910
91906
91902
91901
Total
95116
92415
92411
92410
92408
92407
92405
92404
92399
SAN DIEGO
SAN BERNARDINO
Mandatory
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 64 of 225Report Created at 4/6/2010 4:54:44 PM
2
9
2
27
26
2
10
5
879
1
1
8
22
10
24
19
61
5
91915
91913
91912
91911
91910
91906
91902
91901
Total
95116
92415
92411
92410
92408
92407
92405
92404
92399
SAN DIEGO
SAN BERNARDINO
Mandatory
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 65 of 225Report Created at 4/6/2010 4:54:44 PM
0000152001048000
00002113050097000
00003319020136000
00003531002161000
00001222020000000
000010010000000
000000001001000
000010000000000
000000010000000
000000020010000
000050000001000
00001713060375000
0000207000013000
000000002000000
000030010001000
000041000003000
000032000001000
0000104020012000
92026
92025
92021
92020
92019
92011
92009
92008
92007
92003
91978
91977
91950
91946
91945
91942
91941
91932SAN DIEGOMandatory
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 66 of 225Report Created at 4/6/2010 4:54:44 PM
30
55
64
76
36
2
2
1
1
3
6
51
31
2
5
8
6
19
92026
92025
92021
92020
92019
92011
92009
92008
92007
92003
91978
91977
91950
91946
91945
91942
91941
91932SAN DIEGOMandatory
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 67 of 225Report Created at 4/6/2010 4:54:44 PM
000020600003000
000032004046000
000000000020000
000001040271000
000010000000000
000033131121000
000075002012000
000040000012000
000012061000000
0000103000213000
000083020003000
0000151030095000
0000131000220000
000000001000000
000030000000000
000010000000000
000047000071000
000079020015000
92081
92078
92075
92071
92070
92069
92065
92064
92058
92057
92056
92054
92040
92037
92036
92029
92028
92027SAN DIEGOMandatory
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 68 of 225Report Created at 4/6/2010 4:54:44 PM
11
19
2
15
1
15
17
7
10
19
16
33
18
1
3
1
19
24
92081
92078
92075
92071
92070
92069
92065
92064
92058
92057
92056
92054
92040
92037
92036
92029
92028
92027SAN DIEGOMandatory
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 69 of 225Report Created at 4/6/2010 4:54:44 PM
000050000000000
000033000011000
000075010010000
0000136010120000
0000251010026000
0000394020054000
000074000121000
000010000000000
000001000000000
000021000000000
000001000000000
000031130412204000
000041000001000
0000352070011000
000020000000000
0000100000000000
0000151010073000
000010000000000
92119
92117
92116
92115
92114
92113
92111
92110
92109
92108
92107
92105
92104
92102
92101
92084
92083
92082SAN DIEGOMandatory
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 70 of 225Report Created at 4/6/2010 4:54:44 PM
5
8
14
23
35
54
15
1
1
3
1
75
6
46
2
10
27
1
92119
92117
92116
92115
92114
92113
92111
92110
92109
92108
92107
92105
92104
92102
92101
92084
92083
92082SAN DIEGOMandatory
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 71 of 225Report Created at 4/6/2010 4:54:44 PM
000001000000000
000040000000000
000030000000000
00005622297682122130111000
000010000000000
000010000000000
0000143013040000
0000123010015000
000030000040000
000001000000000
000011000000000
000021000000000
000010000000000
000000030206000
00001111020151000
000011000010000
000000000002000
000010000000000
94107
94103
94102
Total
95662
92583
92173
92154
92139
92131
92130
92129
92128
92127
92126
92123
92122
92120
SAN FRANCISCO
SAN DIEGOMandatory
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 72 of 225Report Created at 4/6/2010 4:54:44 PM
1
4
3
1,150
1
1
25
22
7
1
2
3
1
11
31
3
2
1
94107
94103
94102
Total
95662
92583
92173
92154
92139
92131
92130
92129
92128
92127
92126
92123
92122
92120
SAN FRANCISCO
SAN DIEGOMandatory
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 73 of 225Report Created at 4/6/2010 4:54:44 PM
000040000011000
00008412120163000
000010000000000
000080100000000
000010020000000
000032000000000
000010000100000
000030000000000
0000213000020000
000010000021000
000020000001000
000031000000000
000020000020000
000010000000000
000084000000000
0000101000000000
000080000001000
000040000000000
95202
Total
94142
94134
94133
94132
94130
94127
94124
94122
94121
94116
94115
94114
94112
94110
94109
94108
SAN JOAQUIN
SAN FRANCISCO
Mandatory
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 74 of 225Report Created at 4/6/2010 4:54:44 PM
6
109
1
9
3
5
2
3
26
4
3
4
4
1
12
11
9
4
95202
Total
94142
94134
94133
94132
94130
94127
94124
94122
94121
94116
94115
94114
94112
94110
94109
94108
SAN JOAQUIN
SAN FRANCISCO
Mandatory
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 75 of 225Report Created at 4/6/2010 4:54:44 PM
000010020000000
000020300000000
000010050000000
000020000000000
0000360056110000
000001000001000
000012000004000
000005000000000
000074000110000
000052010010000
000032000110000
0000181000030000
0000155110010000
00002511040006000
00002210110020000
0000182002002000
0000110000010000
000070000020000
95330
95320
95258
95242
95240
95237
95231
95220
95219
95215
95212
95210
95209
95207
95206
95205
95204
95203SAN JOAQUINMandatory
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 76 of 225Report Created at 4/6/2010 4:54:44 PM
3
5
6
2
49
2
7
5
13
9
7
22
23
46
36
24
12
9
95330
95320
95258
95242
95240
95237
95231
95220
95219
95215
95212
95210
95209
95207
95206
95205
95204
95203SAN JOAQUINMandatory
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 77 of 225Report Created at 4/6/2010 4:54:44 PM
000010000000000
000030000000000
000050000020000
000052000021000
000051010040000
000010000000000
000041040010000
000010000000000
000010000000000
000010000000000
000022453821861919000
000020000000000
000071000100000
0000125000210000
000000200000000
000010000000000
0000120100004000
0000122020041000
94301
94089
94087
94086
94085
94043
94040
94022
93728
91411
Total
95632
95377
95376
95368
95366
95337
95336
SANTA CLARA
SAN JOAQUINMandatory
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 78 of 225Report Created at 4/6/2010 4:54:44 PM
1
3
7
10
11
1
10
1
1
1
358
2
9
20
2
1
17
21
94301
94089
94087
94086
94085
94043
94040
94022
93728
91411
Total
95632
95377
95376
95368
95366
95337
95336
SANTA CLARA
SAN JOAQUINMandatory
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 79 of 225Report Created at 4/6/2010 4:54:44 PM
000010000000000
000021000010000
000080001000000
000080000001000
000062010010000
000040001000000
000002010010000
000010000020000
000010000010000
000040000011000
000000002000000
000010000000000
000000000010000
0000104000010000
000010000000000
000032000002000
000010003000000
000020200001000
95119
95118
95117
95116
95112
95111
95110
95054
95051
95050
95046
95038
95037
95035
95032
95020
95014
95008SANTA CLARAMandatory
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 80 of 225Report Created at 4/6/2010 4:54:44 PM
1
4
9
9
10
5
4
3
2
6
2
1
1
15
1
7
4
5
95119
95118
95117
95116
95112
95111
95110
95054
95051
95050
95046
95038
95037
95035
95032
95020
95014
95008SANTA CLARAMandatory
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 81 of 225Report Created at 4/6/2010 4:54:44 PM
000080000000000
000000000001000
000010020040000
000010000000000
000000000010000
000030000010000
000040000003000
000030000000000
000000010000000
000021000002000
000090002212000
000011000000000
000070000000000
000001000000000
000040002030000
0000180300040000
000080100000000
000000200000000
95148
95138
95136
95135
95133
95132
95131
95130
95129
95128
95127
95126
95125
95124
95123
95122
95121
95120SANTA CLARAMandatory
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 82 of 225Report Created at 4/6/2010 4:54:44 PM
8
1
7
1
1
4
7
3
1
5
16
2
7
1
9
25
9
2
95148
95138
95136
95135
95133
95132
95131
95130
95129
95128
95127
95126
95125
95124
95123
95122
95121
95120SANTA CLARAMandatory
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 83 of 225Report Created at 4/6/2010 4:54:44 PM
0000100000030000
000010000000000
000041000010000
0000162032200000
0000103001040000
000020000000000
000010000000000
0000212010013000
0000151000031000
000010000000000
000040000000000
000090000010000
000020000000000
0000163188101123214000
000030000000000
000070000000000
000020000000000
000020000000000
95358
95357
95356
95355
95354
95353
95352
95351
95350
95323
95319
95307
95112
Total
95823
95758
95173
95151
STANISLAUS
SANTA CLARAMandatory
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 84 of 225Report Created at 4/6/2010 4:54:44 PM
13
1
6
25
18
2
1
28
20
1
4
10
2
258
3
7
2
2
95358
95357
95356
95355
95354
95353
95352
95351
95350
95323
95319
95307
95112
Total
95823
95758
95173
95151
STANISLAUS
SANTA CLARAMandatory
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 85 of 225Report Created at 4/6/2010 4:54:44 PM
