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Healthcare Changes Are Coming for Dually Eligible Medi-Cal and Medicare Patients!

Effective April 1, 2014, the California Department of Health Care Services (DHCS) and the Centers for Medicare and Medicaid Services (CMS) will be rolling out Cal MediConnect, a new program to coordinate care for some of San Diego’s most vulnerable patients.

Cal MediConnect, a three-year demonstration project for patients dually eligible for Medicare and Medi-Cal, is part of the California Coordinated Care Initiative (CCI). This demonstration project will give participating health plans responsibility to coordinate Medi-Cal, Medicare, and long-term services and supports previously offered by the State and through the County of San Diego’s Aging and Independence Services (such as “In-Home Supportive Services” and the “Multi-Purpose Senior Services Program”), with the goal of keeping patients in their homes and independent for as long as possible.

Patients will have the right to choose a managed care plan participating in CCI to coordinate medical, behavioral health, and long-term care. Dually eligible patients can change their health plan throughout the course of the demonstration project. If patients decide not to respond with their choice, they will be passively enrolled into a participating managed care plan for both their Medicare and Medi-Cal services.

Patients can choose to stay in “fee for service” for their Medicare; however, patients must choose a Medi-Cal managed care plan regardless of their Medicare choice. Patients who decide not to participate and stay in “fee for service” Medicare will not have access to the same coordinated care as those participating in the demonstration project.

The goal of this demonstration program is to offer assistance to patients, their caregivers, and their physicians in order to minimize the complexity and confusion in getting needed services. The health plans’ care managers will shoulder this responsibility and will be held accountable for the quality outcomes of the demonstration project. The demonstration also allows the plan to offer supplemental services such as meals, additional home or personal care services, and respite benefits to address the needs of individual patients.

Physicians who contract with Care1st, Community Health Group, Health Net and Molina will have the opportunity to participate in the Coordinated Care Initiative. Interested physicians who would like to participate but do not have a contract should reach out to the participating health plans to join their networks.

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