Beneficiaries

About the Coordinated Care Initiative

If you pay for your health care services using both Medicare and Medi-Cal, you have new choices to make about your health care coverage. In 2014, the Department of Health Care Services (DHCS) began a program called the Coordinated Care Initiative (CCI), which is designed to provide participants with better health care service.

The federal Medicare program and the state Medi-Cal program have partnered to start a new project to improve care for California’s seniors and people with disabilities who are dually eligible for both of the public health insurance programs, “dual eligible beneficiaries” (also known as “dual eligibles,” Medi-Medi beneficiaries” or “Medi-Medis”.)  This project, the Coordinated Care Initiative (CCI), will take place in seven counties: Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo, and Santa Clara.  If you’re a dually eligible beneficiary, this means changes for the way your health care operates. The CCI has two parts:

  • Cal MediConnect: All of a beneficiary’s medical, behavioral health,* long-term institutional, and home- and community-based services will be combined into a single health plan.  This will allow your providers to better coordinate your care and make it simpler for you to get the right care at the right time in the right place. 
  • Medi-Cal Managed Long Term Supports and Services (MLTSS): Medi-Cal beneficiaries, including dual eligible beneficiaries who have opted out of Cal MediConnect or who are not eligible for Cal MediConnect, are required to join a Medi-Cal managed care health plan to receive their Medi-Cal benefits, including long-term supports and services (LTSS) and Medicare wrap-around benefits.

 

Frequently Asked Questions About the CCI

Information & Educational Materials For You

    • Who to Call for Help:  County-specific information about who to call with questions about the Coordinated Care Initiative.
    • Sample Enrollment Notices, Guidebooks and Forms: To enroll in a plan or get information tailored to you, contact Health Care Options (HCO). (If you live in Orange or San Mateo counties, you must call the county health plan to enroll instead of Health Care Options. Find those phone numbers on the county-specific pages.)  Here you can find sample versions of the notices and materials you’ll receive in the mail.
    • Fact sheets, Brochures & Presentations: These documents are simple explanations of the Coordinated Care Initiative and key topics such as eligibility for Cal MediConnect, how to continue your care, and your rights as a health plan member.
    • Glossary: An explanation of technical terms on this website that might be new to you. 
    • Information about Plans: Find links to Cal MediConnect plans to learn more about their benefits and provider networks.   
    • Long-Term Services and supports (LTSS) integration with the CCI: Learn about how you LTSS services, including access to In-Home Supportive Services (IHSS), Multipurpose Senior Service Program (MSSP) and Community-Based Adult Centers (CBAS) works as part of the CCI. 

Update Your Address to Ensure You Receive Your Notices

 

Frequently Asked Questions About the CCI



How do I know if I am eligible?

The Coordinated Care Initiative will only affect beneficiaries in the seven participating counties: Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo, and Santa Clara.  All Medi-Medi beneficiaries who receive long-term services and supports through Medi-Cal will be affected, and here is how to know which program you are eligible for:

    • Cal MediConnect: Most people with full Medicare and Medi-Cal benefits (Medi-Medis) can join a Cal MediConnect health plan. 

These people are not eligible for Cal MediConnect:

    • Medi-Medi beneficiaries younger than 21.
    • Medi-Medis with partial benefits or other health coverage.
    • Home and Community Based Services waiver enrollees (except MSSP; all others must disenroll from those programs to be eligible for the Cal MediConnect; will not be passively enrolled).
    • Medi-Medis with developmental disabilities.
    • Medi-Medis with End-Stage Renal Disease (exception for San Mateo & Orange).
    • PACE and AIDS Health Care Foundation enrollees (who must disenroll from those programs to be eligible for the Cal MediConnect; will not be passively enrolled). 
  • MLTSS: Medi-Cal recipients in participating counties who receive long-term services and supports, such as MSSP, CBAS, IHSS or who live in a nursing facility, will need to enroll in a managed care plan for those benefits.  This applies both to those who opt out of Cal MediConnect and those who are not eligible.



How will I be notified?

If you need to select a new plan, you will receive three different notices, sent 90, 60 and 30 days ahead of your enrollment date.  This is the same for beneficiaries in Cal MediConnect and beneficiaries in Medi-Cal fee-for-service who need to choose a managed care plan for their long-term services and supports (MLTSS).

  • The first notice, sent 90 days ahead of your enrollment date, will alert you to the coming change.
  • The second notice is sent 60 days ahead.  You will also receive a packet with information about plan benefits and provider networks to help you select a plan.  This will include a plan that is the best match for you based on how many of your current providers are included in a plan’s provider network.
  • The third notice, sent 30 days ahead, will provide you with information about your specific plan.  This will be the plan you have chosen based on the 60 day notice.  If you did not make a selection, it will be the plan that is the best match. 

Those beneficiaries who are NOT eligible for Cal MediConnect and who are already enrolled in a Medi-Cal managed care plan will receive one notice prior to the change in their benefit package.  This change is the MLTSS program, which adds long-term services and supports to beneficiaries’ existing plan.

Sample notices are available here.

You do not need to do anything until you receive your notices.



What are my options?

Your enrollment date will depend on several factors, including which county you live in and whether you are already in a Medi-Cal managed care plan.  You will receive a choice form in your 60 day packet that you can use to select a plan.  You can also call Health Care Options to enroll in a plan at 1-844-580-7272 or TTY: 1-800-430-7077.