0000121000000000
0000100000000000
000042000000000
00003816002054000
0000120000000000
0000110030020000
000090010010000
0000420000112000
000003000070000
000081020476000
000010000000000
000040000004000
0000115150432194000
000010000000000
000011000000000
0000121000030000
000051000010000
000003000020000
93270
93261
93258
93257
93256
93247
93235
93223
93221
93219
93215
93201
Total
95386
95368
95367
95363
95361
TULARE
STANISLAUSMandatory
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 86 of 225Report Created at 4/6/2010 4:54:44 PM
13
10
6
65
12
16
11
19
10
28
1
8
162
1
2
16
7
5
93270
93261
93258
93257
93256
93247
93235
93223
93221
93219
93215
93201
Total
95386
95368
95367
95363
95361
TULARE
STANISLAUSMandatory
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 87 of 225Report Created at 4/6/2010 4:54:44 PM
000000003010000
00008,1122,418964152042651,363687300
0000258808102109144300
000000000060000
0000103000010000
000010000000000
000020000000000
000018300400291000
000034000050000
0000262000221000
0000156000147000
000044000041000
000000000020000
000010000000000
0000251700021300
000001000000000
00003941000317000
000010000300000
94501
Total
93666
93647
93646
93631
93618
93615
93292
93291
93286
93279
93278
93277
93275
93274
93272
ALAMEDA
Total
TULARE
Voluntary
Mandatory
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 88 of 225Report Created at 4/6/2010 4:54:44 PM
4
13,563
506
6
14
1
2
82
12
33
33
13
2
1
39
1
64
4
94501
Total
93666
93647
93646
93631
93618
93615
93292
93291
93286
93279
93278
93277
93275
93274
93272
ALAMEDA
Total
TULARE
Voluntary
Mandatory
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 89 of 225Report Created at 4/6/2010 4:54:44 PM
000030000000000
000070000001000
000001000000000
000040000001000
010040000000000
000000000001000
000000000010000
000010100000000
000000000001000
000000000010000
000010000001000
000000000020000
000133000011001
000031000000000
000001000001000
000041000020000
000000000021000
000010000000000
94605
94603
94602
94601
94587
94580
94568
94560
94555
94551
94546
94545
94544
94541
94539
94538
94536
94531ALAMEDAVoluntary
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 90 of 225Report Created at 4/6/2010 4:54:44 PM
3
8
1
5
5
1
1
2
1
1
2
2
10
4
2
7
3
1
94605
94603
94602
94601
94587
94580
94568
94560
94555
94551
94546
94545
94544
94541
94539
94538
94536
94531ALAMEDAVoluntary
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 91 of 225Report Created at 4/6/2010 4:54:44 PM
000010000000000
000070000000000
000010000000000
000020000000000
02015691041108001
000010000000000
000010000000000
000000001000000
000010000000000
010010000000000
000090000000000
000011000000000
000010000000000
000030000000000
000001000000000
000010000000000
000030000100000
000030000000000
94513
94509
94121
90017
Total
95124
94806
94710
94703
94702
94621
94619
94612
94610
94609
94608
94607
94606
CONTRA COSTA
ALAMEDAVoluntary
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 92 of 225Report Created at 4/6/2010 4:54:44 PM
1
7
1
2
93
1
1
1
1
2
9
2
1
3
1
1
4
3
94513
94509
94121
90017
Total
95124
94806
94710
94703
94702
94621
94619
94612
94610
94609
94608
94607
94606
CONTRA COSTA
ALAMEDAVoluntary
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 93 of 225Report Created at 4/6/2010 4:54:44 PM
000012001100000
000010000000000
000010000110000
000010000000000
010030100000000
000010000000000
000020000000000
000010000000000
000021000002000
010000000000000
000010000000000
000000000020000
000010000000000
000040000010000
000010000000000
000020000000000
000010000000000
000040000000000
94806
94805
94804
94803
94801
94601
94583
94572
94565
94564
94563
94556
94547
94531
94525
94523
94521
94520CONTRA COSTA
Voluntary
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 94 of 225Report Created at 4/6/2010 4:54:44 PM
5
1
3
1
5
1
2
1
5
1
1
2
1
5
1
2
1
4
94806
94805
94804
94803
94801
94601
94583
94572
94565
94564
94563
94556
94547
94531
94525
94523
94521
94520CONTRA COSTA
Voluntary
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 95 of 225Report Created at 4/6/2010 4:54:44 PM
000020000000000
000022000000000
000020000012000
000000000001000
000010000001000
000000000010000
000010000000000
000001000000000
000011000001000
000001000000000
000030000000000
000021000000000
000001000010000
000025000220000
000000000010000
000010000000000
0200403101242000
000020000000000
93650
93648
93646
93641
93640
93631
93630
93625
93622
93621
93619
93618
93616
93612
93611
93210
Total
95812
FRESNO
CONTRA COSTA
Voluntary
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 96 of 225Report Created at 4/6/2010 4:54:44 PM
2
4
5
1
2
1
1
1
3
1
3
3
2
11
1
1
55
2
93650
93648
93646
93641
93640
93631
93630
93625
93622
93621
93619
93618
93616
93612
93611
93210
Total
95812
FRESNO
CONTRA COSTA
Voluntary
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 97 of 225Report Created at 4/6/2010 4:54:44 PM
000021000020000
0000101010001000
000003000000000
000070000001000
000020000000000
000030000000000
000022000000000
0000511013065000
000075001141000
100062000013000
0100106000012000
000073200012000
000013000010000
000000310010000
000001000000000
000081010020000
000010000000000
000033000001000
93725
93722
93721
93720
93718
93711
93710
93706
93705
93704
93703
93702
93701
93662
93660
93657
93656
93654FRESNOVoluntary
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 98 of 225Report Created at 4/6/2010 4:54:44 PM
5
13
3
8
2
3
4
31
19
13
20
15
5
5
1
12
1
7
93725
93722
93721
93720
93718
93711
93710
93706
93705
93704
93703
93702
93701
93662
93660
93657
93656
93654FRESNOVoluntary
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 99 of 225Report Created at 4/6/2010 4:54:44 PM
000010000000000
000010000000000
000000000010000
000020000000000
000050000110000
0000110000000000
000010000000000
000030000011000
000010000000000
000001000000000
000010000000000
000010000000000
11001106656433526000
000010000000000
000001000000000
000054000000000
000083010044000
000054010061000
93283
93268
93263
93250
93241
93215
93205
93203
92545
92117
90640
90011
Total
93745
93729
93728
93727
93726
KERN
FRESNOVoluntary
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 100 of 225Report Created at 4/6/2010 4:54:44 PM
1
1
1
2
7
11
1
5
1
1
1
1
257
1
1
9
20
17
93283
93268
93263
93250
93241
93215
93205
93203
92545
92117
90640
90011
Total
93745
93729
93728
93727
93726
KERN
FRESNOVoluntary
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 101 of 225Report Created at 4/6/2010 4:54:44 PM
000010000105000
000000000100000
000000000100000
010060000010000
000010000000000
000050000000000
000000000001000
100000000000000
010020000010000
000020000000000
000001000000000
000081000000000
000060000022000
0000124000131000
000061000010000
0000140000003000
0000130000023000
000041000001000
93555
93527
93523
93505
93501
93389
93386
93384
93313
93312
93311
93309
93308
93307
93306
93305
93304
93301KERNVoluntary
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 102 of 225Report Created at 4/6/2010 4:54:44 PM
7
1
1
8
1
5
1
1
4
2
1
9
10
21
8
17
18
6
93555
93527
93523
93505
93501
93389
93386
93384
93313
93312
93311
93309
93308
93307
93306
93305
93304
93301KERNVoluntary
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 103 of 225Report Created at 4/6/2010 4:54:44 PM
010091000110000
000120000000000
000020010000000
000011000000000
000000000001000
0601322110020000
010020010000000
120071000220000
020082010100000
000010000000000
110001000001000
030083020002000
030081000000000
0100182000011000
12001151000051317000
000010000000000
000001000000000
000070000000000
90018
90017
90016
90015
90012
90011
90008
90007
90006
90005
90004
90003
90002
90001
Total
93581
93561
93560
LOS ANGELES
KERNVoluntary
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 104 of 225Report Created at 4/6/2010 4:54:44 PM
13
3
3
2
1
45
4
15
14
1
4
18
12
23
163
1
1
7
90018
90017
90016
90015
90012
90011
90008
90007
90006
90005
90004
90003
90002
90001
Total
93581
93561
93560
LOS ANGELES
KERNVoluntary
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 105 of 225Report Created at 4/6/2010 4:54:44 PM
000001000000000
000112000010000
000010000010000
0200200000100000
000050000002000
000022000010000
000010000000000
0100173000060000
0000100000020000
000042000020000
010040000010000
000010000000000
000040000000000
001012000000000
0101117000000000
010174000002000
000001000000000
010021001000000
90041
90040
90039
90037
90036
90035
90034
90033
90032
90031
90029
90028
90027
90026
90023
90022
90020
90019LOS ANGELESVoluntary
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 106 of 225Report Created at 4/6/2010 4:54:44 PM
1
5
2
