Office of Medicare Innovation and Integration
The Department of Health Care Services (DHCS) Office of Medicare Innovation and Integration (OMII) provides focused leadership and expertise on innovative models for Medicare beneficiaries in California, including Medicare-only beneficiaries, and individuals dually eligible for Medicare and Medi-Cal. The purpose of OMII is to improve health outcomes, quality, affordability, and equity for Medicare beneficiaries in California.
Consistent with the Governor’s Master Plan for Aging, OMII will: 1) Support new and existing models and strategies to benefit Medicare-only beneficiaries in California and increase access to Long-Term Services and Supports; and 2) Lead and advise on DHCS policies for beneficiaries dually eligible for Medicare and Medi-Cal. This includes the California Advancing and Innovating Medi-Cal (CalAIM) efforts to implement integrated care through aligned enrollment in Medicare Dual-Eligible Special Needs Plans (D-SNPs) and Medi-Cal plans, as well as expanded Managed Long-Term Services and Supports (MLTSS) for dually eligible beneficiaries.
For Beneficiaries
Help with Medicare Enrollment and Choices
Did you know Medicare covers a variety of mental health services? For more information, please see the older adult mental health resources page.
Data and Information
Key Facts:
- Approximately 6.6 million Californians are enrolled in Medicare, including 5 million Medicare-only beneficiaries, and 1.6 million beneficiaries dually eligible for Medicare and Medi-Cal.
- Across all Medicare beneficiaries in the state, approximately 90 percent are age 65 and older, and 10 percent are under age 65. Among dually eligible beneficiaries in California, approximately 25 percent are under age 65.
DHCS is partnering with The SCAN Foundation and ATI Advisory to develop a series of chartbooks that provide information about Medicare beneficiaries in California, which are available below.
Health Care Survey of Californians Age 55 and Older:
- DHCS partnered with The SCAN Foundation on a survey of Californians ages 55 and older on health care needs and experiences, prepared by NORC at the University of Chicago. The survey was conducted between January 25 and February 10, 2022, online and by phone, in Spanish and English, to determine respondents' medical needs, coordination of health care services, caregiver experiences, and need for and access to in-home care and services. A total of 1,540 participants completed the survey. The sample did not include adults living in institutional settings, such as skilled nursing facilities. Please see the survey results on The SCAN Foundation webpage.
- The SCAN Foundation's new fact sheets distill findings as they relate to the following:
Policy Issues
Medicare Advantage Supplemental Benefits:
- Each year Medicare Advantage (MA) plans offer supplemental benefits which are not covered benefits for Original Medicare. Supplemental benefits offered by MA plans has expanded over the past few years and includes similar benefits covered by Medi-Cal. The 2023 Medicare Advantage Supplemental Benefits Factsheet includes a comparison of MA supplemental benefits and Medi-Cal benefits including those covered in the 1915(c) Waiver, the California State Plan, and Community Supports.
ACOs:
- Medicare Accountable Care Organizations (ACOs) are provider-led organizations that work to improve health care quality, outcomes, and experience of care for their patients while lowering the total cost of care. This fact sheet presents an overview of Medicare ACO models relevant to California, including key characteristics of select models and definitions of key terms. It was developed by the Center for Health Care Strategies to inform California Department of Health Care Services’ (DHCS) stakeholders about Medicare ACO models that have served California Medicare beneficiaries over time. Medicare ACO models serve Medicare beneficiaries in Original Medicare. Please see the Medicare Accountable Care Organizations (ACOs) in California document for more information.
MLTSS:
- Under the California Advancing and Innovating Medi-Cal (CalAIM) Initiative, DHCS is expanding integrated care options and Managed Long-Term Services and Supports (MLTSS) for dually eligible beneficiaries. Please see the CalAIM MLTSS page for further details.
LTSS Public Benefit:
- The Budget Act of 2019 authorized funding for DHCS to contract with an actuarial firm to prepare a feasibility study and actuarial analysis of public long-term services and supports financing and services options for California. The final report, which contains policy options and fiscal estimates, was completed in September 2020, and is posted on the DHCS website.
Medi-Cal Outreach & Enrollment for Older Californians:
Alzheimer's Disease and Related Dementias:
- The Department of Health Care Services (DHCS) is committed to improving detection, care, caregiver support, and data analysis for individuals with Alzheimer's disease and related dementias. Most individuals with Alzheimer's disease and related dementias have Medicare and/or Medi-Cal coverage. Please see the Alzheimer's disease and related dementias page for further details.