Revised sample Choice Forms for Los Angeles, Riverside, San Bernardino and San Diego counties are now available in English (Enrollment Materials) and Spanish (Español).
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Final MLTSS Resource Guide and Choice Book
October 6, 2016NEW MLTSS Enrollment Materials Finalized
Managed Care Resource Guide and Choice Book for New Dual Eligible Beneficiaries in CCI Counties
The Department of Health Care Services (DHCS) is proud to announce the new Medi-Cal Managed Care Plan Resource Guide and Choice Book.
These materials will be mailed to two groups of dual eligible beneficiaries as a part of their regular enrollment process:
• New dual eligible beneficiaries who have Medicare first and later gain Medi-Cal eligibility in CCI counties; and
• Existing dual eligible beneficiaries who move into a CCI county.
All of these beneficiaries are already required to enroll into a Medi-Cal managed care health plans (MCP) for their Managed Long-Term Services and Supports (MLTSS) in order to receive their Medi-Cal benefits. These new materials will ensure that this group of beneficiaries receives information on all of their available options – including Cal MediConnect.
The new materials incorporate some of the lessons learned about how to most effectively communicate with dual eligible beneficiaries about the CCI, including feedback from stakeholder input and beneficiary testing. Prior to being finalized, these materials underwent a final literacy review to ensure that they meet readability standards and are not above a sixth-grade reading level. All final materials are also being translated into threshold languages and will be available in accessible formats, as required.
Click below to access the new MLTSS enrollment materials:
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ATTENTION:
These materials are SAMPLES, created specifically for stakeholders to view. In these samples, CareMore was mistakenly omitted as a Cal MediConnect option. Actual mailings to beneficiaries will accurately reflect all health plan options for the county in which the beneficiary lives, including CareMore. To avoid confusion, a corrected sample will be posted shortly.
Any questions can be sent to info@calduals.org.
Notices
May 9, 2017|
Resource Guide
(2016 voluntary enrollment) |
Choice Book
(2016 voluntary enrollment) |
- Cal MediConnect Choice Book (previous version)
- Cal MediConnect Choice Forms (previous version)
- Cal MediConnect Choice Form Instructions (previous version)
- Cal MediConnect Notices and Guidebook (notices in 12 languages – previous version)
- Blue Envelope (previous version)
- MLTSS Choice Books (previous version)
- MLTSS Notices (in 12 languages -previous version)
- Medicare Part D Notices
- D-SNP documents
- Integrated Denial Notice
- Status of Notices
- Disenrollment Notices
- Medi-Cal Managed Care Non-Medical Exemption Request Form for American Indians and Beneficiaries with HIV/AIDS
- San Mateo Cal MediConnect Enrollment Materials
- Orange County Cal MediConnect and MLTSS Enrollment Materials
Sample Choice Book, Forms, and Instructions
Beneficiaries living in Los Angeles, Riverside, San Bernardino, San Diego, and Santa Clara Counties will receive a choice form with their health plan guidebook, which they can use to make health plan choices. Beneficiaries living in San Mateo county will receive a Non-Auto Enrollment Form with their health plan guidebook. Draft samples of these forms are available below.
Revised Sample Choice Book with Sample Choice Forms (county-specific) – The revised sample Choice Book and Choice Forms have been revised following beneficiary testing and stakeholder comment and will begin to be mailed to beneficiaries around their 60-day notice, beginning in September 2014.
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Sample Choice Book – all counties
(August 2014)
Cal MediConnect Choice Forms
To enroll in a plan by mail, use the blank Choice Forms available here
Sample Choice Form
These forms were in use beginning in September 2014. Find blank, usable version of these linked above.
A visual guide to filling out the Choice Form. This is posted online only. Beneficiaries do not receive this in the mail.
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Cal MediConnect Notices and Guidebook
These notices will be mailed to beneficiaries 90, 60, and 30 days prior to an individual’s scheduled date of passive enrollment into Cal MediConnect. The Cal MediConnect Plan Guidebook will be mailed to individuals approximately 60 days prior to their scheduled date of passive enrollment.
Revised Cal MediConnect Notices (July 2014)
These notices have been revised following beneficiary testing and stakeholder comment and will begin mailing to beneficiaries with the 90-day notice in July and remaining notices in August.
CCI Notice Envelopes
Notices from DHCS about the Cal MediConnect program will be sent in blue envelopes. Larger envelopes will contain the guidebooks and choice books, while other notices will come in smaller, regular-sized envelopes. Click here to see an example of the larger envelopes.
