ການດູແລແບບປະສົມປະສານສໍາລັບຜູ້ໄດ້ຮັບຜົນປະໂຫຍດສອງເທົ່າ
ຜູ້ໄດ້ຮັບຜົນປະໂຫຍດທີ່ມີສິດສອງເທົ່າແມ່ນຄົນທີ່ລົງທະບຽນຢູ່ໃນທັງ Medicare ແລະ Medi-Cal. Medicare ແມ່ນຜູ້ຈ່າຍເງິນຫຼັກສໍາລັບການບໍລິການການດູແລແບບສ້ວຍແຫຼມ ແລະຫຼັງສ້ວຍແຫຼມ. Medi-Cal ອ້ອມຮອບ Medicare ໂດຍການໃຫ້ການຊ່ວຍເຫຼືອກັບຄ່າປະກັນໄພຂອງ Medicare ແລະການແບ່ງປັນຄ່າໃຊ້ຈ່າຍ, ແລະໂດຍການກວມເອົາບາງການບໍລິການທີ່ Medicare ບໍ່ໄດ້ກວມເອົາ, ເຊັ່ນ: ການບໍລິການ ແລະການຊ່ວຍເຫຼືອໄລຍະຍາວ (LTSS). ເປັນສ່ວນຫນຶ່ງຂອງ CalAIM, DHCS ແມ່ນນະໂຍບາຍທີ່ງ່າຍດາຍເພື່ອສົ່ງເສີມການດູແລແບບປະສົມປະສານສໍາລັບຜູ້ໄດ້ຮັບຜົນປະໂຫຍດທີ່ມີສິດໄດ້ຮັບສອງຢ່າງສໍາລັບ Medicare ແລະ Medi-Cal.
ຂໍ້ມູນການລົງທະບຽນ
ແຜນ Medi-Medi
ແຜນ Medi-Medi ແມ່ນແຜນ Medicare Advantage ທີ່ລວມເອົາຜົນປະໂຫຍດຂອງ Medicare ແລະ Medi-Cal ແລະມີຢູ່ໃນເຂດທີ່ເລືອກໃນຄາລິຟໍເນຍ. ແຜນ Medi-Medi ໃຫ້ການດູແລແບບປະສານງານຜ່ານແຜນສຸຂະພາບອັນດຽວ ແລະລວມເອົາຜົນປະໂຫຍດເພີ່ມເຕີມທີ່ເປັນໄປໄດ້ເຊັ່ນ: ແຂ້ວ, ການໄດ້ຍິນ, ຫຼືການຄຸ້ມຄອງສາຍຕາ. ສຶກສາເພີ່ມເຕີມກ່ຽວກັບແຜນ Medi-Medi.
ຊັບພະຍາກອນສໍາລັບການແກ້ໄຂຄໍາຮ້ອງທຸກສໍາລັບຜູ້ໄດ້ຮັບຜົນປະໂຫຍດກັບ Medicare ແລະ Medi-Cal
ໃນຄາລິຟໍເນຍມີໂຄງການ Ombudsperson ຫຼາກຫຼາຍຊະນິດທີ່ພ້ອມທີ່ຈະຊ່ວຍເຫຼືອຜູ້ໄດ້ຮັບຜົນປະໂຫຍດ. ຫນ້າທີ່ຕົ້ນຕໍຂອງໂຄງການ Ombudsperson ແມ່ນເພື່ອຊ່ວຍໃຫ້ບຸກຄົນຄົ້ນຫາແລະຊ່ວຍເຫຼືອພວກເຂົາໃນການກໍານົດທາງເລືອກທີ່ຈະຊ່ວຍແກ້ໄຂຂໍ້ຂັດແຍ່ງແລະນໍາເອົາຄວາມກັງວົນທີ່ເປັນລະບົບໄປສູ່ຄວາມສົນໃຈຂອງຜູ້ທີ່ເຫມາະສົມທີ່ສຸດເພື່ອແກ້ໄຂບັນຫາ. ສຶກສາເພີ່ມເຕີມໂຄງການ Ombudsman.
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.
ການລົງທະບຽນການດູແລທີ່ມີການຄຸ້ມຄອງ Medi-Cal ທົ່ວປະເທດສໍາລັບຜູ້ໄດ້ຮັບຜົນປະໂຫຍດສອງເທົ່າ
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.
ຊັບພະຍາກອນນະໂຍບາຍ
ຂໍ້ມູນປະໂຫຍດຂອງ Medicare ສໍາລັບຜູ້ໄດ້ຮັບຜົນປະໂຫຍດສອງເທົ່າ
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.
ແຜນຄວາມຕ້ອງການພິເສດທີ່ມີສິດສອງເທົ່າໃນຄາລິຟໍເນຍ
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 ສັນຍາ ແລະຄູ່ມືນະໂຍບາຍ
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.
ການລາຍງານຄຸນນະພາບ ແລະຂໍ້ມູນ D-SNP
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.
ການດູແລໄລຍະຍາວທີ່ມີການຄຸ້ມຄອງຂອງລັດ
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.
ກຸ່ມເຮັດວຽກ
CalAIM ຄຸ້ມຄອງການບໍລິການໄລຍະຍາວ & ສະຫນັບສະຫນູນ & ກຸ່ມເຮັດວຽກປະສົມປະສານຄູ່
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).
ອຸປະກອນການເຜີຍແຜ່
ຄໍາຖາມແລະຄໍາເຫັນ
Contact DHCS with any questions or comments about Integrated Care for Dual Eligible Beneficiaries at info@calduals.org.