23
7
5
1
27
12
8
6
1
4
4
20
15
1
5
90041
90040
90039
90037
90036
90035
90034
90033
90032
90031
90029
90028
90027
90026
90023
90022
90020
90019LOS ANGELESVoluntary
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 107 of 225Report Created at 4/6/2010 4:54:44 PM
000000000010000
101034001000000
000001000000000
000010000000000
000061000000000
000064010001000
000030000020000
000000000010000
140092000000000
000010000000000
000040000111000
000010000000000
000010000000000
020041000111000
000010000000000
030192000021000
000050000000000
010132000100000
90211
90201
90066
90065
90064
90063
90062
90061
90059
90058
90057
90056
90048
90047
90046
90044
90043
90042LOS ANGELESVoluntary
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 108 of 225Report Created at 4/6/2010 4:54:44 PM
1
10
1
1
7
12
5
1
16
1
7
1
1
10
1
18
5
8
90211
90201
90066
90065
90064
90063
90062
90061
90059
90058
90057
90056
90048
90047
90046
90044
90043
90042LOS ANGELESVoluntary
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 109 of 225Report Created at 4/6/2010 4:54:44 PM
000061000020000
000001000000000
000010000000000
000001000010000
040030000012000
000121000010000
210082000010000
0300101000021000
010000000021000
000022000000000
000311010000000
010003000010000
000010000000000
000000000010000
000012010110000
000042000050000
0501131000050000
1200153000032000
90280
90275
90274
90270
90262
90260
90255
90250
90249
90247
90242
90241
90240
90232
90230
90222
90221
90220LOS ANGELESVoluntary
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 110 of 225Report Created at 4/6/2010 4:54:44 PM
9
1
1
2
10
5
14
17
4
4
6
5
1
1
6
11
25
26
90280
90275
90274
90270
90262
90260
90255
90250
90249
90247
90242
90241
90240
90232
90230
90222
90221
90220LOS ANGELESVoluntary
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 111 of 225Report Created at 4/6/2010 4:54:44 PM
010271000000000
010052000011000
000032000000000
000010000010000
020010000000000
000001000000000
010003010000000
000001000000000
000000010000000
010002000000000
000001000000000
000010000010000
000020000000000
010030000030000
000020000000000
000020000020000
000020000010000
010000000100000
90650
90640
90606
90605
90604
90603
90602
90601
90505
90501
90404
90401
90305
90304
90303
90302
90301
90292LOS ANGELESVoluntary
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 112 of 225Report Created at 4/6/2010 4:54:44 PM
11
10
5
2
3
1
5
1
1
3
1
2
2
7
2
4
3
2
90650
90640
90606
90605
90604
90603
90602
90601
90505
90501
90404
90401
90305
90304
90303
90302
90301
90292LOS ANGELESVoluntary
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 113 of 225Report Created at 4/6/2010 4:54:44 PM
010052000000000
000000010000000
000000000020000
000000000020000
120020000020000
000010000000000
110022003000000
000070000000000
000000000110000
000011010000000
110000000010000
000010000001000
010050000000000
010000000000000
000010040000000
010000000000000
000142010001000
000000000100000
90802
90755
90746
90745
90744
90732
90731
90723
90717
90716
90712
90710
90706
90703
90701
90670
90660
90651LOS ANGELESVoluntary
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 114 of 225Report Created at 4/6/2010 4:54:44 PM
8
1
2
2
7
1
9
7
2
3
3
2
6
1
5
1
9
1
90802
90755
90746
90745
90744
90732
90731
90723
90717
90716
90712
90710
90706
90703
90701
90670
90660
90651LOS ANGELESVoluntary
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 115 of 225Report Created at 4/6/2010 4:54:44 PM
000011000000000
000001000000000
010001000000000
000000000010000
000001000000000
000010000000000
000000000001000
010010000000000
000020000000000
000030001000000
0500113200000000
030043000000000
000000001000000
100000000010000
020062000020000
0310128010023000
000010000110000
000000000001000
91042
91040
91020
91016
91011
91010
91007
91006
91001
90814
90813
90810
90808
90807
90806
90805
90804
90803LOS ANGELESVoluntary
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 116 of 225Report Created at 4/6/2010 4:54:44 PM
2
1
2
1
1
1
1
2
2
4
21
10
1
2
12
30
3
1
91042
91040
91020
91016
91011
91010
91007
91006
91001
90814
90813
90810
90808
90807
90806
90805
90804
90803LOS ANGELESVoluntary
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 117 of 225Report Created at 4/6/2010 4:54:44 PM
010020000001000
000000000100000
000001000000000
100000000020000
000000000001000
000010000000000
000000000001000
000025000010000
000004000052000
010002000000000
000113000000000
010017000000000
0000012000001000
000001000000000
000010000000000
020040000000000
010000000000000
000010000000000
91304
91303
91302
91301
91214
91208
91207
91206
91205
91204
91203
91202
91201
91117
91115
91104
91101
91077LOS ANGELESVoluntary
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 118 of 225Report Created at 4/6/2010 4:54:44 PM
4
1
1
3
1
1
1
8
11
3
5
9
13
1
1
6
1
1
91304
91303
91302
91301
91214
91208
91207
91206
91205
91204
91203
91202
91201
91117
91115
91104
91101
91077LOS ANGELESVoluntary
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 119 of 225Report Created at 4/6/2010 4:54:44 PM
010000000000000
000000000001000
010030000010000
010012000000000
000000000001000
000021000001000
000010000000000
000031000001000
010052000011000
000131000000000
000012000001000
000000000010000
010080000001000
000020000000000
010000000000000
010011000000000
000020000000000
010032000010000
91356
91355
91352
91351
91350
91345
91344
91343
91342
91340
91335
91333
91331
91325
91324
91316
91311
91306LOS ANGELESVoluntary
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 120 of 225Report Created at 4/6/2010 4:54:44 PM
1
1
5
4
1
4
1
5
10
5
4
1
10
2
1
3
2
7
91356
91355
91352
91351
91350
91345
91344
91343
91342
91340
91335
91333
91331
91325
91324
91316
91311
91306LOS ANGELESVoluntary
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 121 of 225Report Created at 4/6/2010 4:54:44 PM
030010000101000
120040000111000
000011001000000
000030010000000
020030000000000
000020000000000
000010000000000
000001000000000
000004000000000
020010000000000
000001000000000
000071001010000
020033000001000
010010000000000
020000000000000
000001001000000
010020000000000
010001000000000
91706
91702
91607
91606
91605
91602
91504
91502
91501
91411
91406
91405
91402
91401
91387
91384
91367
91364LOS ANGELESVoluntary
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 122 of 225Report Created at 4/6/2010 4:54:44 PM
6
10
3
4
5
2
1
1
4
3
1
10
9
2
2
2
3
2
91706
91702
91607
91606
91605
91602
91504
91502
91501
91411
91406
91405
91402
91401
91387
91384
91367
91364LOS ANGELESVoluntary
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 123 of 225Report Created at 4/6/2010 4:54:44 PM
0100162010000000
0000140000010000
000021010001000
000000000010000
000030000002000
000010000000000
000000000001000
000060000000000
000010001020000
1200101020110000
000001000000000
000020000000000
000062000000000
120010010000000
0000108000000000
000020000000000
000050000000000
000010000000000
91768
91767
91766
91765
91755
91754
91748
91746
91745
91744
91741
91740
91733
91732
91731
91723
91722
91711LOS ANGELESVoluntary
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 124 of 225Report Created at 4/6/2010 4:54:44 PM
20
15
5
1
5
1
1
6
4
18
1
2
8
5
18
2
5
1
91768
91767
91766
91765
91755
91754
91748
91746
91745
91744
91741
91740
91733
91732
91731
91723
91722
91711LOS ANGELESVoluntary
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 125 of 225Report Created at 4/6/2010 4:54:44 PM
10001412000121000
010110001021000
000010000000000
000010000000000
000010000000000
000010000000000
010110001400000
000100000000000
100000000000000
000000000010000
000001000000000
000031000000000
000000000010000
010030000000000
000020000000000
000020000000000
010061000000000
000010000000000
93535
93534
93313
92404
92394
91977
91803
91801
91793
91792
91791
91790
91789
91776
91775
91773
91770
91769LOS ANGELESVoluntary
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 126 of 225Report Created at 4/6/2010 4:54:44 PM
31
7
1
1
1
1
8
1
1
1
1
4
1
4
2
2
8
1
93535
93534
93313
92404
92394
91977
91803
91801
91793
91792
91791
91790
91789
91776
91775
91773
91770
91769LOS ANGELESVoluntary
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 127 of 225Report Created at 4/6/2010 4:54:44 PM
000010000000000
000020400010000
001020010001000
000010001000000
000100000000000
000022000000000
010000000000000
000012000000000
000020000000000
17127320639219329132410551000
000010000000000
000000040000000
000020000000000
000094000101000
000030000000000
0300148000121000
000010000000000
000020000000000
92230
92223
92220
92203
92202
92201
91752
90255
90022
Total
95758
94544
93602
93552
93551
93550
93543
93536
