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Dual Eligibles: Important Information about Changes to your Medicare and Medi-Cal Benefits

Brooke Phillips, CWCMS
Editor | Shield HealthCare
08/07/14  5:36 PM PST
what is cal mediconnect

UPDATED NOVEMBER 2014

You may have already received a notice from the State of California Coordinated Care Initiative (CCI) about an important change that is taking place for those beneficiaries who qualify for both Medicare and Medi-Cal coverage, known as a Medi-Medi or Dual Eligible.

To assist with this transition, Shield HealthCare has begun sending each one of our potentially impacted customers a letter outlining your choice of health plans. Our highest priority is to help you and your loved ones through this important change.

WHAT is Cal MediConnect?

The state Medi-Cal program and the federal Medicare program have partnered to create a new program in California called Cal MediConnect. This program is designed to integrate care for California’s Medi-Medi seniors and people with disabilities by moving them into a single health plan that will coordinate all Medicare and Medi-Cal benefits.

WHO is affected?

The Cal MediConnect program impacts many beneficiaries in seven California counties: San Mateo, Santa Clara, San Bernardino, Los Angeles, Orange, Riverside and San Diego Counties.

WHEN will this happen?

The State of California has already begun this enrollment process. In Southern California, this change is now impacting beneficiaries in San Diego, Los Angeles, Riverside and San Bernardino Counties. In Northern California, this change is now impacting beneficiaries in San Mateo and Santa Clara Counties. Medi-Medi beneficiaries in these counties can expect the following:

  • You will receive a letter in the mail describing the Cal MediConnect program.
  • You will need to choose a health plan from a list of choices that are provided in the letter.
  • If you do not choose a health plan, Cal MediConnect will choose a health plan for you.
  • You will need to tell the health plan which of the following options you choose:
    • You want to keep your existing Medicare benefits and let the health plan provide your Medi-Cal, or
    • You want the health plan to provide both your Medicare and Medi-Cal benefits.

The contracted providers by county for the Cal MediConnect program in Southern California are:

  • Orange: CalOptima
  • San Diego: Care 1st, Health Net, Molina Healthcare, Community Health Group
  • Los Angeles: Care 1st, Molina Healthcare, Health Net, LA Care, CareMore
  • Riverside: Inland Empire Health Plan (IEHP), Molina Healthcare
  • San Bernardino: Inland Empire Health Plan (IEHP), Molina Healthcare
(Plans in bold are contracted with Shield HealthCare.)

The contracted providers by county for the Cal MediConnect program in Northern California are:

  • San Mateo:  Health Plan of San Mateo
  • Santa Clara:  Anthem Blue Cross, Santa Clara Family Health Plan
(Plans in bold are contracted with Shield HealthCare.)

California County-Specific Program Details

Care coordination activities for Duals in California vary by county. The details provided below are based on the most up-to-date information available as of November 20th, 2014 and include changes in the timeline for Orange County.

There are seven participating counties and twelve contracted health plans in California’s Coordinated Care Initiative (CCI) or Cal MediConnect program. Implementation is county-specific according to the following:

  • San Mateo County: Passive enrollment begins no sooner than April 1, 2014. All eligible Duals enroll at once. Health Plan of San Mateo is the only health plan choice.
  • Riverside & San Bernardino Counties: Voluntary enrollment begins no sooner than April 1, 2014. Passive enrollment begins no sooner than May 1, 2014. April and May birthdays enroll in May then it follows enrollment schedule by birth month. Inland Empire Health Plan and Molina Healthcare are the health plan choices.
  • San Diego County: Voluntary enrollment begins no sooner than April 1, 2014. Passive enrollment begins no sooner than May 1, 2014. April and May birthdays enroll in May then it follows enrollment schedule by birth month. Care 1st, Community Health Group*, Health Net and Molina Healthcare are the health plan choices.
  • Los Angeles County: Voluntary enrollment begins no sooner than April 1, 2014. Passive enrollment begins no sooner than July 1, 2014 for CareMore*, Care 1st, Molina Healthcare and Health Net. LA Care will be eligible for passive enrollment once it improves its Medicare quality ratings. It is not known when this will happen. July birthdays enroll in July then it follows enrollment schedule by birth month. Those are the five health plan choices.
  • Santa Clara County: Passive enrollment begins no sooner than January 1, 2015. January birthdays enroll in January then it follows enrollment schedule by birth month. Anthem Blue Cross and Santa Clara Family Health Plan* are the health plan choices.
  • UPDATED Orange County: Passive enrollment begins no sooner than August 2015, and opt-in enrollment begins no sooner than July 2015. August birthdays enroll in August then it follows enrollment schedule by birth month. Cal-Optima is the only health plan choice.
(*SHC is not contracted with these plans.)

Please check back with Shield HealthCare’s California Community for the latest health care updates.

For more information about Cal MediConnect, visit CalDuals.org.

Shield HealthCare | Medical Supplies For Care At Home Since 1957

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