Are You Affected by Cal MediConnect?

Are You Affected by Cal MediConnect?

Starting April 1, 2014, beneficiaries dually eligible for Medicare and Medi-Cal (informally called “duals” or “Medi-Medis”) in a few counties have received notices about or experienced changes in how they receive benefits. The changes are brought about by “Cal MediConnect,” a demonstration to integrate Medicare and Medi-Cal. Cal MediConnect is part of the larger Coordinated Care Initiative (CCI), which aims to integrate the delivery of medical, behavioral, and long-term care services. By coordinating care, the goal is to provide the right care at the right time and in the right place. Eight counties selected for CCI: Alameda, Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo and Santa Clara.

In San Mateo County, on April 1st 3,008 duals were enrolled in CareAdvantage Cal MediConnect plan, which is administered by Health Plan of San Mateo (HPSM). Due to the small duals population, San Mateo is the first county to implement Cal MediConnect and to enroll all eligible duals in one month, April 2014. Duals may opt out of Cal MediConnect, and some already have.

In Riverside, San Bernardino and San Diego Counties, 15,833 duals with birthdays in April and May will be enrolled in a Cal MediConnect plan starting May 1 unless they opt out.

In Los Angeles County, duals with birthdays in July received notices starting April 1 informing them about Cal Mediconnect. Starting May 1, they will receive more notices with more information about their options.

In the remaining 3 counties, Alameda, Orange and Santa Clara, Cal MediConnect will begin no sooner than January 2015.

The implementation of Cal MediConnect and CCI is complex. Not only is the start date varied among the 8 participating counties, but there are many other nuances to the program as well. For instance, not all duals are eligible for Cal MediConnect, and a person’s enrollment date may not always be in their birth month. For more information, please see our Cal MediConnect webinar and fact sheet linked to below. If you have questions, please call your local Health Insurance Counseling and Advocacy Program (HICAP) at 1-800-434-0222.

Our blogger Karen J. Fletcher is CHA's publications consultant. She provides technical expertise, writing and research on Medicare, health disparities and other health care issues. With a Masters in Public Health from UC Berkeley, she serves in health advocacy as a trainer and consultant. See her current articles.