双重合格受益人的综合护理
双重合格受益人是同时参加 Medicare 和 Medi-Cal 的人。医疗保险是急性和急性后护理服务的主要支付者。Medi-Cal 为 Medicare 提供全方位服务，包括提供 Medicare 保费和费用分摊援助，以及涵盖 Medicare 不涵盖的一些服务，例如长期服务和支持 (LTSS)。作为 CalAIM 的一部分，DHCS 正在实施政策，为同时符合 Medicare 和 Medi-Cal 资格的受益人提供综合护理。
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，在加利福尼亚州的部分县提供。Medi-Medi 计划通过一项健康计划提供协调一致的医疗服务，并可能包含牙科、听力或视力保险等额外福利。了解更多关于 Medi-Medi 计划的信息。
针对 Medicare 和 Medi-Cal 受益人的投诉解决资源
加利福尼亚州有多种监察员计划随时为受益人提供帮助。 监察员计划的主要职责是帮助个人探索和协助他们确定有助于解决冲突的选项，并将系统性问题提请最适合解决问题的人关注。了解更多监察员计划。
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.
Alzheimer’s Disease and Related Dementias
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
The CalAIM MLTSS and Duals Integration Workgroup is a stakeholder collaboration hub, including health plans, providers, advocates, other stakeholders, and the U.S. Centers for Medicare & Medicaid Services (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.