RIVERSIDE
LOS ANGELESVoluntary
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 128 of 225Report Created at 4/6/2010 4:54:44 PM
1
7
5
2
1
4
1
3
2
1,250
1
4
2
15
3
29
1
2
92230
92223
92220
92203
92202
92201
91752
90255
90022
Total
95758
94544
93602
93552
93551
93550
93543
93536
RIVERSIDE
LOS ANGELESVoluntary
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 129 of 225Report Created at 4/6/2010 4:54:44 PM
1000141103000000
000120000001000
000000000110000
000013000000000
010020000000000
000030000001000
000000000010000
000010000000000
000020000000000
000030000000000
000020100000000
000000010000000
010010000000000
000011000000000
000010000000000
000050040000000
000040000000000
000010000000000
92509
92507
92506
92505
92504
92503
92502
92501
92407
92324
92320
92282
92274
92254
92253
92240
92236
92234RIVERSIDEVoluntary
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 130 of 225Report Created at 4/6/2010 4:54:44 PM
20
4
2
4
3
4
1
1
2
3
3
1
2
2
1
9
4
1
92509
92507
92506
92505
92504
92503
92502
92501
92407
92324
92320
92282
92274
92254
92253
92240
92236
92234RIVERSIDEVoluntary
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 131 of 225Report Created at 4/6/2010 4:54:44 PM
000010000000000
000010000000000
010010000010000
000000001000000
000000000010000
000030000000000
000020100010000
000000300000000
000000000010000
000010000000000
011020000000000
1201151200001000
000020000000000
000020000000000
000051000000000
010030000001000
001053000022000
010050002020000
92805
92596
92595
92592
92586
92584
92583
92571
92570
92562
92555
92553
92551
92548
92545
92544
92543
92530RIVERSIDEVoluntary
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 132 of 225Report Created at 4/6/2010 4:54:44 PM
1
1
3
1
1
3
4
3
1
1
4
23
2
2
6
5
13
10
92805
92596
92595
92592
92586
92584
92583
92571
92570
92562
92555
92553
92551
92548
92545
92544
92543
92530RIVERSIDEVoluntary
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 133 of 225Report Created at 4/6/2010 4:54:44 PM
000020000000000
000041000102000
000050000010000
002030000001000
000001001051000
000020000000000
000020000000000
000030000000000
29331171912671127000
000020000000000
000010000000000
000001000000000
000010000000000
000041000010000
000040000000000
000001000000000
000030000000000
000002000000000
95626
95624
95621
95610
95608
94703
94619
94601
Total
95380
95127
92887
92883
92882
92881
92880
92879
92860
SACRAMENTO
RIVERSIDEVoluntary
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 134 of 225Report Created at 4/6/2010 4:54:44 PM
2
8
6
6
8
2
2
3
198
2
1
1
1
6
4
1
3
2
95626
95624
95621
95610
95608
94703
94619
94601
Total
95380
95127
92887
92883
92882
92881
92880
92879
92860
SACRAMENTO
RIVERSIDEVoluntary
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 135 of 225Report Created at 4/6/2010 4:54:44 PM
000000000001000
000041000000000
000000000004000
000111000010000
000071000010000
000010000020000
0000100000000000
000010000000001
000051020011000
000012000000000
010020000020000
010140000021000
000000000010000
0000140010010000
000010000000000
010060000200000
000010000110000
010021000020000
95819
95818
95817
95816
95815
95814
95812
95811
95758
95757
95673
95670
95662
95660
95638
95632
95630
95628SACRAMENTOVoluntary
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 136 of 225Report Created at 4/6/2010 4:54:44 PM
1
5
4
4
9
3
10
2
10
3
5
9
1
16
1
9
3
6
95819
95818
95817
95816
95815
95814
95812
95811
95758
95757
95673
95670
95662
95660
95638
95632
95630
95628SACRAMENTOVoluntary
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 137 of 225Report Created at 4/6/2010 4:54:44 PM
010030000011000
000041000100000
000040000130000
000062000030000
000030010000000
010083000000000
000060000101000
010041000000000
000000000001000
0000154020022000
000023000100000
000020010000000
000150000000000
000192000100001
0001291010035000
000062000121000
000091010010000
000092010011000
95843
95842
95841
95838
95835
95834
95833
95832
95831
95828
95827
95826
95825
95824
95823
95822
95821
95820SACRAMENTOVoluntary
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 138 of 225Report Created at 4/6/2010 4:54:44 PM
6
6
8
11
4
12
8
6
1
25
6
3
6
14
40
12
12
14
95843
95842
95841
95838
95835
95834
95833
95832
95831
95828
95827
95826
95825
95824
95823
95822
95821
95820SACRAMENTOVoluntary
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 139 of 225Report Created at 4/6/2010 4:54:44 PM
000001000000000
000010000000000
000010000000000
000100000000000
000081000000000
000050200000000
000012600100000
000020000000000
000010000000000
000020100000000
000020000000000
000010001000000
010000000000000
000010000000000
000030000000000
000000200000000
0725207310131103625002
000020030002000
92202
92139
92071
91786
91764
91763
91762
91761
91739
91737
91710
91709
91016
90303
90221
90004
Total
95864
SAN BERNARDINO
SACRAMENTOVoluntary
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 140 of 225Report Created at 4/6/2010 4:54:44 PM
1
1
1
1
9
7
10
2
1
3
2
2
1
1
3
2
339
7
92202
92139
92071
91786
91764
91763
91762
91761
91739
91737
91710
91709
91016
90303
90221
90004
Total
95864
SAN BERNARDINO
SACRAMENTOVoluntary
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 141 of 225Report Created at 4/6/2010 4:54:44 PM
010130001000000
001030010000000
000030000000000
000010000000000
020060000012000
000040000000000
000080000200000
000050000005000
000030000000000
000010000000000
000040000011000
000040000001000
000020100000000
1000112000020000
020040500110000
000001000000000
000000001000000
000000004000000
92376
92374
92356
92354
92345
92344
92336
92335
92324
92317
92316
92311
92308
92307
92301
92286
92277
92252SAN BERNARDINO
Voluntary
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 142 of 225Report Created at 4/6/2010 4:54:44 PM
6
5
3
1
11
4
10
10
3
1
6
5
3
16
13
1
1
4
92376
92374
92356
92354
92345
92344
92336
92335
92324
92317
92316
92311
92308
92307
92301
92286
92277
92252SAN BERNARDINO
Voluntary
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 143 of 225Report Created at 4/6/2010 4:54:44 PM
000010000000000
001010000000000
1101616314191751011000
000010000000000
000010000000000
000010000000000
000010000000000
010063000010000
000080000020000
000010000000000
000240000000000
000080000000000
0001142200001000
000000000001000
020051000000000
010100000020000
0000191000100000
000040000000000
91902
91901
Total
93562
93534
92503
92415
92411
92410
92408
92407
92405
92404
92399
92395
92394
92392
92377
SAN DIEGO
SAN BERNARDINO
Voluntary
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 144 of 225Report Created at 4/6/2010 4:54:44 PM
1
2
248
1
1
1
1
11
10
1
6
8
20
1
8
4
21
4
91902
91901
Total
93562
93534
92503
92415
92411
92410
92408
92407
92405
92404
92399
92395
92394
92392
92377
SAN DIEGO
SAN BERNARDINO
Voluntary
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 145 of 225Report Created at 4/6/2010 4:54:44 PM
000011000000000
000041000000000
000000001000000
000030000000000
020076000000000
000088000110000
000003000020000
000021000000001
010000000010000
100020000010001
000020000000000
010040000010000
000030000000000
001000000001000
000020010000000
000061000000000
000040000010001
000020030010000
92026
92025
92023
92022
92021
92020
92019
91977
91963
91950
91946
91945
91942
91941
91932
91915
91911
91910SAN DIEGOVoluntary
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 146 of 225Report Created at 4/6/2010 4:54:44 PM
2
5
1
3
15
18
5
4
2
5
2
6
3
2
3
7
6
6
92026
92025
92023
92022
92021
92020
92019
91977
91963
91950
91946
91945
91942
91941
91932
91915
91911
91910SAN DIEGOVoluntary
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 147 of 225Report Created at 4/6/2010 4:54:44 PM
000000001010000
000000000012000
000001010002000
100021010000000
000000003000000
000020000000000
000000000001000
001000000000000
000012000000000
010061010000000
000000000111000
000051000010000
000000000010000
000040000010000
000000000001000
000001000000000
000030000003000
003010000000000
92079
92078
92071
92069
92065
92064
92061
92059
92058
92057
92056
92054
92052
92040
92037
92033
92030
92027SAN DIEGOVoluntary
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 148 of 225Report Created at 4/6/2010 4:54:44 PM
2
3
4
5
3
2
1
1
3
9
3
7
1
5
1
1
6
4
92079
92078
92071
92069
92065
92064
92061
92059
92058
92057
92056
92054
92052
92040
92037
92033
92030
92027SAN DIEGOVoluntary
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 149 of 225Report Created at 4/6/2010 4:54:44 PM
000000001000000
000010000000000
000150000000000
000031000011000
010022020001000
010023030021000
000000010010000
000001000021000
010000000000000
0100103010012000
010040000100001
