雙重合資格受益人綜合照顧
雙重合資格的受益人是同時註冊聯邦醫療保險和 Medi-Cal 的人。聯邦醫療保險是急性和急性後護理服務的主要付款人。Medi-Cal 通過提供聯邦醫療保險保費和成本分享的協助，以及涵蓋醫療保險不涵蓋的某些服務，例如長期服務和支持（LTSS）。作為 CalAIM 的一部分，DHCS 正在簡化政策，以促進對雙重資格獲得聯邦醫療保險和 Medi-Cal 的受益人的綜合護理。
報名資訊
中醫計劃
Medi-Medi 計劃是聯合聯邦醫療保險和 Medi-Cal 福利的聯邦醫療保險計劃，並在加利福尼亞州的特定縣提供。Medi-Medi 計劃通過一個健康計劃提供協調護理，並包括可能的其他福利，例如牙科，聽力或視力保障。了解更多有關醫療計劃的更多信息。
醫療保險和 Medi-Cal 受益人投訴解決資源
在加利福尼亞州，有各種申訴專員計劃準備為受益人提供幫助。 申訴專員計劃的主要職責是幫助個人探索並協助他們確定有助於解決衝突的選擇，並將系統性關注意事項提供最適合解決問題的人的注意。了解更多申訴專員計劃。
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.
雙重合格受益人的全州Medi-Cal Managed Care登記
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.
政策資源
聯邦醫療保險雙重資格受益人的優勢訊息
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.
加利福尼亞州的雙合資格特殊需求計劃
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 合約及政策指南
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 品質與資料報告
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.
全州管理的長期護理
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.
工作群組
CalAIM 託管長期服務 & 支持 & 雙集成工作群組
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).
外展資料
問題和評論
Contact DHCS with any questions or comments about Integrated Care for Dual Eligible Beneficiaries at info@calduals.org.