California's Coordinated Care Initiative - Cal MediConnect
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.
Individuals who are over 65 and are also disabled may qualify for both Medicare and MediCal benefits. These individuals are known as "dual eligibles" or "Medi-Medis."
Coverage includes doctor and dental services, clinic and hospital services, nursing home and home health care, mental health care and some prescription drugs.
Depending on the county you live in, California's Medi-Medis program has a variety of benefits for California's seniors that may include covering your co-pays and paying your Part A and B premiums.
Some Medi-Medis may also qualify for California's Medi-Connect program available in the counties of Alameda, Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo and Santa Clara. Medi-Connect is a managed health plan where all of your healthcare costs, including hospital, doctor visits, prescription drug, long term care and in home health care will be provided by one'plan.
California's Medicare and MediCAL programs provide great benefits for California's seniors but are complex.
About the Coordinated Care Initiative
If you pay for your health care services using both Medicare and MediCal, 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 desianed to provide participants with better health care service. The federal Medicare progiam and the state MediCal program have partnered to start a new proiect 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" ).
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 vou're a dually eligible beneficiary, this means changes for the way your health care operates. The CCI has two parts:
All of a beneficiaries 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 more simple for you to get the right care at the right time in the right place.
MediCal Managed Long Term Supports and Services (MLTSS)
MediCal 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 MediCal managed care health plan to receive their MediCal benefits, including long-term supports and services (LTSS) and Medicare wrap-around benefits.