000010000000000
000050000000000
010000100000000
000010000000000
000070000001000
002000000000000
000030000000000
92124
92117
92116
92115
92114
92113
92112
92111
92108
92105
92104
92103
92102
92101
92084
92083
92082
92081SAN DIEGOVoluntary
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 150 of 225Report Created at 4/6/2010 4:54:44 PM
1
1
6
6
8
12
2
4
1
18
7
1
5
2
1
8
2
3
92124
92117
92116
92115
92114
92113
92112
92111
92108
92105
92104
92103
92102
92101
92084
92083
92082
92081SAN DIEGOVoluntary
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 151 of 225Report Created at 4/6/2010 4:54:44 PM
000010000010000
000010000000000
000020000000000
000010000000000
000001000000000
000030000000000
000001000000000
000010000000000
2128112744114632520005
000010000000000
000020000000000
000021000002000
000011000020000
010011000000000
000001000000000
000001000000000
000000000010001
000001000010000
94124
94117
94116
94115
94112
94110
94108
94102
Total
95822
92220
92173
92154
92139
92131
92130
92129
92126
SAN FRANCISCO
SAN DIEGOVoluntary
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 152 of 225Report Created at 4/6/2010 4:54:44 PM
2
1
2
1
1
3
1
1
268
1
2
5
4
3
1
1
2
2
94124
94117
94116
94115
94112
94110
94108
94102
Total
95822
92220
92173
92154
92139
92131
92130
92129
92126
SAN FRANCISCO
SAN DIEGOVoluntary
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 153 of 225Report Created at 4/6/2010 4:54:44 PM
000000100000000
000031000000000
000040000000000
000000000100000
000062000000000
000000000001001
000013000000000
000002000001000
000051000000000
010021000010000
000000000100000
000000000010000
000000000010001
000050000001000
0110112000010000
000010000000000
001010000000000
010000000000000
95357
95336
95330
95304
95240
95219
95210
95209
95207
95206
95205
95204
95203
95202
Total
94520
94134
94127
SAN JOAQUIN
SAN FRANCISCO
Voluntary
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 154 of 225Report Created at 4/6/2010 4:54:44 PM
1
4
4
1
8
2
4
3
6
5
1
1
2
6
16
1
2
1
95357
95336
95330
95304
95240
95219
95210
95209
95207
95206
95205
95204
95203
95202
Total
94520
94134
94127
SAN JOAQUIN
SAN FRANCISCO
Voluntary
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 155 of 225Report Created at 4/6/2010 4:54:44 PM
000142000020000
000040000010000
000010000002000
000000000010000
000000000010000
000010000000000
000000000010000
000010000020000
000010000100000
000000000010000
000000000011000
01003510100234002
000010000000000
000010000000000
000010000000000
000030000001000
000010000000000
000020000000000
95035
95020
95014
94306
94303
94301
94089
94087
94085
94041
94022
Total
95686
95391
95377
95376
95368
95366
SANTA CLARA
SAN JOAQUINVoluntary
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 156 of 225Report Created at 4/6/2010 4:54:44 PM
9
5
3
1
1
1
1
3
2
1
2
58
1
1
1
4
1
2
95035
95020
95014
94306
94303
94301
94089
94087
94085
94041
94022
Total
95686
95391
95377
95376
95368
95366
SANTA CLARA
SAN JOAQUINVoluntary
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 157 of 225Report Created at 4/6/2010 4:54:44 PM
000011000011000
000003000020000
000012000000000
000020000000000
000000000020000
000030000010000
000021310020000
000010000010000
000010000010000
000011000000000
000010000000000
000011000000000
000013000010000
000041000020000
000010000000000
000000000010000
000010000000000
000010000010000
95133
95132
95131
95130
95129
95128
95127
95122
95121
95118
95117
95116
95112
95111
95110
95109
95051
95050SANTA CLARAVoluntary
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 158 of 225Report Created at 4/6/2010 4:54:44 PM
4
5
3
2
2
4
9
2
2
2
1
2
5
7
1
1
1
2
95133
95132
95131
95130
95129
95128
95127
95122
95121
95118
95117
95116
95112
95111
95110
95109
95051
95050SANTA CLARAVoluntary
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 159 of 225Report Created at 4/6/2010 4:54:44 PM
01002831000144000
000030000050000
000000000010000
000070000031000
000020100000000
000002000030000
000040000002000
000000000010000
000030000010000
000041000000000
000030000001000
010000000000000
000010000000000
000010000000000
000137183301287000
000022000002000
000000000021000
000011020010000
Total
95382
95381
95380
95363
95360
95357
95356
95354
95351
95350
95326
95307
94551
Total
95148
95138
95136
STANISLAUS
SANTA CLARAVoluntary
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 160 of 225Report Created at 4/6/2010 4:54:44 PM
51
8
1
11
3
5
6
1
4
5
4
1
1
1
98
6
3
5
Total
95382
95381
95380
95363
95360
95357
95356
95354
95351
95350
95326
95307
94551
Total
95148
95138
95136
STANISLAUS
SANTA CLARAVoluntary
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 161 of 225Report Created at 4/6/2010 4:54:44 PM
000061000120000
000010000020000
000000000010000
000010000000000
000040000010000
000000000011000
0000131200020001
000010000000000
000010000000000
000010000000000
000011000000000
000061000010000
000020000000000
000010000000000
000000000001000
000010000010000
000030000010000
000000000100000
93291
93286
93280
93278
93277
93275
93274
93270
93267
93261
93258
93257
93256
93247
93235
93223
93221
93219TULAREVoluntary
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 162 of 225Report Created at 4/6/2010 4:54:44 PM
10
3
1
1
5
2
19
1
1
1
2
8
2
1
1
2
4
1
93291
93286
93280
93278
93277
93275
93274
93270
93267
93261
93258
93257
93256
93247
93235
93223
93221
93219TULAREVoluntary
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 163 of 225Report Created at 4/6/2010 4:54:44 PM
000010000000000
000011000000000
000010000000000
000010000000000
000010000000000
000010000000000
000020000000000
000020000010000
000020000000000
000040000000000
000010000000000
2417518371,733454497243603211840011
00004862003252001
000011000010000
0000110000110000
000010000000000
000010000000000
000020000110000
94606
94605
94603
94601
94588
94587
94565
94544
94541
94501
90006
Total
93647
93618
93615
93612
93292
ALAMEDA
Total
TULARE
Exempt
Voluntary
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 164 of 225Report Created at 4/6/2010 4:54:44 PM
1
2
1
1
1
1
2
3
2
4
1
3,181
87
3
13
1
1
4
94606
94605
94603
94601
94588
94587
94565
94544
94541
94501
90006
Total
93647
93618
93615
93612
93292
ALAMEDA
Total
TULARE
Exempt
Voluntary
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 165 of 225Report Created at 4/6/2010 4:54:44 PM
000010000000000
000030000000000
000010000000000
000000000014000
000001000010000
000010000000000
000073101031001
000001000000000
000010000000000
000000001000000
000001000000000
000000000030000
000050000000001
000001000001000
000010000000000
000000100000000
0000181000010000
000010000000000
93662
93657
93622
93612
93611
93602
Total
94806
94804
94801
94598
94583
94565
94553
94509
93618
Total
95758
FRESNO
CONTRA COSTA
ALAMEDAExempt
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 166 of 225Report Created at 4/6/2010 4:54:44 PM
1
3
1
5
2
1
17
1
1
1
1
3
6
2
1
1
20
1
93662
93657
93622
93612
93611
93602
Total
94806
94804
94801
94598
94583
94565
94553
94509
93618
Total
95758
FRESNO
CONTRA COSTA
ALAMEDAExempt
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 167 of 225Report Created at 4/6/2010 4:54:44 PM
000010000000000
000001000000010
000020000000000
000024100010210000
000000001000000
000001000000000
000020000000000
000011000000000
000040000000000
000030000000000
000001000000000
000012000001000
000002000000000
000030000000000
000010000001000
000031000000000
000000000004000
000001000000000
93219
93215
93203
Total
95823
93728
93727
93726
93722
93720
93711
93706
93705
93704
93703
93702
93701
93675
KERN
FRESNOExempt
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 168 of 225Report Created at 4/6/2010 4:54:44 PM
1
2
2
47
1
1
2
2
4
3
1
4
2
3
2
4
4
1
93219
93215
93203
Total
95823
93728
93727
93726
93722
93720
93711
93706
93705
93704
93703
93702
93701
93675
KERN
FRESNOExempt
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 169 of 225Report Created at 4/6/2010 4:54:44 PM
000000010001000
000001000000000
000010000000000
000020000100000
000010000000000
000010000000000
000020000000000
000022000000000
000010000000000
0000141010010010
000000010000000
000020000000000
000030000010000
000010000000000
000010000000000
000010000000000
000020000000000
000010000000000
90022
90018
90017
90011
90008
90007
90004
90003
90001
Total
93561
93550
93313
93312
93309
93306
93304
93301
LOS ANGELES
KERNExempt
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 170 of 225Report Created at 4/6/2010 4:54:44 PM
2
1
1
3
1
1
2
4
1
18
1
2
4
1
1
1
2
1
90022
90018
90017
90011
90008
90007
90004
90003
90001
Total
93561
93550
93313
93312
93309
93306
93304
93301
LOS ANGELES
KERNExempt
