Medicare Advantage Plans
Certification Process (Optional Enhancement)
Objective
Provide a flowchart on the county Mental Health Plans (MHPs) submission of claims for Medi-Cal reimbursement for Short-Doyle/Medi-Cal (SDMC) reimbursable specialty mental health services provided to beneficiaries eligible for both Medicare and Medi-Cal (dual eligibles) whose Medicare coverage is provided through a Medicare Advantage plan (also known as a Medicare Risk HMO or Medicare Part C plan).
References
INFORMATION NOTICES 09-09, 10-11, 10-23, 11-06, and 13-24
Process Steps
If dual eligibles with FFS Medicare, MHPs are not required to bill Fee-For-Service Medicare for reimbursement for services which DHCS has determined are not covered by Medicare because the service, the provider type, or the combination of the service, provider type, and place of service are not reimbursable by Medicare.
All Mental Health Plans periodically access MedCCC website to verify if insurance carrier on the list.
Mental Health Plan obtains the certification letter certifying that the plan provides no additional coverage for specialty mental health services beyond that which is provided by FFS Medicare. The certification letter must include the following information:
The Medicare Advantage plan name;
Federal contract number; and
Calendar year(s) of service to which it applies, which must not include any year of service later than the year following the date of the letter.
The MHP sends certification letter to MedCCC at Mental Health Services Division, County Customer Service Section at: MedCCC@DHCS.CA.GOV using the subject line: “FFS-Equivalent Coverage Certification.”
MedCCC ensures the SDMC system will treat the plan as a FFS-equivalent plan when adjudicating services for the service dates covered by the certification letter.
MHPs with claims which were previously denied because the services were not first billed to the beneficiary’s Medicare Advantage plan may submit replacement claims for any such denied claims which include services which no longer require billing to the Medicare Advantage plan before billing Medi-Cal.
Certification Status
| Health Plan Name | Federal Contract # | Date Received | Implementation Date |
Certified Date Range (Revised April, 2026) |
|---|---|---|---|---|
| Aetna Better Health of California | H4982 | 4/3/2023 | 4/25/2023 | 01/01/2023 – 12/31/2023 |
| Aetna Health of California | H0523 & H5521 | 07/29/14 | 09/03/14 | 01/01/12 – 12/31/15 |
| Aids Healthcare Foundation, dba Positive Healthcare Partners (PHP) | H5852 | 01/13/17 | 01/25/17 | 01/01/14 – 12/31/17 |
| Alameda Alliance for Health | H7292 | 02/25/14 | 04/24/14 | 01/01/10 – 12/31/15 |
| Alameda Alliance for Health | H2035 | 12/02/25 | 03/24/26 | 01/01/26 – 12/31/26 |
| Alignment Health Plan formerly Citizens Choice Health Plan HMO | H3815 | 04/01/26 | 04/01/26 | 01/01/13 – 12/31/17 01/01/25 – 12/31/26 |
| Anthem Blue Cross | H4471 | 11/25/2025 | 12/24/2025 | 01/01/25 – 12/31/26 |
| Blue Shield | H0504 | 04/06/17 | 04/10/17 | 01/01/14 – 12/31/17 |
| Blue Shield of California | H2819 | 03/30/26 | 04/01/26 | 01/01/25 – 12/31/26 |
| Blue Shield of California | H5609 | 04/06/17 | 04/10/17 | 01/01/16 – 12/31/17 |
| CalOptima | H5433 | 12/03/2025 | 12/24/2025 | 01/01/14 – 12/31/26 |
| Care First Total Dual Plan aka BSC Promise Health Plan | H5928 | 03/16/23 | 03/30/23 | 01/01/08 – 12/31/23 |
| CareMore Health Plan | H0544 | 05/09/16 | 06/15/16 | 01/01/16 – 12/31/16 |
| CenCal Health | H7620 | 4/15/2026 | 4/16/2026 | 01/01/2026 – 12/31/2026 |
| Central California Alliance for Health | H5692 | 11/12/2025 | 12/23/2025 | 01/01/26-12/31/26 |
| Central Health Medicare Plan of California | H5649 | 07/13/16 | 08/24/16 | 01/01/12 – 12/31/17 |
| Community Health Group | H4733 | 11/13/2025 | 12/24/2025 | 01/01/25 -12/31/26 |
| Community Health Group | H5172 | 02/10/14 | 04/24/14 | 01/01/14 – 12/31/15 |
| Community Health Group | H7086 | 07/27/20 | 09/04/20 | 01/01/14 – 12/31/20 |
| Contra Costa Care Plus Dual Eligible Special Needs Plan | H5119 | 04/08/26 | 04/09/26 | 01/01/26 – 12/31/26 |
| Chinese Community Health Plan | H0571 | 11/13/2025 | 12/23/2025 | 01/01/22 -12/31/26 |
| Easy Choice Health Plan | H5087 | 10/07/14 | 01/13/15 | 01/01/14 – 12/31/15 |
| Health Net of California, Inc. | H0562 | 03/28/23 | 05/01/23 | 01/01/14 – 12/31/23 |
| Health Plan of San Mateo | H5428 | 12/06/21 | 12/29/21 | 01/01/10 – 12/31/22 |
| CareAdvantage Mediconnect | H7885 | 12/14/22 | 02/02/23 | 01/01/10 – 12/31/22 |
| CareAdvantage Dual Eligible | H6019 | 11/26/25 | 12/23/25 | 01/01/23 – 12/31/26 |
| IEHP DualChoice | H8894 | 11/12/2025 | 12/24/2025 | 01/01/25 – 12/31/26 |
| Inland Empire Health Plan (IEHP) | H5640 | 02/08/16 | 06/15/16 | 01/01/11 – 12/31/16 |
| Inter Valley Health Plan | H0545 | 03/14/16 | 06/15/16 | 01/01/14 – 12/31/16 |
| L.A. Care Health Plan | H2643 | 02/29/16 | 06/15/16 | 09/26/13 – 12/31/14 |
| Molina Healthcare of California | H5810 | 03/13/23 | 03/17/23 | 01/01/11 – 12/31/23 |
| Partnership Health Plan of California | H5782 | 01/28/14 | 05/13/14 | 03/01/10 – 12/31/15 |
| Santa Clara Family Health Plan | H4045 | 11/13/2025 | 12/24/2025 | 01/01/25 – 12/31/26 |
| SCAN Health Plan | H5425 | 07/13/16 | 08/24/16 | 01/01/11 – 12/31/17 |
| United Healthcare of California/Secure Horizons | H0543 | 05/23/14 | 06/16/14 | 01/01/10 – 12/31/15 |