California’s Cal MediConnect transitions to Medicare Medi-Cal Plans
On January 1st, California’s Cal MediConnect plans for dually eligible individuals transitioned to newly created Medicare Medi-Cal Plans. Known as Medi-Medi Plans or MMPs, these plans are provided by the same insurance carriers as Cal Medi-Connect and offer the same healthcare benefits. The matching plans are designed to coordinate care for people with both Medicare and Medi-Cal.
In 2014, California implemented Cal MediConnect in its seven Coordinated Care Initiative (CCI) counties. Cal MediConnect is part of California’s larger CCI and combines Medicare and Medi-Cal benefits into one health plan. To build and expand on the benefits of Cal MediConnect, the California Department of Health Care Services (DHCS) and federal Medicare partners established the new Medicare Medi-Cal Plans.
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Cal MediConnect members received notices about the transition starting in October of 2022. Cal MediConnect members received their services and remained on their plans until they were systematically enrolled into MMPs starting on January 1st.
The transition took place in all of California’s CCI counties: Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo, and Santa Clara. DHCS says MMPs will be available to dual-eligible members in other California counties by 2026.
“DHCS is consulting with Medi-Cal plans and the Centers for Medicare & Medicaid Services regarding any counties – in addition to the seven CCI counties – where MMPs may be available sooner than contract year 2026,” Katherine Weir-Ebster, PIO of DHCS told State of Reform.
Currently, Los Angeles County has seven MMPs; Orange County has one; Riverside County has three; San Bernardino County has three; San Diego County has six; San Mateo County has two; and Santa Clara County has three.
“Individuals dually eligible for both Medicare and Medi-Cal in all counties can choose to enroll in a Medicare Advantage plan, or stay enrolled in Original Medicare,” Weir-Ebster told State of Reform.
Californians who are eligible for both Medicare and Medi-Cal frequently have high rates of chronic conditions and functional impairments. According to DHCS, dual-eligible members are three times more likely than Medicare-only members to report being in poor health.
For the majority of dual-eligible members, Medicare and Medi-Cal operate separately with limited coordination across program benefits. This creates challenges for members who often use services at a high level due to the need to navigate the health programs.
MMPs are only available to dual-eligible members, and provide Medicare Part A, B, and D services, specialized care coordination, and wrap-around Medi-Cal services. MMPs will work to deliver all covered benefits to their members, who will receive integrated member materials, such as one integrated member identification card.
Integrated materials include one phone number to call for both Medicare and Medi-Cal benefits, leading to reduced administrative burden. MMP members will also receive care coordination, including a unified Health Risk Assessment, a person-centered individualized care plan, and an interdisciplinary care team that includes Medicare, Medi-Cal, and service providers.
Additionally, MMP members will receive continuity of care so they can continue to see their provider for up to 12 months, in many cases even if the provider is outside of the MMP’s provider network, according to DHCS.
The matching plans will include doctors that patients are currently seeing, and will continue providing medical and home services of care, community-based services, and medical supplies and medications.
MMPs will coordinate all benefits and services across both programs, such as all Medicare-covered services including medical providers, hospitals, prescription drugs, labs, and x-rays, all Medi-Cal covered services including long-term services and supports, durable medical equipment (DME), and medical transportation, among others.
The California Health Care Foundation (CHCF) released a report in November of 2022, which highlighted the benefits of Medicare Medi-Cal plans for dually eligible members.
CHCF’s report mentioned how the alignment of Medi-Medi Plans will reduce duplication and confusion in the coordination of care, prevent delays in receiving DME, and make enrollees eligible for certain non-medical supports to address social needs and improve care outcomes.