California’s Coordinated Care Initiative – Cal MediConnect
The state Medi-Cal program and the federal Medicare program partnered to create a three-year project to promote coordinated health care delivery to seniors and people with disabilities who are dually eligible for both of the public health insurance programs, or “dual eligible beneficiaries.”
The program is called Cal MediConnect.
It began starting after April 2014 in seven counties:
The Cal MediConnect program aims to improve care coordination for dual eligible beneficiaries and drive high quality care that helps people stay healthy and in their homes for as long as possible. Additionally, shifting services out of institutional settings and into the home and community helps 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: 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 Cal MediConnect in the seven counties.
- Medi-Cal Managed Long-Term Supports and Services (MLTSS): All Medi-Cal beneficiaries, including dual eligible beneficiaries, must join a Medi-Cal managed care health plan to receive their Medi-Cal benefits, including LTSS and Medicare wrap-around benefits.
Click here to see fact sheets on the Coordinated Care Initiative.
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)
Click on each county below to learn more about the specifics across the state:
When did enrollment into the Cal MediConnect program begin?
Enrollment into Cal MediConnect began for some beneficiaries after April 2014, with enrollment into plans continuing by birth month through July 2016. Notification of these changes were mailed to eligible participants starting in January 2014. Notifications were sent out three months prior to a beneficiary joining a new health plan.
Enrollment is phased in over 12 months in all counties, except Los Angeles and San Mateo.
Understanding Passive (Automatic) Enrollment for Different Populations
- For people with both Medicare and Medi-Cal eligible for Cal MediConnect: The state is using a passive enrollment process. This means that the state is automatically enrolling all eligible individuals into a Cal MediConnect health plan unless the individual actively chooses not to join and notifies the state of this choice. The state sends / will send eligible individuals multiple notices describing their choices, including a Guidebook and Choice Form that allows those individuals to make a decision.
“Opting out”: This is when an eligible beneficiary chooses not to join a coordinated health plan and keep his or her Medicare benefits separate by choosing a Medi-Cal plan only. Beneficiaries who enroll in a Cal MediConnect health plan may 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 seven 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: As mentioned above, 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 only 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 are key to the program’s success. State and federal officials will continue to monitor the health plans closely to ensure provision of all beneficiary protections. Additionally, the In-Home Supportive Services program will become a managed care benefit, but it will remain an entitlement program and current consumers’ rights will not change.
Why is the government proposing these changes?
Today, dual eligible beneficiaries must access services through a complex system of disconnected programs funded by different government offices. This fragmentation often leads to beneficiary confusion, delayed care, inappropriate utilization and unnecessary costs. Integrating all services and financing for dual eligible beneficiaries will promote care coordination and result in improved beneficiary health and lower costs.
Click here for more answers to Frequently Asked Questions.