Bumalik sa Pinagsanib na Pangangalaga para sa Dalawang Kwalipikadong Benepisyaryo

Miyembro ka ba ng Cal MediConnect? Matuto nang higit pa tungkol sa hinaharap ng Cal MediConnect.

Passage of the Coordinated Care Initiative (CCI) in July 2012 marked an important step toward transforming California’s Medi-Cal (Medicaid) care delivery system to better serve the state’s low-income seniors and persons with disabilities. Building upon many years of stakeholder discussions, the CCI begins the process of integrating delivery of medical, behavioral, and long-term care services and provides a road map to integrate Medicare and Medi-Cal for beneficiaries of both programs, called “dual eligible” beneficiaries.  

Created through a public process involving stakeholders and health care consumers, the CCI was enacted through Senate Bill 1008 (Chapter 33, Statutes of 2012) and Senate Bill 1036 (Chapter 45, Statutes of 2012).

The CCI was implemented in seven counties beginning in 2014. The seven counties are Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo, and Santa Clara.

Mga Pangunahing Bahagi ng Coordinated Care Initiative

• Cal MediConnect: Isang boluntaryong Planong Pangkalusugan para sa dalawahang kwalipikadong benepisyaryo upang makatanggap ng magkakaugnay na medikal, kalusugan ng pag-uugali, pangmatagalang institusyonal, at mga serbisyong nakabatay sa tahanan at komunidad sa pamamagitan ng isang organisadong sistema ng paghahatid. Pinagsasama ng Cal MediConnect ang parehong mga benepisyo ng Medicare at Medi-Cal sa karagdagang mga benepisyo sa koordinasyon ng pangangalaga.  
• Managed Medi-Cal Long-Term Supports and Services (MLTSS): Lahat ng mga benepisyaryo Medi-Cal , kabilang ang dalawahang kwalipikadong benepisyaryo, sa mga county ng CCI ay kinakailangang sumali sa isang Medi-Cal Managed Care Planong Pangkalusugan upang matanggap ang kanilang mga benepisyo Medi-Cal , kabilang ang LTSS at Medicare wrap-around na mga benepisyo.

What’s New with Cal MediConnect

Under the California Advancing and Innovating Medi-Cal (CalAIM) initiative, starting on January 1, 2023, Cal MediConnect members will be transitioned to MMPs, or Medi-Medi Plans. MMPs is the California-specific program name for Exclusively Aligned Enrollment Dual Eligible Special Needs Plans (EAE D-SNPs). Under exclusively aligned enrollment, beneficiaries can enroll in a D-SNP for Medicare benefits and in a Medi-Cal managed care plan for Medi-Cal benefits, which are both operated by the same parent organization for better care coordination and integration. DHCS will work with health plans, stakeholders, and the Centers for Medicare & Medicaid Services (CMS) to transition and expand integrated care statewide.  This policy is intended to help meet the statewide goals of improved care integration and person-centered care, under both the CalAIM initiative and the California Master Plan for Aging.

DHCS is convening the monthly public CalAIM MLTSS & Duals Integration Workgroup to work with stakeholders to support this transition. Information on how to register for the CalAIM MLTSS & Duals Integration Stakeholder Workgroup, and background materials from previous workgroup meetings is available here.

Pangkalahatang Impormasyon

• How to Enroll – Shares basic information about how to enroll in Cal MediConnect.
• Cal MediConnect Benefits and Services – Includes basic information about CMC’s benefits/services.
• PACE – Includes brief background on the PACE program, a link to CalPACE, and four PACE FAQs.
• Health Plan 101 – An explanation of different health plan components and a series of related questions and answers.

Mga Fact Sheet ng CCI

1. Mga Mapagkukunan para sa mga Makikinabang

• Beneficiary FAQ – Includes basic FAQs about CMC for beneficiaries.
• Toolkit ng Benepisyaryo (Ingles)
• Toolkit ng Benepisyaryo (Spanish)
• Fact Sheet ng Miyembro ng Matibay na Kagamitang Medikal
• Balita sa Medi-Cal: Libreng Transportasyong Benepisyo!
• Ang Iyong Mga Serbisyo sa Ngipin sa Pamamagitan ng Medi-Cal

     2. Mga Mapagkukunan para sa Mga Provider

• Toolkit ng Doktor
• Toolkit ng Tagapamahala ng Kaso ng Ospital
• FAQ ng CCI Provider
• Fact Sheet ng Provider ng Matibay na Kagamitang Medikal

     3. Mga Mapagkukunan para sa Mga Tagapagtaguyod

• Gabay ng Mga Tagapagtaguyod sa CCI
• Dalawang Proteksyon sa Pagiging Karapat-dapat sa Cal MediConnect: Pagpapalagay at Pagbibigay ng Tulong na Nakabinbin

     4. Makasaysayang Impormasyon ng CCI

• Background on the CCI – Contains brief background information on the CCI and five FAQs about the CCI
• What is Cal MediConnect? – A brief overview of Cal MediConnect (CMC), including which benefits are coordinated and information about how to join.
• Managed Long-Term Services and Supports (MLTSS) page –Includes brief information about MLTSS, a link to find an MLTSS plan, and three MLTSS FAQs.
• Fact Sheet ng CCI-HIV (Oktubre 2015)
• Coordinated Care Initiative: Executive Summary (Na-update noong Marso 27, 2013)
• CCI Population Chart: Updated table showing groups included in and excluded from the demonstration and mandatory Medi-Cal enrollment (March 27, 2013)
• CCI Population Summary: (March 27, 2013) A summary of the participating populations
• CCI Beneficiary Protections: (August 30, 2012)  A summary of all the beneficiary protections included in the CCI.
• CCI Legislative Reporting Requirements: (August 30, 2012) A summary of the legislative reporting requirements for the CCI.
• Mga Kinakailangan sa Pakikipag-ugnayan ng Stakeholder ng CCI: (Agosto, 30, 2012) Buod ng mga kinakailangan sa muling konsultasyon ng stakeholder.
• CCI Evaluation Strategy: (October 12, 2012)  An overview of the evaluation and quality monitoring for the duals demonstration.
• CCI’s Commitment to Quality: (October 12, 2012) An overview of State efforts to advance high quality care delivery.
• Mga Ulat sa Rate ng Cal MediConnect 

Pinagtibay na Batas

• CCI Trailer Bill Senate Bill 1008 (Hulyo 2012)
• CCI Trailer Bill Senate Bill 1036 (July  2012) 

Mga Naunang Bersyon ng Legislative Language

• Mga Iminungkahing Pagbabago sa Wika ng Coordinated Care Initiative Trailer Bill (Mayo 24, 2012
• Fact Sheet na nagpapaliwanag ng mga pagbabago sa May Revision sa CCI Trailer Bill Language (Mayo 24, 2012
• Mga Pangmatagalang Suporta at Serbisyo TBL Fact Sheet (Marso 26, 2012
• Legislative Language on the Brown Administration’s Coordinated Care Initiative (March 26, 2012)
• Savings Estimates and Methodology for the Coordinated Care Initiative (February) 

For more information about the Coordinated Care Initiative and Cal MediConnect, please visit the Integrated Care for Dual Eligible Beneficiaries webpage.