双重合格受益人的综合护理
双重资格受益人是指同时参加了联邦医疗保险 (Medicare) 和加州医疗补助计划 (Medi-Cal) 的人。Medicare是急性期和康复期护理服务的主要支付方。 Medi-Cal通过提供Medicare保费和费用分摊方面的援助，以及涵盖Medicare不涵盖的一些服务（例如Long-Term Services and Supports ( LTSS )），来补充Medicare 。 作为 CalAIM 的一部分，DHCS 正在简化政策，以促进对同时符合 Medicare 和 Medi-Cal 资格的受益人的综合护理。
入学信息
医疗保险计划
Medi-Medi 计划是结合了Medicare和Medi-Cal福利的Medicare Advantage 计划，在California的特定县提供。 综合医疗保险计划通过一个Health Plan提供协调的医疗服务，并可能包含牙科、听力或视力等额外福利。了解更多关于综合医疗保险计划的信息。
针对 Medicare 和 Medi-Cal 受益人的投诉解决资源
In California there are a variety of Ombudsperson programs ready to assist beneficiaries. The primary duties of an Ombudsperson program is to help individuals explore and assist them in determining options to help resolve conflicts and to bring systemic concerns to the attention of those best suited to solve the problem. Learn more Ombudsman programs.
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.
双重合格受益人的全州 Medi-Cal 管理式医疗登记
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.
政策资源
双重合格受益人的医疗保险优势信息
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.
加州双重资格特殊需求计划
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 合同和政策指南
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.
D-SNP 质量和数据报告
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.
全州管理的长期护理
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.
阿尔茨海默病及相关痴呆症
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.
工作组
CalAIM 管理长期服务与支持及双重集成工作组
CalAIM MLTSS和双重身份整合工作组是一个利益相关者合作中心，包括Health Plan 、提供者、倡导者、其他利益相关者以及美国Medicare和Medicaid服务中心 (CMS)。
宣传材料
问题和评论
Contact DHCS with any questions or comments about Integrated Care for Dual Eligible Beneficiaries at info@calduals.org.