If you are eligible for Cal MediConnect, here are your options:

1.  Enroll in Cal MediConnect

  • Combine your Medicare and Medi-Cal benefits under one plan
  • Beneficiaries can access the same Medicare benefits that they could through a fee-for-service or Medicare Advantage plan

2. Join a Medi-Cal plan only

  • Your fee-for-service Medicare or Medicare Advantage plan remains as it is
  • However, you must enroll in a Medi-Cal plan for your Medi-Cal benefits

3.  Enroll in PACE

  • Only certain Medi-Medi beneficiaries are eligible for PACE; you must be 55 or older, live in your home or community setting, need a high level of care, and in a ZIP code served by a PACE health plan with openings.

 

Those who are not eligible for Cal MediConnect or who opt out still must enroll in a Medi-Cal managed care plan or PACE:

1.  Enroll in Medi-Cal managed care plan for long term services and supports

  • All current Medi-Cal benefits
  • IHSS, CBAS, MSSP and nursing facility care
  • Medicare share of cost, wrap-around benefits

2. Enroll in PACE

  • Only certain Medi-Medi beneficiaries are eligible for PACE. You must be 55 or older, live in your home or community setting, need a high level of care, and in a ZIP code served by a PACE health plan with openings.



When do I need to enroll?

Enrollment dates will vary.  You don’t need to do anything until you receive your notices.


Can I keep my providers?

Your new Cal MediConnect or Medi-Cal health plan is required to make sure your care continues and is not disrupted. Your health plan will work with you and your doctors to make sure you get all the care you need.

You have the right to continue to receive needed services, even if you may no longer be able to receive them from the same providers. Eventually, you must get all your covered services from providers who work with your plan.  These are “in-network” providers.

  • Your Doctors: If your primary care or specialist doctor is not in your plan, you may be able to continue to see them for 6 months for Medicare services and 12 months for Medi-Cal Services as long as:
    • You have seen the doctor twice in the 12 months before enrolling in the plan;
    • Your doctor is willing to work with the plan and accept payment from them; and
    • Your doctor isn’t excluded from your plan for quality or other reasons.
    • Nursing Facilities: You have the right to stay in your current nursing home under Cal MediConnect, unless it is excluded from the plan’s network for quality or other concerns.
    • Long-term Supports & Services (LTSS): You won’t have to change In-Home Supportive Services (IHSS), Community-Based Adult Services (CBAS) and Multipurpose Senior Services Program (MSSP) providers.
    • Other Providers: Continuity of care protections do not apply to suppliers of medical equipment, medical supplies, and transportation.  They also do not apply to home health or physical therapy providers. 

For more information about continuity of care, please refer to this web page or read this fact sheet.



Why did I receive a letter that says I will be disenrolled from my prescription (Part D) coverage?

If you qualify for both Medicare and Medi-Cal, you will be automatically matched with (and eventually enrolled into) a Cal MediConnect plan, unless you otherwise choose to keep your Medicare they way it is now and choose a plan for your Medi-Cal benefits, or if you choose a PACE plan. Since you can only be in one Medicare plan at a time, your enrollment in Cal MediConnect will automatically end your enrollment in any other Medicare prescription drug plan. Your Part D prescription drug coverage will then be covered by a Cal MediConnect plan.

You receive the disenrollment notice because your current Medicare program recognizes that you are scheduled to join Cal MediConnect, and is alerting you that your coverage will switch to that new plan once your new coverage begins.  You will not lose your prescription drug coverage at any time.

If you do not want to be in Cal MediConnect, you may keep your Medicare the same and stay in your current prescription drug plan.  You will still have to select a Medi-Cal plan for your Medi-Cal benefits. You just need to let Health Care Options know your decision.

(Read more about your options here.)



What information should I consider in making this decision?

Your 60-day packet will contain information to help you make your decision, including identifying health plan that may be the best fit with your current doctors and other health care providers.  You should contact this health plan’s Member Services phone number to be sure your doctor(s) and other health care providers that you use are in the plan’s network.  If you want to find a new doctor, the health plan can help you find one.

You will also want to make sure that the Cal MediConnect health plan’s Medicare Prescription Drug formulary includes the medications that you need to take.  Be sure to have the exact name of the prescription drug when calling the plan(s).

You may also want to talk with family members, your doctor(s) or other people you rely on in making this decision.  Individual counseling is also available from the local Health Insurance Counseling and Advocacy Program. (You can find all health plan, and HICAP, contact information here.)



Where can I get more information? How can I exercise my options?

  • The Health Insurance Counseling and Advocacy Program (HICAP) is available to help you understand these changes and new options.  HICAP provides workshops on Medicare issues, including Cal MediConnect, and also provides individual counseling to assist individuals in understanding their options.  You can call 1-800-434-0222 to talk with someone at your local HICAP.  You can find a phone number for your local HICAP here.
  • Health Care Options staff can also help you to understand these new options and Medi-Cal changes, and to enroll in the managed care or Medi-Cal program of your choice.  They can be reached by calling 1-844-580-7272. 
  • The Cal MediConnect Ombudsman Program helps beneficiaries voice complaints and solve problems with Cal MediConnect. If you need help with your services or your plan, you can reach Ombudsman services Mon – Fri, 9 a.m. – 5 p.m., by calling 1-855-501-3077 (TTY 1-855-874-7914). Learn more on our Ombudsman Program page.

For additional printed information, check out our fact sheets related to the CCI.



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*Some behavioral health benefits will continue to be provided through the counties, not by the Cal MediConnect plans.