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 171 of 225Report Created at 4/6/2010 4:54:44 PM
000017000000000
000010000000000
000071000000000
000010000000000
000011000000000
000051000000000
000011000000000
000031100000000
000031000000000
000030000000000
000010000000000
000021100200000
010000000000000
000020000200000
000052000010000
000020000000000
000010000000000
000030000000000
90601
90301
90280
90255
90250
90221
90220
90201
90063
90059
90047
90044
90043
90037
90033
90032
90031
90023LOS ANGELESExempt
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 172 of 225Report Created at 4/6/2010 4:54:44 PM
8
1
8
1
2
6
2
5
4
3
1
6
1
4
8
2
1
3
90601
90301
90280
90255
90250
90221
90220
90201
90063
90059
90047
90044
90043
90037
90033
90032
90031
90023LOS ANGELESExempt
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 173 of 225Report Created at 4/6/2010 4:54:44 PM
000010000000000
000000000010000
000050001000000
000010000000000
000020000000000
000010000000000
000040000000000
000000010000000
000001001000000
000000010000000
000011000000000
000011020000000
000030000000000
000000010000000
000002010000000
000002000000000
000001000000000
000010000000000
90810
90806
90805
90804
90803
90745
90723
90717
90706
90670
90660
90650
90640
90637
90606
90604
90603
90602LOS ANGELESExempt
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 174 of 225Report Created at 4/6/2010 4:54:44 PM
1
1
6
1
2
1
4
1
2
1
2
4
3
1
3
2
1
1
90810
90806
90805
90804
90803
90745
90723
90717
90706
90670
90660
90650
90640
90637
90606
90604
90603
90602LOS ANGELESExempt
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 175 of 225Report Created at 4/6/2010 4:54:44 PM
000011000000000
000040000000000
000010000000000
000020000000000
000001000000000
000020000000000
000002000000000
000020000000000
000001000000000
000001000000000
000000000001000
010000000000000
000020000000000
000010000000000
000001000000000
000010000000000
000010000000000
000010000000000
91790
91776
91755
91744
91741
91702
91605
91602
91502
91501
91409
91402
91342
91331
91321
91303
91007
90813LOS ANGELESExempt
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 176 of 225Report Created at 4/6/2010 4:54:44 PM
2
4
1
2
1
2
2
2
1
1
1
1
2
1
1
1
1
1
91790
91776
91755
91744
91741
91702
91605
91602
91502
91501
91409
91402
91342
91331
91321
91303
91007
90813LOS ANGELESExempt
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 177 of 225Report Created at 4/6/2010 4:54:44 PM
000050000000000
000010000000000
000001000000000
000010000000000
000010000000000
000020000000000
000010000000000
000010000000000
020010735376522000
000010000000000
000050000000000
000010004000000
000021000000000
000030000000000
000010000000000
000020000000000
000020000000000
000000100000000
92223
92113
91768
Total
95650
Total
77373
75602
Total
94537
93550
93535
93534
93304
92557
92532
92405
92324
RIVERSIDE
PLACER
OUT OF STATE
LOS ANGELESExempt
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 178 of 225Report Created at 4/6/2010 4:54:44 PM
5
1
1
1
1
2
1
1
169
1
5
5
3
3
1
2
2
1
92223
92113
91768
Total
95650
Total
77373
75602
Total
94537
93550
93535
93534
93304
92557
92532
92405
92324
RIVERSIDE
PLACER
OUT OF STATE
LOS ANGELESExempt
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 179 of 225Report Created at 4/6/2010 4:54:44 PM
0000234311001000
000010000000000
000010000000000
000020000000000
000001000000000
000020000000000
000020000000000
000000100000000
000001001000000
000010000000000
000000000001000
000011000000000
000010000000000
000020010000000
000010000000000
000030000000000
000000100000000
000000100000000
Total
95127
93219
92879
92595
92584
92567
92557
92553
92551
92544
92543
92539
92506
92504
92324
92254
92240RIVERSIDEExempt
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 180 of 225Report Created at 4/6/2010 4:54:44 PM
33
1
1
2
1
2
2
1
2
1
1
2
1
3
1
3
1
1
Total
95127
93219
92879
92595
92584
92567
92557
92553
92551
92544
92543
92539
92506
92504
92324
92254
92240RIVERSIDEExempt
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 181 of 225Report Created at 4/6/2010 4:54:44 PM
000011030000000
000010000000000
000020000000000
000011000000000
000020000000000
000000000001000
010000000000000
000010000000000
000000000011000
000001000000000
000010000000000
000010000000000
000050000000000
000010010001000
000000002000000
000030000000000
000030000000000
000000000100000
95823
95822
95821
95820
95819
95818
95763
95670
95660
95626
95624
95621
95610
95608
95603
95376
95240
92324SACRAMENTOExempt
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 182 of 225Report Created at 4/6/2010 4:54:44 PM
5
1
2
2
2
1
1
1
2
1
1
1
5
3
2
3
3
1
95823
95822
95821
95820
95819
95818
95763
95670
95660
95626
95624
95621
95610
95608
95603
95376
95240
92324SACRAMENTOExempt
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 183 of 225Report Created at 4/6/2010 4:54:44 PM
000000200000000
000020000000000
000010000000000
000010000000000
000000100000000
000010000000000
000010000000000
000010000000000
0100303042246000
000000000002000
000020000000000
000010000000000
000000000001000
000010000020000
000010000000000
000010000010000
000000000100000
000020000000000
92335
91766
91764
91763
91761
91730
91710
90001
Total
95864
95843
95842
95841
95838
95833
95828
95827
95824
SAN BERNARDINO
SACRAMENTOExempt
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 184 of 225Report Created at 4/6/2010 4:54:44 PM
2
2
1
1
1
1
1
1
52
2
2
1
1
3
1
2
1
2
92335
91766
91764
91763
91761
91730
91710
90001
Total
95864
95843
95842
95841
95838
95833
95828
95827
95824
SAN BERNARDINO
SACRAMENTOExempt
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 185 of 225Report Created at 4/6/2010 4:54:44 PM
000002000000000
000000001000000
000001000000000
000010000000000
0000230320001000
000020000000000
000020000000000
000010000000000
000020000000000
000010000000000
000010000000000
000010000000000
000020000000000
000020010000000
000010000000000
000000010000000
000000000001000
000010000000000
91932
91911
91910
90640
Total
93706
92860
92507
92411
92408
92407
92404
92395
92392
92376
92345
92337
92336
SAN DIEGO
SAN BERNARDINO
Exempt
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 186 of 225Report Created at 4/6/2010 4:54:44 PM
2
1
1
1
29
2
2
1
2
1
1
1
2
3
1
1
1
1
91932
91911
91910
90640
Total
93706
92860
92507
92411
92408
92407
92404
92395
92392
92376
92345
92337
92336
SAN DIEGO
SAN BERNARDINO
Exempt
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 187 of 225Report Created at 4/6/2010 4:54:44 PM
000000001000000
000001000010000
000010000000000
010000010001000
000010000000000
000000000010000
000001000000000
000010000000000
000000000010000
000000000010000
000010000000000
000010000000000
000001010000000
000000000010000
000001000000000
000000000010000
000010000000000
000000001000000
92173
92154
92115
92114
92111
92108
92105
92103
92083
92069
92065
92058
92056
92027
92021
92010
91977
91946SAN DIEGOExempt
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 188 of 225Report Created at 4/6/2010 4:54:44 PM
1
2
1
3
1
1
1
1
1
1
1
1
2
1
1
1
1
1
92173
92154
92115
92114
92111
92108
92105
92103
92083
92069
92065
92058
92056
92027
92021
92010
91977
91946SAN DIEGOExempt
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 189 of 225Report Created at 4/6/2010 4:54:44 PM
000010000000000
000010000000000
000001000000000
000000000100000
000010000000000
0000111000100000
000010000000000
000020000000000
000010000000000
000010000000000
000001000100000
000030000000000
000010000000000
000010000000000
000010000000000
000050000000000
000050000000000
010077023061000
95050
94513
94086
94085
93622
Total
95337
95336
95240
95215
95210
95207
95205
95203
95202
Total
94124
Total
SANTA CLARA
SAN JOAQUIN
SAN FRANCISCO
SAN DIEGOExempt
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 190 of 225Report Created at 4/6/2010 4:54:44 PM
1
1
1
1
1
13
1
2
1
1
2
3
1
1
1
5
5
27
95050
94513
94086
94085
93622
Total
95337
95336
95240
95215
95210
95207
95205
95203
95202
Total
94124
Total
SANTA CLARA
SAN JOAQUIN
SAN FRANCISCO
SAN DIEGOExempt
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 191 of 225Report Created at 4/6/2010 4:54:44 PM
000010000001000
000010000000000
000020000000000
000020000000000
000050000020000
000010000000000
000030000000000
000000000010000
000000000010000
000010000000000
000092000101000
000010000000000
000001000000000
000010000000000
000010000000000
000010000001000
000010000000000
000010000000000
93257
93256
93247
93216
Total
95363
95356
95355
95351
95307
Total
95148
95132
95128
95127
95123
95122
95112
TULARE
STANISLAUS
SANTA CLARAExempt
