Tsev Medi-Medi Plan (EAE D-SNP) Tus Qauv Sau Npe Ua Ntej​​ 

Medi-Medi Plan (EAE D-SNP) Default Enrollment Pilot​​ 

Rov qab mus rau Medi-Medi Kev Tshaj Tawm​​ 

DHCS tau pib ua qhov Default Enrollment Pilot rau qee cov phiaj xwm Medi-Medi, uas tau pib thaum nruab nrab xyoo 2024. Rau cov phiaj xwm sim no, thaum ib tug tswv cuab hauv Medi-Cal managed care plan (MCP) tsim nyog rau Medicare (vim muaj hnub nyoog lossis kev tsis taus), tus tswv cuab yuav raug sau npe rau hauv Dual Eligible Special Needs Plan (D-SNP) uas phim nrog MCP ntawd, tshwj tsis yog tias tus tswv cuab xaiv lwm txoj kev xaiv Medicare, xws li Original Medicare, lossis lwm txoj kev npaj Medicare Advantage.​​ 

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.​​ 

Qhov kev sim no TSIS cuam tshuam rau ob tug tswv cuab uas tsim nyog uas twb tau rau npe rau hauv Medicare lawm. Tsis tas li ntawd xwb, qhov kev sim no tsis cuam tshuam rau cov tib neeg uas twb tau sau npe rau hauv Medicare thiab cov neeg tshiab sau npe rau hauv Medi-Cal. Qhov kev sim no cuam tshuam rau cov tswv cuab me me txhua hli, thiab cov phiaj xwm koom nrog raug saib xyuas ze.​​ 

Keeb kwm ntawm Medicare thiab Medi-Cal​​ 

Cov neeg uas tsim nyog tau txais Medicare thiab Medi-Cal yog cov neeg tau txais txiaj ntsig "ob qho tib si". Ib yam li txhua tus neeg tau txais kev pab Medicare, cov neeg tau txais kev pab uas tsim nyog ob leeg tuaj yeem xaiv seb puas yuav tau txais kev kho mob los ntawm Original Medicare, lossis rau npe rau hauv Medicare Advantage (MA) txoj kev npaj. Rau Medi-Cal, feem ntau cov neeg uas tsim nyog tau txais kev pab ob npaug yog cov uas tau sau npe rau hauv Medi-Cal MCPs.​​ 

Cov phiaj xwm Medicare Medi-Cal (Medi-Medi Plans lossis MMPs) yog ib hom phiaj xwm MA uas sib koom tes txhua qhov txiaj ntsig thiab cov kev pabcuam thoob plaws ob qho kev pab cuam rau cov neeg tsim nyog ob leeg.​​ 

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.​​ 

Hauv qhov kev sim Default Enrollment, ib tug tswv cuab yuav tau txais ib daim ntawv ceeb toom ua ntej 60 hnub thiab 30 hnub ua ntej lub hlis uas lawv tsim nyog tau txais Medicare. Ib daim ntawv ceeb toom piv txwv 60/30 hnub txog tus tsav dav hlau tuaj yeem pom hauv qab no: ​​ 

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​​ 

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​​ 

Tiv tauj DHCS yog tias muaj lus nug lossis lus tawm tswv yim txog Medicare Medi-Cal Plans ntawm info@calduals.org.


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