California’s Duals Demonstration – Cal MediConnect
The Cal MediConnect program aims to improve care coordination for dual eligible beneficiaries and drive high quality care that helps people stay health and in their homes for as long as possible. Additionally, shifting services out of institutional settings and into the home and community will help create a person-centered health care system that is also sustainable.
The Cal MediConnect program is part of California’s larger Coordinated Care Initiative (CCI). Building on many years of stakeholder discussions, the CCI was enacted in July 2012 through SB 1008 (Chapter 33, Statutes of 2012) and SB 1036 (Chapter 45, Statutes of 2012).
Major Parts of the Coordinated Care Initiative
- Cal MediConnect Program: A voluntary three-year demonstration for dual eligible beneficiaries to receive coordinated medical, behavioral health, long-term institutional, and home-and community-based services through a single organized delivery system. No more than 456,000 beneficiaries would be eligible for the duals demonstration in the eight counties.
- Managed Medi-Cal Long-Term Supports and Services (LTSS): All Medi-Cal beneficiaries, including dual eligible beneficiaries, required to join a Medi-Cal managed care health plan to receive their Medi-Cal benefits, including LTSS and Medicare wrap-around benefits.
Who are dual eligible beneficiaries?
Dual eligible beneficiaries are people who qualify for both public health insurance programs, Medicare and Medi-Cal. In California, as many as seven in ten dual eligible beneficiaries are age 65 and older, and most are women. Approximately one in three are younger people with disabilities. California has about 1.1 million of these beneficiaries. Of these, about 456,000 are estimated to be eligible for enrollment into the Cal MediConnect program, including a 200,000 enrollment cap in Los Angeles. (Learn more)
LOS ANGELES COUNTY
Cal MediConnect Health Plans:
The telephone numbers below are for new members:
- L.A. Care 1-888-522-1298 (TTY: 1-888-212-4460)
- Partner (subcontracted) Plans:
- CareMore 1-888-350-3447 (TTY: 711)
- Care 1st Health Plan 1-888-592-7168 (TTY: 1-888-592-7168)
- Kaiser 1-800-464-4000 (TTY: 1-800-777-1370)
- Health Net 1-888-788-5395 (TTY: 1-888-788-6383)
The Health Consumer Center of Los Angeles run by Neighborhood Legal Services helps LA County residents navigate today’s health care system.
- Toll free: (800) 896-3203 TDD: (818) 834-7575
- 13327 Van Nuys Blvd Pacoima, CA 91331-3099
The Center for Health Care Rights provides enrollment counseling to people with Medicare and Medi-Cal. It is part of the Health Insurance Counseling & Advocacy Program(HICAP).
- (213) 383-4519 Toll-free (800) 824-0780
- 520 S. LaFayette Park Place, Suite 214 Los Angeles, CA 9005
- Toll free: (800) 896-3203 TDD: (818) 834-7575
When will enrollment into the Cal MediConnect program begin?
Enrollment in Cal MediConnect will begin no sooner than January 2014. Notification of these changes will be mailed to eligible participants starting in October 2013.
Enrollment will be phased in over 12 months in all counties, except Los Angeles and San Mateo. Assuming a January 2014 start date, in Los Angeles, enrollment will be phased in over 15 months. In San Mateo, enrollment will be completed in January 2014.
Understanding Enrollment for Different Populations
- For people with both Medicare and Medi-Cal eligible for Cal MediConnect: The state will use a passive enrollment process. This means that the state will enroll eligible individuals into a health plan that combines their Medicare and Medi-Cal benefits unless the individual actively chooses not to join and notifies the state of this choice. The state will send eligible individuals multiple notices describing their choices, including the option to “opt out” of joining a Cal MediConnect health plan.
“Opting out”: This is when an eligible beneficiary chooses not to join a demonstration health plan and keep his or her Medicare benefits separate and out of the demonstration health plan. Beneficiaries who enroll in a Cal MediConnect health plan may opt out or change health plans at any time.
Note: Opting out applies only to Medicare benefits. Beneficiaries must still get their Medi-Cal benefits through a health plan, as described below.
- For nearly all people with Medi-Cal: The state will require mandatory enrollment into a Medi-Cal health plan. This means that nearly all people with Medi-Cal in the eight CCI counties MUST get all their Medi-Cal benefits, including long-term services and supports, through a Medi-Cal health plan. Most people with only Medi-Cal already are enrolled in a Medi-Cal health plan; now they will also get their long-term supports and services through their health plan.
- For people with both Medicare and Medi-Cal who do not enroll in a Cal MediConnect Health Plan: The state will require enrollment in a Medi-Cal plan for all Medi-Cal long-term services and supports and any Medicare deductibles or costs. For dual eligible beneficiaries, enrolling in a Medi-Cal health plan does not change their Medicare benefits. They can still go to their Medicare doctors, hospitals, and providers.
How would services be integrated by Cal MediConnect health plans?
Cal MediConnect health plans will be responsible for providing their enrollees all Medicare and Medi-Cal benefits and services, including medical care, long-term care, behavioral health care and social supports. Beneficiaries, their family members and other caregivers will be able to participate in care coordination teams that help ensure delivery of the right services at the right time and place.
Strong consumer protections grounded in personal choice and continuity of care will be core to the program’s success. State and federal officials will monitor the health plans closely to ensure provision of all beneficiary protections. Additionally, the In-Home Supportive Services program would become a managed care benefit, but it would remain an entitlement program and current consumers’ rights would not change.