CalAIM Subacute Care Facility Long-Term Care Carve-In: Member Information
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Starting on January 1, 2024, Medi-Cal members who live in Subacute Care Facilities will be enrolled in a Medi-Cal Managed Care Plan. This means members in a Subacute Care Facility receiving adult or pediatric subacute care services will get their services paid for by their Managed Care Plan.
Managed Care Plans will be responsible for making sure members' health care needs are met and that they continue to get services in the Subacute Care Facility.
Below are additional resources for members and the Subacute Care Facility Enrollment Notices on the upcoming transition. For more information on subacute care services, please visit:
https://www.dhcs.ca.gov/provgovpart/Pages/SubacuteCare.aspx.
Subacute Care Facility Long-Term Care (LTC) Enrollment Notices
DHCS will mail each Medi-Cal member in a Subacute Care Facility Enrollment Notices 60 days and 30 days before January 1, 2024. DHCS will also mail Member notices to authorized representatives documented within the Medi-Cal Eligibility Data System (MEDS).
These notices differ depending on the
county the member lives in and whether the member is a part of
Medi-Cal matching plan policy.
- Members in Subacute Care Facilities in Geographic Managed Care (GMC), Two-Plan, or Regional counties that are part of the Medi-Cal matching plan policy will receive notices with the Managed Care Plan that they must join based on their Medicare Advantage plan. These members will automatically be enrolled in the Managed Care Plan that matches their Medicare Advantage plan.
- Members in Subacute Care Facilities in Geographic Managed Care (GMC), Two-Plan, or Regional counties, but not part of the Medi-Cal matching plan policy will receive notices that include the Medi-Cal Managed Care Plan they will be enrolled in if they do not choose one by the selection deadline. These members will also receive a separate
My Medi-Cal Choice packet to choose a Medi-Cal Managed Care Plan in November.
- Members in Subacute Care Facilities in County Organized Health System (COHS) and Single Plan expansion counties that are part of the Medi-Cal matching plan policy will receive notices with the Managed Care Plan they will automatically be enrolled that matches their Medicare Advantage plan.
- Members in Subacute Care Facilities in COHS and Single Plan expansion counties, but not part of the Medi-Cal matching plan policy will receive notices with the Managed Care Plan they will automatically be enrolled in.
LTC Subacute Care Facility Notice of Additional Information (NOAI)
The Subacute Care Facility LTC Notice of Additional Information (NOAI) is also below. The NOAI has more information about the change to Medi-Cal Managed Care and what it means for Medi-Cal members receiving subacute care services.
Where Members Can Go for More Information and Help
Members can contact any of the following groups with any questions about the Subacute Care transition to managed care. All calls are free.
For Questions about Why Your Medi-Cal Services are Changing:
DHCS Ombudsman Office
- Call (888) 452-8609 (TTY: California State Relay at 711) (toll free), Monday to Friday, 8 a.m. to 5 p.m. PT.
- Or email them at
MMCDOmbudsmanOffice@dhcs.ca.gov.
- The Ombudsman Office helps people with Medi-Cal use their benefits and understand their rights and responsibilities.
Medicare Medi-Cal Ombudsman Program
- Call (855) 501-3077 (toll free).
- The Medi-Cal Ombudsman helps people with complaints and issues for both Medicare and Medi-Cal.
Long-Term Care Ombudsman
- Call (800) 231-4024. The line is available 24 hours a day, 7 days a week (toll free).
- The Long-Term Care Ombudsman helps people who live in a skilled nursing home, intermediate care facility, and subacute care facility with complaints and know their rights and responsibilities.
To Learn More about Health Plan and Provider Choices:
Health Care Options
- Call (800) 430-4263 (TTY: (800) 430-7077), Monday to Friday, 8 a.m. to 6 p.m.
- Or go to the Health Care Options website at www.healthcareoptions.dhcs.ca.gov.
- Health Care Options helps people with plan choices and doctor or clinic choices.
For Questions about Medi-Cal:
DHCS Medi-Cal Helpline
- Call (800) 541-5555 (toll free), Monday to Friday, 8 a.m. to 5 p.m. PT.
