Medi-Medi Plan (EAE D-SNP) Default Enrollment Pilot
Rov qab mus rau Medi-Medi Kev Tshaj Tawm
DHCS tau pib ua Tus Thawj Saib Xyuas Kev Nkag Mus Kawm Default rau xaiv Medi-Medi Plans, uas tau pib thaum nruab nrab xyoo 2024. Rau cov phiaj xwm kev sim no, thaum ib tus tswv cuab hauv Medi-Cal tswj hwm txoj kev npaj kho mob (MCP) tau tsim nyog rau Medicare (vim muaj hnub nyoog lossis kev tsis taus), tus tswv cuab yuav tau txais kev tso npe rau hauv Dual Eligible Special Needs Plan (D-SNP) raws li MCP, tshwj tsis yog tus tswv cuab xaiv lwm qhov kev xaiv Medicare, xws li Advance Care Original.
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.
Tus tsav tsheb tsis cuam tshuam rau ob tus tswvcuab tsim nyog uas twb tau cuv npe hauv Medicare. Tsis tas li ntawd, tus tsav tsheb tsis cuam tshuam rau cov tib neeg uas twb tau cuv npe hauv Medicare uas tau tso npe tshiab hauv Medi-Cal. Qhov kev sim no cuam tshuam rau cov tswv cuab tsawg tsawg txhua lub hlis, thiab cov phiaj xwm koom nrog raug saib xyuas zoo.
Keeb kwm ntawm Medicare thiab 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 lossis MMPs) yog hom phiaj xwm MA uas tswj hwm txhua qhov txiaj ntsig thiab kev pab cuam thoob plaws ob qho kev pab cuam rau ob tus neeg tsim nyog.
Hloov tshiab tseem ceeb
Tus Thawj Saib Xyuas Kev Nkag Mus Kawm Default tau ua tiav hauv ob lub nroog, San Diego thiab San Mateo. Tsuas yog Medi-Medi Plans pom zoo los ntawm DHCS, thiab Lub Chaw rau Medicare thiab Medicaid Services (CMS) tuaj yeem koom tau.
- Community Health Group (CHG) hauv San Diego tam sim no pom zoo rau tus tsav.
- Kev Npaj Khomob ntawm San Mateo (HPSM) hauv San Mateo tam sim no tau pom zoo rau tus tsav.
- Kaiser hauv San Mateo tam sim no tau pom zoo rau tus tsav.
Hauv qab no yog cov yeeb yaj kiab rau cov tswv cuab uas xav kom tau txais Cov Lus Qhia Ntxiv Txog Kev Nkag Mus Kawm Default.
- 2 024 Medi-Medi Plan Default Enrollment Pilot
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- 2024 Medi-Medi Plan Default Enrollment Pilot – American Sign Language Interpretation
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
Raws li lub Kaum Hlis 2023, cov txheej txheem rau npe nkag tau raug siv hauv 12 lub xeev thiab Puerto Rico (AZ, CO, HI, KY, NM, NY, OR, PA, PR, TN, UT, VA, WI). CMS suav nrog cov kev taw qhia ntawm D-SNP default rau npe rau hauv nws txhua xyoo MA Kev Sau Npe thiab Kev Qhia Tawm Tawm.
Cov peev txheej ntxiv
- Preamble lus ntawm cov cai rau Default Enrollment los ntawm CMS.
- For information on the benefits of Default Enrollment, view MACPAC’s publication on Improving Integration for Dually Eligible Beneficiaries: Strategies for State Contracts with Dual Eligible Special Needs Plans.
Koom nrog
Yog xav paub ntxiv txog Medi-Medi Plans thiab kev tso npe tsis raug cai, cov neeg muaj feem tuaj yeem koom nrog CalAIM Managed Long-Term Services thiab Supports thiab Duals Integration Workgroup peb lub hlis twg, uas tseem qhib rau pej xeem. Pawg neeg ua haujlwm yog lub chaw sib koom tes uas cov neeg koom nrog tuaj yeem tawm tswv yim rau Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) thiab koom nrog kev sib tham txog txoj cai, kev ua haujlwm, thiab lub tswv yim rau kev hloov pauv D-SNP.
Lus nug thiab lus pom
Hu rau DHCS nrog rau cov lus nug lossis lus hais txog Medicare Medi-Cal Plans ntawm info@calduals.org.