CCI Information for Beneficiaries
The state Medi-Cal program and the federal Medicare program have partnered to start a new project to improve care for California’s seniors and people with disabilities who are dually eligible for both of the public health insurance programs, “dual eligible beneficiaries." This project, the Coordinated Care Initiative (CCI), will take place in seven counties: Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo, and Santa Clara. The CCI has two parts:
-
Cal MediConnect: All of a beneficiary’s medical, behavioral health**, long-term institutional, and home-and community-based services will be combined into a single health plan. This will allow your providers to better coordinate your care and make it simpler for you to get the right care at the right time in the right place.
-
Managed Medi-Cal Long-Term Supports and Services (MLTSS): All Medi-Cal beneficiaries, including dual eligible beneficiaries, are required to join a Medi-Cal managed care health plan to receive their Medi-Cal benefits, including LTSS and Medicare wrap-around benefits.
**Some behavioral health benefits will continue to be provided through the counties, not by the Cal MediConnect plans.
Information for Beneficiaries
How do I know if I am eligible?
The Coordinated Care Initiative will only affect beneficiaries in the seven participating counties: Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo, and Santa Clara. All beneficiaries who receive long-term services and supports through Medi-Cal will be affected, and here is how to know which program you are eligible for:
-
Cal MediConnect: Most people with full Medicare and Medi-Cal benefits (Medi-Medi beneficiaries) can join a Cal MediConnect health plan.
-
MLTSS: Medi-Cal recipients in these counties who receive long-term services and supports, such as MSSP, CBAS, IHSS or who live in a nursing facility, will need to enroll in a managed care plan for those benefits. This applies both to those who opt out of Cal MediConnect and those who are not eligible. These people are not eligible for Cal MediConnect:
Medi-Medi beneficiaries younger than 21.
Medi-Medis with partial benefits or other health coverage.
Home and Community Based Services waiver enrollees (except MSSP; all others must disenroll from those programs to be eligible for the Cal MediConnect; will not be passively enrolled).
Medi-Medis with developmental disabilities.
Medi-Medis with end-stage renal disease (exception for San Mateo & Orange)
PACE and AIDS Health Care Foundation enrollees (who must disenroll from those programs to be eligible for the Cal MediConnect;
will not be passively enrolled).
How will I be notified?
If you need to select a new plan, you will receive three different notices, sent 90, 60 and 30 days ahead of your enrollment date. This is the same for beneficiaries in Cal MediConnect and beneficiaries in Medi-Cal fee-for-service who need to choose a managed care plan for their long-term services and supports (MLTSS).
The first notice, sent 90 days ahead of your enrollment date, will alert you to the coming change.
The second notice is sent 60 days ahead. You will also receive a packet with information about plan benefits and provider networks to help you select a plan. This will include a plan that is the best match for you based on how many of your current providers are included in a plan’s provider network.
The third notice, sent 30 days ahead, will provide you with information about your specific plan. This will be the plan you have chosen based on the 60 day notice. If you did not make a selection, it will be the plan that is the best match.
Those beneficiaries who are NOT eligible for Cal MediConnect and who are already enrolled in a Medi-Cal managed care plan will receive one notice prior to the change in their benefit package. This change is the MLTSS program, which adds long-term services and supports to beneficiaries’ existing plan.
You do not need to do anything until you receive your notices.
What are my options?
Your enrollment date will depend on several factors, including which county you live in and whether you are already in a Medi-Cal managed care plan. You will receive a choice form in your 60 day packet that you can use to select a plan. You can also call Health Care Options to enroll in a plan at (800) 430-4263 or TTY: (800) 430-7077.
If you are eligible for Cal MediConnect, here are your options:
-
Enroll in Cal MediConnect
Combine your Medicare and Medi-Cal benefits under one plan -
Opt out of Cal MediConnect
Your Medicare remains the same (fee-for-service or Medicare Advantage plan)
You must enroll in a Medi-Cal plan for your Medi-Cal benefits -
Enroll in PACE
Only certain Medi-Medi beneficiaries are eligible for PACE, you must be 55 or older, live in your home or community setting, need a high level of care, and in a ZIP code served by a PACE health plan with openings.
Those who are not eligible for Cal MediConnect or who opt out still must enroll in a Medi-Cal managed care plan:
-
Enroll in Medi-Cal managed care plan for long term services and supports
- All current Medi-Cal benefits
IHSS, CBAS, MSSP and nursing facility care
Medicare share of cost, wrap-around benefits
When do I need to enroll?
Enrollment dates will vary. You don’t need to do anything until you receive your notices.
What information should I consider in making this decision?
Your 60-day packet will contain information to help you make your decision, including identifying health plan that may be the best fit with your current doctors and other health care providers. But you should contact this health plan’s Member Services phone number to be sure your doctor(s) and other health care providers that you use are in the plan’s network. If you want to find a new doctor, the health plan can help you find one.
You will also want to make sure that the Cal MediConnect health plan’s Medicare Prescription Drug formulary includes the medications that you need to take. Be sure to have the exact name of the prescription drug when calling the plan(s).
You may also want to talk with family members, your doctor(s) or other people you rely on in making this decision. Individual counseling is also available from the local Health Insurance Counseling and Advocacy Program.
Can I keep my providers?
If your provider is not in one of the plans in your county, you can work with the provider and the health plan to continue to receive their services:
- For Medicare: Up to 6 months.
- For Medi-Cal: Up to 12 months.
After the 6 or 12 months, if your provider does not join the health plan network, you will need to choose a provider within the health plan’s network.
This applies to primary care and specialist providers, not to providers of ancillary services such as durable medical equipment (DME) and transportation.
What information should I consider in making this decision?
Your 60-day packet will contain information to help you make your decision, including identifying health plan that may be the best fit with your current doctors and other health care providers. But you should contact this health plan’s Member Services phone number to be sure your doctor(s) and other health care providers that you use are in the plan’s network. If you want to find a new doctor, the health plan can help you find one.
You will also want to make sure that the Cal MediConnect health plan’s Medicare Prescription Drug formulary includes the medications that you need to take. Be sure to have the exact name of the prescription drug when calling the plan(s).
You may also want to talk with family members, your doctor(s) or other people you rely on in making this decision. Individual counseling is also available from the local Health Insurance Counseling and Advocacy Program.
Where can I get more information?
More information about the Coordinated Care Initiative is available on the
www.CalDuals.org website. Here is information on where you can call for more information:
- The Health Insurance Counseling and Advocacy Program (HICAP) is available to help you understand these changes and new options. HICAP provides workshops on Medicare issues, including Cal MediConnect, and also provides individual counseling to assist individuals in understanding their options. You can call (800) 434-0222 to talk with someone at your local HICAP.
- Health Care Options staff can also help you to understand these new options and Medi-Cal changes. They can be reached by calling (800) 430-4263 or TTY: (800) 430-7077.
