Integrated Care rau Dual Eligible Benficiaries
Dually eligible beneficiaries are people enrolled in both Medicare and Medi-Cal. Medicare is the primary payer for acute and post-acute care services. Medi-Cal wraps around Medicare by providing assistance with Medicare premiums and cost sharing, and by covering some services that Medicare does not cover, such as long-term services and supports (LTSS). As part of CalAIM, DHCS is simplementing policies to promote integrated care for beneficiaries dually eligible for Medicare and Medi-Cal.
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Medi-Medi Plans
Medi-Medi Plans are Medicare Advantage plans that combine Medicare and Medi-Cal benefits and are available in select counties in California. Medi-Medi Plans provide coordinated care through one health plan and include possible additional benefits such as dental, hearing, or vision coverage. Learn more about 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.
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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 Contract and Policy Guide
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.
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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 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.