Medi-Medi Plan (EAE D-SNP) Default Enrollment Pilot
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DHCS is launched a Default Enrollment Pilot for select Medi-Medi Plans, which started in mid-2024. For these pilot plans, when a member in a Medi-Cal managed care plan (MCP) becomes eligible for Medicare (due to age or disability), the member will be automatically enrolled into the Dual Eligible Special Needs Plan (D-SNP) aligned with that MCP, unless the member chooses a different Medicare option, such as Original Medicare, or another Medicare Advantage plan.
Default enrollment expands enrollment into integrated care plans for newly dual eligible members and supports continuity of care with a member's Medi-Cal providers.
The pilot does NOT impact dual eligible members who are already enrolled in Medicare. Also, the pilot does not impact individuals already enrolled in Medicare who newly enroll in Medi-Cal. This pilot impacts a small number of members each month, and participating plans are closely monitored.
Background on Medicare and Medi-Cal
People who qualify for both Medicare and Medi-Cal are “dual eligible" beneficiaries. Like all Medicare beneficiaries, dual eligible beneficiaries can choose whether to receive care through Original Medicare, or enroll in a Medicare Advantage (MA) plan. For Medi-Cal, most dual eligible individuals are enrolled in Medi‑Cal MCPs.
Medicare Medi-Cal Plans (Medi-Medi Plans or MMPs) are a type of MA plan that coordinates all benefits and services across both programs for dual eligible individuals.
Important Updates
The Default Enrollment Pilot is being implemented in two counties, San Diego and San Mateo. Only Medi-Medi Plans approved by DHCS, and the Centers for Medicare and Medicaid Services (CMS) can participate.
Below are videos for members wishing to get more Information about the Default Enrollment pilot.
In the Default Enrollment pilot, a member will receive a written notice both 60-days and 30-days before the month they become eligible for Medicare. A sample 60/30 day notice regarding the Pilot can be found below:
D-SNP Default Enrollment in Other States
As of October 2023, the default enrollment process is being used in 12 states and Puerto Rico (AZ, CO, HI, KY, NM, NY, OR, PA, PR, TN, UT, VA, WI). CMS includes guidance on D-SNP default enrollment in its annual MA Enrollment and Disenrollment Guidance.
Additional Resources
Get Involved
To learn more about Medi-Medi Plans and default enrollment, stakeholders can participate in the quarterly CalAIM Managed Long-Term Services and Supports and Duals Integration Workgroup , which is also open to the public. The workgroup is a collaboration hub where stakeholders can offer feedback to the Department of Health Care Services (DHCS) and engage in discussions related to the policy, operations, and strategy for the D-SNP transition.
Questions and Comments
Contact DHCS with any questions or comments about Medicare Medi-Cal Plans at info@calduals.org.
