Integrated Care rau Dual Eligible Benficiaries
Cov neeg tau txais txiaj ntsig ob leeg tau txais txiaj ntsig yog cov neeg rau npe hauv Medicare thiab Medi-Cal. Medicare yog thawj tus neeg them nyiaj rau cov kev pabcuam mob hnyav thiab tom qab mob hnyav. Medi-Cal qhwv ib ncig ntawm Medicare los ntawm kev muab kev pab nrog Medicare cov nqi them thiab kev sib faib nqi, thiab los ntawm kev them rau qee cov kev pabcuam uas Medicare tsis them, xws li cov kev pabcuam mus sij hawm ntev thiab kev txhawb nqa (LTSS). Raws li ib feem ntawm CalAIM, DHCS yog cov kev cai yooj yim los txhawb kev saib xyuas kev sib koom ua ke rau cov neeg tau txais txiaj ntsig ob leeg tsim nyog rau Medicare thiab Medi-Cal.
Cov ntaub ntawv rau npe
Medi-Medi Plans
Medi-Medi Plans yog Medicare Advantage cov kev npaj uas muab Medicare thiab Medi-Cal cov kev pab cuam thiab muaj nyob rau hauv ib cheeb tsam hauv California. Medi-Medi Plans muab kev saib xyuas sib koom ua ke los ntawm ib txoj kev pab them nqi kho mob thiab suav nrog cov txiaj ntsig ntxiv xws li kev kho hniav, hnov lus, lossis kev pom zoo. Kawm paub ntxiv txog Medi-Medi Plans.
Cov peev txheej rau kev daws qhov tsis txaus siab rau cov neeg tau txais txiaj ntsig nrog Medicare thiab Medi-Cal
Hauv California muaj ntau yam kev pab Ombudsperson npaj los pab cov neeg tau txais txiaj ntsig. Lub luag haujlwm tseem ceeb ntawm Ombudsperson program yog los pab tib neeg tshawb nrhiav thiab pab lawv los txiav txim siab cov kev xaiv los pab daws cov teeb meem tsis sib haum xeeb thiab coj cov kev txhawj xeeb ntawm cov neeg ua haujlwm zoo tshaj plaws los daws qhov teeb meem. Kawm paub ntau ntxiv Ombudsman cov kev pab cuam.
Medi-Cal “Matching Plan Policy” for Dual Eligible Beneficiaries
Txhawm rau daws cov teeb meem ntawm kev sib koom tes ntawm ntau hom phiaj xwm kev noj qab haus huv rau Medicare thiab Medi-Cal cov txiaj ntsig, DHCS muaj txoj cai phiaj xwm sib phim Medi-Cal hauv 17 lub nroog hauv xyoo 2025. Xyoo 2026, txoj cai npaj sib phim Medi-Cal yuav raug siv rau hauv txhua lub nroog. Raws li txoj cai no, tus neeg tau txais txiaj ntsig txoj kev xaiv Medicare yog tus thawj coj, thiab txoj kev npaj Medi-Cal ua raws. Kawm ntxiv txog txoj cai ntawm txoj kev npaj sib phim.
Statewide Medi-Cal Managed Care Enrollment rau ob tus neeg tau txais txiaj ntsig
Most dually eligible beneficiaries not already enrolled in Medi-Cal managed care will be newly enrolled in Medi-Cal plans in 2023. Medi-Cal Plans provide wraparound services and care coordination dual eligible beneficiaries, particularly for Long-Term Services and Supports. Learn more about managed care enrollment.
Txoj Cai Tswjfwm
Medicare Advantage Information for Dual Eligible Benficiaries
Like all Medicare beneficiaries, dual eligible beneficiaries can choose whether to receive care through Original Medicare, or enroll in a Medicare Advantage (MA) plan, sometimes called “Part C” or “MA Plans.” Some Medicare Advantage options for dual eligibles in California changed effective January 1, 2023. Learn more about MA.
Dual Tsim Nyog Cov Kev Xav Tau Tshwj Xeeb hauv California
Dual Eligible Special Needs Plans (D-SNPs) are Medicare Advantage (MA) health plans which provide specialized care and coordination for dual eligible beneficiaries. Learn more about D-SNPs.
D-SNP Daim Ntawv Cog Lus thiab Txoj Cai Qhia
Txhua tus D-SNPs hauv California yuav tsum tau ua daim ntawv cog lus nrog Lub Chaw Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS), lub koom haum Medicaid hauv xeev. DHCS kuj tseem muaj Phau Ntawv Qhia Txog Txoj Cai D-SNP, nrog rau cov kev cai ntxiv rau D-SNPs. Kawm ntxiv txog Phau Ntawv Qhia Txoj Cai D-SNPs.
D-SNP Kev Qhia Zoo thiab Cov Ntaub Ntawv
D-SNPs muaj cov kev cai tshaj tawm ruaj khov rau ob qho tib si Medicare thiab Medi-Cal. DHCS saib xyuas D-SNPs kom paub txog qhov zoo ntawm kev saib xyuas thiab kev ncaj ncees ntawm kev noj qab haus huv uas muab rau cov tswv cuab hauv Medi-Cal los ntawm cov kev cai tshaj tawm tshwj xeeb ntawm lub xeev. Kawm ntxiv txog cov kev cai tshaj tawm ntawm D-SNPs.
Statewide Managed Long-Term Care
CalAIM tab tom hloov kev saib xyuas mus sij hawm ntev ntawm cov tsev kho mob mus rau kev tswj hwm kev saib xyuas thoob plaws lub xeev kom sib koom tes zoo dua, ua kom yooj yim rau kev tswj hwm, thiab muab kev paub sib koom ua ke ntau dua. Kawm ntxiv txog kev saib xyuas mus sij hawm ntev.
Alzheimer’s Disease and Related Dementias
DHCS is utilizing the Dementia Care Aware initiative to establish a statewide standard for diagnosing Alzheimer’s Disease and Related Dementias. Learn more about Alzheimer’s Disease and related Dementias.
Pab pawg ua haujlwm
CalAIM Tswj Kev Pabcuam Sijhawm Ntev & Txhawb Nqa & Pab Pawg Ua Haujlwm Kev Sib Koom Ua Haujlwm
The CalAIM MLTSS and Duals Integration Workgroup is a stakeholder collaboration hub, including health plans, providers, advocates, other stakeholders, and the U.S. Centers for Medicare & Medicaid Services (CMS).
Cov ntaub ntawv nthuav tawm
Lus nug thiab lus pom
Contact DHCS with any questions or comments about Integrated Care for Dual Eligible Beneficiaries at info@calduals.org.