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 192 of 225Report Created at 4/6/2010 4:54:44 PM
2
1
2
2
7
1
3
1
1
1
13
1
1
1
1
2
1
1
93257
93256
93247
93216
Total
95363
95356
95355
95351
95307
Total
95148
95132
95128
95127
95123
95122
95112
TULARE
STANISLAUS
SANTA CLARAExempt
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 193 of 225Report Created at 4/6/2010 4:54:44 PM
24179183710,1382,9401555042613341,7068953112
04002936810171492224011
000071000011000
000001000000000
000000000010000
000010000000000
Total
93618
93277
93274
Total
TULARE
Total
Exempt
X05X04X03I01F10F09F06F05F04F03F02F01E12BE11PE09P
DisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 194 of 225Report Created at 4/6/2010 4:54:44 PM
17,207
463
10
1
1
1
Total
93618
93277
93274
Total
TULARE
Total
Exempt
TotalTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 195 of 225Report Created at 4/6/2010 4:54:44 PM
DENTAL Disenrollment Transactions by Status, County, and ZIP
3300166023051
2900145050050
300091072029
2400150040401
100050000050
153007613015119821
40020000020
20020000000
1700110020004
1900133030000
2800141042700
2000100060031
2200162021010
10800561701160315
66003810112059
8800397013150410
90018
90017
90016
90015
90012
90011
90010
90009
90008
90007
90006
90005
90004
90003
90002
90001LOS ANGELESVoluntary
X05X03F10F09F06F05F04F03F02F01
TotalDisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 196 of 225Report Created at 4/6/2010 4:54:44 PM
20010000010
20020000000
130043021012
76004011085327
10010000000
70022030000
53001910079071
160084002110
2700114030072
3100233001031
80060000020
70040021000
2500110060143
20010010000
4400217067102
770042110313071
150044060010
3200155073002
90040
90039
90038
90037
90036
90034
90033
90032
90031
90029
90028
90027
90026
90025
90023
90022
90020
90019LOS ANGELESVoluntary
X05X03F10F09F06F05F04F03F02F01
TotalDisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 197 of 225Report Created at 4/6/2010 4:54:44 PM
520022304001112
20020000000
970036702541915
10010000000
90080001000
160092010040
580016401115057
2100102021132
2500134010070
5200243062386
100032040001
41001100230070
140062020112
10010000000
78003412088187
1700130000211
160041052013
10010000000
90220
90212
90201
90082
90066
90065
90063
90062
90061
90059
90058
90057
90047
90046
90044
90043
90042
90041LOS ANGELESVoluntary
X05X03F10F09F06F05F04F03F02F01
TotalDisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 198 of 225Report Created at 4/6/2010 4:54:44 PM
2100122010411
20010000001
20000002000
51002230130085
10000000001
3600200082231
66004201123053
20020000000
8000331301300714
6600415061364
70061000000
10001000000
2400117002130
20000002000
130023032030
120050042001
47002160201152
950041604203210
90301
90292
90291
90280
90278
90270
90262
90260
90255
90250
90249
90248
90247
90245
90242
90241
90222
90221LOS ANGELESVoluntary
X05X03F10F09F06F05F04F03F02F01
TotalDisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 199 of 225Report Created at 4/6/2010 4:54:44 PM
20000000020
10001000000
70031003000
10010000000
80040004000
10001000000
20010010000
40030000001
20020000000
10000000010
20011000000
50011000300
130036010120
10000010000
20002000000
32001700140010
250092063005
60041000001
90638
90631
90606
90605
90604
90603
90602
90601
90505
90504
90503
90502
90501
90404
90305
90304
90303
90302LOS ANGELESVoluntary
X05X03F10F09F06F05F04F03F02F01
TotalDisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 200 of 225Report Created at 4/6/2010 4:54:44 PM
10010000000
20002000000
60022000110
2900121050371
130090000013
160072032020
40010020001
90030020040
20020000000
30011000010
20020000000
140026010410
3600138030273
30010002000
50020030000
100041013001
3400170074105
180059002020
90755
90746
90745
90744
90731
90723
90717
90716
90715
90713
90712
90710
90706
90701
90670
90660
90650
90640LOS ANGELESVoluntary
X05X03F10F09F06F05F04F03F02F01
TotalDisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 201 of 225Report Created at 4/6/2010 4:54:44 PM
40040000000
20010000010
10010000000
10010000000
140050002070
100040010032
140061030004
30003000000
10000000010
3800170032169
80052000010
10010000000
30000000030
100052000210
5600285272354
30021000000
70070000000
60051000000
91042
91040
91030
91024
91016
91010
91001
90815
90814
90813
90810
90808
90807
90806
90805
90804
90803
90802LOS ANGELESVoluntary
X05X03F10F09F06F05F04F03F02F01
TotalDisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 202 of 225Report Created at 4/6/2010 4:54:44 PM
20002000000
30030000000
1800142000002
1800101011005
170041021009
10000000001
30010000002
20020000000
50001030010
10010000000
30020001000
30030000000
20000000002
80040000040
60010000005
2200141030040
2700124015005
90030000132
91316
91311
91306
91304
91303
91214
91208
91206
91205
91204
91203
91201
91109
91107
91106
91104
91103
91101LOS ANGELESVoluntary
X05X03F10F09F06F05F04F03F02F01
TotalDisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 203 of 225Report Created at 4/6/2010 4:54:44 PM
40012000001
10000000010
20000020000
690034110700161
80070000001
50030020000
40040000000
4000229050022
5000226046048
1900111013111
41001960120112
10010000000
1020048901020627
20002000000
40000000103
1200110010000
1700120001103
160071011024
91356
91354
91353
91352
91351
91345
91344
91343
91342
91340
91335
91334
91331
91330
91326
91325
91324
91321LOS ANGELESVoluntary
X05X03F10F09F06F05F04F03F02F01
TotalDisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 204 of 225Report Created at 4/6/2010 4:54:44 PM
10010000000
3800315010010
9900764081073
10001000000
140062010032
70012000022
40030000001
10000000010
60060000000
180043081101
2400113021016
62003270901121
7000427040278
2100117020100
50002000012
1300100000021
10010000000
20020000000
91607
91606
91605
91604
91601
91504
91502
91501
91423
91411
91406
91405
91402
91401
91390
91387
91384
91367LOS ANGELESVoluntary
X05X03F10F09F06F05F04F03F02F01
TotalDisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 205 of 225Report Created at 4/6/2010 4:54:44 PM
90070000011
3800252130016
30020000001
60020000004
30001020000
90012011031
30010000200
1900120030004
80062000000
4500246013551
10010000000
10010000000
49002530600114
520020301011143
3100181030090
30020000010
3600980401140
60041000010
91767
91766
91765
91755
91754
91748
91747
91746
91745
91744
91741
91740
91733
91732
91731
91722
91706
91702LOS ANGELESVoluntary
X05X03F10F09F06F05F04F03F02F01
TotalDisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 206 of 225Report Created at 4/6/2010 4:54:44 PM
60060000000
5300289032281
20010000010
10001000000
60042000000
2300106001330
2400107000232
50050000000
20010000100
90043000002
50000000500
80060001001
20002000000
50032000000
60030000030
20002000000
90013000023
2200200000020
93551
93550
93543
93539
93536
93535
93534
91803
91801
91792
91791
91790
91789
91780
91776
91773
91770
91768LOS ANGELESVoluntary
X05X03F10F09F06F05F04F03F02F01
TotalDisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 207 of 225Report Created at 4/6/2010 4:54:44 PM
160081033001
6200447000047
10001000000
30030000000
20000002000
10000000010
32001700013020
1300110020000
1700150000020
70050000110
4000311016100
2700223000200
6700518033011
3200191000075
10001000000
4,128002,051446447720098464388
110065000000
37002110110130
95662
95660
95655
95652
95641
95638
95632
95630
95628
95626
95624
95621
95610
95608
95215
Total
93591
93552
SACRAMENTO
LOS ANGELESVoluntary
X05X03F10F09F06F05F04F03F02F01
TotalDisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 208 of 225Report Created at 4/6/2010 4:54:44 PM
70005410000051
10010000000
100052000030
130094000000
10000000010
3200281010110
60022000020
10010000000
100070000300
4100281023700
2300180004001
20020000000
30000000030
10010000000
10000000100
10010000000
1900140000221
4800411002130
95820
95819
95818
95817
95816
95815
95814
95812
95811
95758
95757
95742
95741
95693
95690
95678
95673
95670SACRAMENTOVoluntary
X05X03F10F09F06F05F04F03F02F01
TotalDisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 209 of 225Report Created at 4/6/2010 4:54:44 PM
3800194030381
6400523023013
2800180012070
6700494043070
1900110000800
2800201004003
4400312104060
2000151001030
130093000010
80053000000
98007560021113
1400120000200
1900114010021
3600145021086
5700433001172
1670013510053365
5200384002404
3100280000201
95843
95842
95841
95838
95835
95834
95833
95832
95831
95829
95828
95827
95826
95825
95824
95823
95822
95821SACRAMENTOVoluntary
X05X03F10F09F06F05F04F03F02F01
TotalDisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 210 of 225Report Created at 4/6/2010 4:54:44 PM
20010010000
10000010000
90061100001
10000001000
10010000000
70031021000
10010000000