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Managed Long-Term Services and Supports (MLTSS) Materials
The purpose of the following notifications is to inform current fee-for-service dual eligible beneficiaries, who are not eligible to enroll into a Cal MediConnect plan that they must enroll into a Medi-Cal managed care plan for their Medi-Cal benefits. This notice will include information on which Medi-Cal plan they have been assigned to and other Medi-Cal plan choices. These notices will be mailed to beneficiaries at the specified number of days prior to an individual’s scheduled date of passive enrollment.
To enroll in a plan by mail, use the blank Choice Forms available here.
MLTSS Choice Books
| Choice Book for Beneficiaries with Medicare Doctors |
Choice Book for Beneficiaries with Medi-Cal Doctors |
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Revised MLTSS Notices (August 2014)
In response to stakeholder input, DHCS has developed two sets of revised MLTSS notices. Beneficiaries will receive one set of notices if they have Medicare Part B and see Medicare doctors or a different set of notices if they do not have Medicare Part B and see Medi-Cal doctors.
with Medicare Doctors |
with Medi-Cal Doctors |
Other Notices
Medicare Part D Notices
This notice explains why people eligible for Cal MediConnect receive cancellation notices from their current Medicare Part D plans – because those plans recognize that the person’s drug coverage is scheduled to shift from that current Part D plan to a Cal MediConnect plan instead. They will be mailed out with beneficiaries’ 60-day notices.
- D-SNP Insert (English and 11 other target languages)
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- For more information about the status of CCI notices, including translations, stakeholder comment periods, and dates to finalize.
Disenrollment Notices
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Medi-Cal Managed Care Non-Medical Exemption Request Form for American Indians and Beneficiaries with HIV/AIDS
Health Care Options – 1-844-580-7272
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San Mateo County Materials
Orange County Materials
Ombudsman
March 26, 2017There’s a resource for beneficiaries enrolled in Cal MediConnect: the Cal MediConnect Ombudsman Program. If you have a problem with your services or Cal MediConnect plan, you can turn to the Ombudsman program for help.
If you are having a problem with your Cal MediConnect plan, try to talk to your doctor and your health plan. If your plan has denied coverage or payment for a medical service, the plan will have a process for you to appeal that decision.
If the problem is still not fixed, you have more options for help, including the Cal MediConnect Ombudsman program. The Ombudsman can help you ask for “continuity of care,” which can help you keep seeing your doctors after joining a Cal MediConnect plan. They can also help you file an appeal if your plan has denied a service or treatment.
For More Information
- Read a sample Integrated Denial Notice on your options if your plan denies a claim.
- Read more about your Rights & Responsibilities.
- To learn more about how the Ombudsman Program was founded, .
Other Resources for Help
If you need help understanding your health plan choices, contact the Health Insurance Counseling & Advocacy Program, or HICAP (1-800-434-0222).
If you want to make a change to your health plan, including choosing a different Cal MediConnect plan, a different Medi-Cal plan, or to opt out of Cal MediConnect, contact Health Care Options (1-844-580-7272).
Walk-In Addresses
For appointments at all Ombudsman offices, call HCA’s toll-free number, 1-888-804-3536. Business hours will vary by location.
| County | Organization | Address |
| Los Angeles County | Neighborhood Legal Services of Los Angeles County | 13327 Van Nuys Boulevard Pacoima, CA 91131 |
| 1104 E. Chevy Chase Drive Glendale, CA 91205 |
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| 9354 Telstar Avenue El Monte, CA 91731 |
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| Orange County | Legal Aid Society of Orange County | 2101 N. Tustin Avenue Santa Ana, CA 92705 |
| San Diego County | Legal Aid Society of San Diego – Consumer Center for Health Education & Advocacy | 1764 San Diego Avenue, Suite 200 San Diego, CA 92110 |
| San Mateo County* | Legal Aid Society of San Mateo County* | 330 Twin Dolphin Drive, Suite 123 Redwood City, CA 94065* |
| Santa Clara County | Bay Area Legal Aid | 4 N. Second Street, Suite 600 San Jose, CA 95113 |
*Appointments are to be made in advance
Materials
March 16, 2017Enrollment Materials
Choosing a health plan is important. These materials are available to you free of charge, and are print-ready to help you through the enrollment process. Please feel free to download, print, and use these materials at your convenience.
Resource Guide – This guide will explain your plan choices, what benefits the plans provide, and how you can work with your health plan after you join.
Choice Forms
- Los Angeles County Choice Form
- Orange County Choice Form
- Riverside County Choice Form
- San Bernardino County Choice Form
- San Diego County Choice Form
- San Mateo County Choice Form
- Santa Clara County Choice Form
Notices
Below are sample notices that are mailed to beneficiaries.