​​​DHCS is Offering Integrated Care for People Eligible for Both Medicare​ ​and Medi‑Cal

Starting in January 2023, the Department​ of Health Care Services (DHCS), along with our federal Medicare partners, is establishing Medicare Medi-Cal Plans (Medi-Medi Plans). Medi-Medi Plans will continue to provide integrated care for current Cal MediConnect (CMC) members and are available for new enrollment in 2023.  These plans are available in seven counties (Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo, and Santa Clara) and will be available in additional counties in future years. Medi-Medi Plans are a type of Medicare Advantage Plan for Californians with both Medicare and Medi-Cal. They combine and coordinate both program's benefits, including physical health, behavioral health, long-term institutional care, and home and-community based services. Medi-Medi Plans build on the structure of CMC plans and will expand access to care integration and person-centered care for dual eligible members statewide.

To learn more about how Medi-Medi Plans will impact eligible Californians, we spoke with Anastasia Dodson, Deputy Director of DHCS' Office of Medicare Innovation and Integration.

Why are Medi-Medi Plans being offered now?

The CMC demonstration was time-limited, and is transitioning to an ongoing Medicare Advantage structure known in California as Medi-Medi Plans. California is working to expand this program statewide to all counties by 2026.

Simply put, a Medi-Medi Plan is a type of Medicare Advantage plan. It is for people who have both Medicare and Medi-Cal, and it combines Medicare and Medi-Cal benefits and Medicare prescription drug benefits into one plan. We're making it easier for eligible members to access all of the available benefits both programs have to offer.

In California, dual eligible members have historically had some of the highest rates of chronic conditions, social needs, and health disparities, compared to Medicare-only and Medi-Cal-only members. These members often report being in poor health and have high utilization, yet they must navigate among multiple delivery systems across Medicare and Medi-Cal to receive the care they need, which is challenging for them and their caregivers.

Medicare covers doctor visits, hospital stays, labs, prescription drugs, etc., and Medi-Cal covers long-term services and supports, dental, transportation to medical appointments, and specialty mental health services for dual eligible members.

To provide integrated care for these members, in 2014, DHCS, in partnership with the Centers for Medicare & Medicaid Services, launched the CMC demonstration program to provide coordinated, integrated care to select low-income Californians in seven counties, including Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo, and Santa Clara counties, who were eligible for both Medicare and Medi-Cal.

What are Medi-Medi Plans, and how are they related to the CMC program?

​Medi-Medi Plans provide integrated care and care coordination across members' Medicare and Medi-Cal benefits that can't be found in regular Medicare Advantage or Medi-Cal plans. These plans address members' specialized needs, improve care coordination, and provide integrated member materials and customer service to make it easier to receive care and have better patient experiences and positive health outcomes.

Medi-Medi Plans will continue the benefits of CMC, which has shown that this type of integrated care is possible and leads to good outcomes, strong member satisfaction, and positive experiences for providers. CMC's success and stability paved the way for Medi-Medi Plans, which include: one care team to coordinate care; one health plan to coordinate the delivery of services, including medical supplies, transportation, and long-term services and supports; and one set of benefits and a network of providers, including doctors, hospitals, clinics, labs, pharmacies, and medical equipment suppliers. Members may also be able to access extra benefits, like dental, hearing, or vision coverage, in addition to what Medi-Cal covers.

The lessons learned from CMC will help health plans transition members into Medi-Medi Plans, scale the Medi-Medi Plan model statewide, and expand enrollment.

To enroll in a Medi-Medi Plan, dual members can contact 1-800-Medicare, contact those plans directly, or go online at www.Medicare.gov.

Who is eligible for Medi-Medi Plans?

Starting in 2023, Medi-Medi Plans will be available to members who are dually eligible for both Medicare and Medi-Cal, and who live in one of these seven counties: Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo, and Santa Clara.

Members already enrolled in CMC plans will automatically transition to Medi-Medi Plans in January 2023. Medi-Medi Plans will also be open to new enrollment for those who are dually eligible, age 21 or older, and live in one of the seven counties. By 2026, eligible members will be able to enroll in Medi-Medi Plans in all counties.

Enrollment in Medi-Medi Plans – just like in CMC plans – is voluntary. Dual eligible members still have the option to enroll in different Medicare Advantage plans or remain in Original Medicare (fee-for-service). Dual eligible members can change their plans quarterly or annually during change periods.

How will the transition from CMC plans to Medi-Medi Plans occur?

​CMC members will automatically transition into a Medi-Medi Plan for 2023 operated by the same parent organization as their CMC plan. The name of their health plan may change, but their Medi-Medi Plan will offer the same care coordination and benefits that their CMC plan currently offers. 

Members do not need​ to do anything to stay enrolled with their plan. They received notices explaining the transition. Medicare members receive various marketing materials each fall during Medicare's Annual Enrollment Period. For CMC members, no action is needed to stay enrolled with their existing plans.

DHCS has been holding monthly stakeholder meetings for more than a year regarding this transition, and we have published information and materials on the DHCS website. We are also monitoring the transition experience in real time.

What are you most excited about regarding the statewide transition to Medi-Medi Plans under CalAIM?

We are most excited about the integrated care and added benefits that dual eligible members throughout the state will be able to access. We know that dual eligible members have high rates of chronic conditions, like heart disease, diabetes, and Alzheimer's disease and related dementias, and need help navigating across medical care and long-term services and supports, particularly when they have a hospitalization or skilled nursing facility stay. It can be very frustrating for them and for their caregivers, family, and friends who try to help them. We know that the Medi-Medi Plan model goes a long way toward addressing these concerns by providing integrated care coordination across both the Medicare and Medi-Cal systems.

I'd also like to mention another model for integrated care in California, the Program of All-Inclusive Care for the Elderly (PACE), which is available at a number of sites across the state for dual members who need nursing home level of care. PACE sites also provide integrated Medicare and Medi-Cal benefits and care coordination. Members can visit the DHCS website for more information.

California has been one of the leading states in offering innovative, integrated care options like CMC to dual eligible members. We're pleased now to roll out Medi-Medi Plans.​

What is the best way to stay up to date on Medi-Medi Plans?

The CalAIM website has many tools and resources, including links to the Medi-Medi Plan fact sheet and webpage. You can also follow CalAIM on Twitter and Facebook .​

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