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.
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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
To address the challenges of coordinating across different health plans for Medicare and Medi-Cal benefits, DHCS has a Medi-Cal matching plan policy in 17 counties in 2025. In 2026, the Medi-Cal matching plan policy will be implemented in all counties. Under this policy, a beneficiary’s Medicare plan choice is the lead, and the Medi-Cal plan follows. Learn more about the matching plan policy.
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.
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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
All D-SNPs in California must have executed contracts with the Department of Health Care Services (DHCS), the state Medicaid agency. DHCS also maintains a D-SNP Policy Guide, with further requirements for D-SNPs. Learn more about the D-SNPs Policy Guide.
D-SNP Kev Qhia Zoo thiab Cov Ntaub Ntawv
D-SNPs have robust reporting requirements for both Medicare and Medi-Cal. DHCS monitors D-SNPs for the quality of care and health equity provided to members in Medi-Cal through state-specific reporting requirements. Learn more about D-SNPs reporting requirements.
Statewide Managed Long-Term Care
CalAIM is transitioning institutional long-term care to managed care statewide to better coordinate care, simplify administration, and provide a more integrated experience. Learn more about long-term care.
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.
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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).
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Contact DHCS with any questions or comments about Integrated Care for Dual Eligible Beneficiaries at info@calduals.org.