30011010000
61020030000
30000021000
40030010000
5,541003,0775435508262141569436
30000010002
10000010000
20000000002
1,410001,02697130624310546
20020000000
10010000000
90016
90015
90011
90008
90007
90006
90005
90004
90003
90002
90001
Total
92345
92301
Total
95864
95853
LOS ANGELES
Total
SAN BERNARDINO
SACRAMENTO
Voluntary
Voluntary
X05X03F10F09F06F05F04F03F02F01
TotalDisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 211 of 225Report Created at 4/6/2010 4:54:44 PM
10010000000
20020000000
10010000000
40021000001
90052010001
10010000000
70023020000
10010000000
30011010000
40000002101
20010010000
10100000000
40021010000
70041001010
10000000001
10010000000
60021000300
20010010000
90058
90057
90056
90047
90044
90043
90037
90035
90032
90031
90029
90026
90023
90022
90020
90019
90018
90017LOS ANGELESVoluntary
X05X03F10F09F06F05F04F03F02F01
TotalDisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 212 of 225Report Created at 4/6/2010 4:54:44 PM
70030000031
30030000000
10010000000
70050010001
50032000000
30021000000
10001000000
10000000010
40010020010
70060000001
50022000001
60030020010
10000000001
10001000000
50001003001
30020001000
30030000000
20000001010
90280
90262
90260
90255
90250
90247
90242
90241
90222
90221
90220
90201
90066
90065
90063
90062
90061
90059LOS ANGELESVoluntary
X05X03F10F09F06F05F04F03F02F01
TotalDisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 213 of 225Report Created at 4/6/2010 4:54:44 PM
10010000000
30012000000
10010000000
10010000000
10010000000
20011000000
10010000000
20010000010
10010000000
20010000010
10000000100
50040000001
10010000000
10010000000
10010000000
10001000000
10010000000
10010000000
90806
90805
90802
90801
90745
90744
90731
90723
90710
90706
90660
90650
90606
90605
90602
90502
90303
90301LOS ANGELESVoluntary
X05X03F10F09F06F05F04F03F02F01
TotalDisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 214 of 225Report Created at 4/6/2010 4:54:44 PM
30021000000
20020000000
10001000000
20020000000
30012000000
40040000000
10010000000
10000010000
10010000000
10010000000
10010000000
10000000001
10000010000
10000000010
10010000000
10010000000
10010000000
10000000010
91321
91316
91311
91306
91304
91303
91207
91205
91114
91107
91106
91104
91103
91042
91040
91031
90813
90808LOS ANGELESVoluntary
X05X03F10F09F06F05F04F03F02F01
TotalDisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 215 of 225Report Created at 4/6/2010 4:54:44 PM
10010000000
20020000000
10000000100
20010000010
60030010020
20010000010
10000001000
20020000000
10010000000
40040000000
30020000010
30010010001
70010000006
40030000001
10010000000
40021000001
10010000000
10001000000
91506
91423
91406
91405
91402
91401
91381
91352
91351
91344
91343
91342
91340
91335
91334
91331
91325
91324LOS ANGELESVoluntary
X05X03F10F09F06F05F04F03F02F01
TotalDisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 216 of 225Report Created at 4/6/2010 4:54:44 PM
10010000000
30010000020
20002000000
10010000000
20020000000
20000000002
10010000000
40020000002
10000010000
10010000000
40030010000
40000000040
50003000020
20002000000
30020000010
50030000011
40040000000
20010000010
91776
91770
91768
91767
91766
91765
91762
91755
91746
91745
91744
91733
91731
91724
91722
91706
91606
91605LOS ANGELESVoluntary
X05X03F10F09F06F05F04F03F02F01
TotalDisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 217 of 225Report Created at 4/6/2010 4:54:44 PM
10001000000
10000000010
30030000000
50020000003
10010000000
50031001000
50040000010
10010000000
90270000000
40030000010
32211175401301262828
40040000000
20011000000
20020000000
20011000000
10000010000
10010000000
30020000001
95655
95638
95632
95630
95628
95624
95621
95611
95610
95608
Total
93550
93536
93535
93534
92879
91792
91790
SACRAMENTO
LOS ANGELESVoluntary
X05X03F10F09F06F05F04F03F02F01
TotalDisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 218 of 225Report Created at 4/6/2010 4:54:44 PM
70070000000
2900280000100
1400110000201
20011000000
1000100000000
10000000010
30003000000
1100100001000
20000000110
50050000000
10010000000
90050000220
50050000000
10010000000
10000010000
1200100000020
1500100001112
1400111010100
95824
95823
95822
95821
95820
95817
95816
95815
95814
95812
95811
95758
95757
95742
95680
95673
95670
95660SACRAMENTOVoluntary
X05X03F10F09F06F05F04F03F02F01
TotalDisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 219 of 225Report Created at 4/6/2010 4:54:44 PM
598133815513622194139
10000000001
10000000001
27502206150610131310
1300110000011
30030000000
70060001000
150063021210
50030002000
40040000000
60041001000
20020000000
10010000000
10010000000
2900183020312
20010001000
40021000001
60050001000
Total
92301
Total
95843
95842
95841
95838
95835
95834
95833
95832
95831
95829
95828
95827
95826
95825
Total
SAN BERNARDINO
SACRAMENTOVoluntary
X05X03F10F09F06F05F04F03F02F01
TotalDisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 220 of 225Report Created at 4/6/2010 4:54:44 PM
10000010000
10000000010
10001000000
10010000000
20000000101
10010000000
10010000000
30003000000
10000000100
10010000000
10001000000
20020000000
30000000300
10010000000
20011000000
20000000002
10010000000
50010040000
90255
90250
90248
90242
90222
90221
90220
90061
90059
90042
90039
90037
90032
90026
90023
90019
90011
90003LOS ANGELESVoluntary
X05X03F10F09F06F05F04F03F02F01
TotalDisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 221 of 225Report Created at 4/6/2010 4:54:44 PM
10000000010
30021000000
10001000000
10010000000
10001000000
10000000010
10010000000
10001000000
10001000000
10010000000
10000000010
10010000000
20000002000
10001000000
10010000000
10001000000
60060000000
20020000000
91335
91331
91304
91106
91103
91016
91001
90815
90806
90805
90803
90660
90652
90504
90304
90302
90262
90260LOS ANGELESVoluntary
X05X03F10F09F06F05F04F03F02F01
TotalDisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 222 of 225Report Created at 4/6/2010 4:54:44 PM
10000000100
10010000000
50040001000
20020000000
20020000000
10000001000
30001000020
10010000000
60060000000
10010000000
20020000000
10010000000
10000000010
10010000000
10010000000
10010000000
20020000000
20020000000
93552
93551
93535
91766
91754
91746
91732
91722
91706
91702
91606
91605
91602
91411
91405
91402
91401
91343LOS ANGELESVoluntary
X05X03F10F09F06F05F04F03F02F01
TotalDisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 223 of 225Report Created at 4/6/2010 4:54:44 PM
1100100000001
20020000000
10010000000
60060000000
10010000000
10010000000
30030000000
90080000010
20001000010
10000000010
40040000000
20000000200
30020001000
30021000000
40040000000
10001000000
30020000100
91005214054673
95820
95818
95817
95815
95811
95758
95673
95670
95660
95632
95628
95626
95624
95621
95610
95609
95608
Total
SACRAMENTO
LOS ANGELESVoluntary
X05X03F10F09F06F05F04F03F02F01
TotalDisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 224 of 225Report Created at 4/6/2010 4:54:44 PM
127001076012362
20020000000
20020000000
30030000000
20010000001
40031000000
30030000000
30030000000
70060001000
10001000000
90070000020
30010010010
30030000000
20020000000
80080000000
70061000000
1000100000000
10010000000
Total
95864
95843
95842
95841
95838
95835
95834
95833
95831
95828
95827
95826
95825
95824
95823
95822
95821SACRAMENTOVoluntary
X05X03F10F09F06F05F04F03F02F01
TotalDisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
COPS-17.1 – Disenrollment Summary Report California Health Care OptionsData for transactions between 2/24/2010 and 3/25/2010
Initiation Codes:Disenrollment Reason Codes:
Contract Reference - 6.5.2.2.F.3-4
E01 = Incarcerated E02 = Prior Care E03 = Enrolled Incorrectly Into a Plan E04 = Deceased E05 = Child Protective Services E06 = Foster Care/Adoption E07 = Problem Using the HCP E08 = Terminated By Plan E09 = Long Term Care
E10 = CCS Not In PCCM Contract E11 = Other Health Coverage E12 = Moved Out Of County E13 = Pregnancy F01 = Could Not Choose Doctor I Wanted F02 = Plan Did Not Cover Bene Needs F03 = Doctor Did Not Meet Beneficiary Needs F04 = Too Far To Go F05 = Did Not Choose This Plan
F06 = Moving Out Of County F09 = Other Reason F10 = No Reason Checked I01 = IS-Generated Disenrollment X01 = Waiver Programs exemption X02 = Dental Exemption X03 = Indian Health Coverage X04 = Medical Exemption X05 = MER type E -Voluntary Aid Code or County
B - Bene D - DHCS P - Plan S - Social Services
Page 225 of 225Report Created at 4/6/2010 4:54:44 PM
6,357133,6176186550290169623480
21800159200669135Total
Total
Voluntary
X05X03F10F09F06F05F04F03F02F01
TotalDisenrollmentTransaction Type Disenrollment Reason Code Aid Code County Name Mailing Zip
