Managed Long-Term Services and Support and Dual Special Needs Plans
Return to Integrated Care for Dual Eligible Beneficiaries
Starting in 2023, CalAIM policies mean more integrated care for those who need Long-Term Services and Supports or who are dually eligible for Medicare and Medi-Cal.
Timeline of Changes
2022
- Launch of CalAIM Community Supports, new services provided by Medi-Cal managed care plans as cost effective alternatives to traditional medical services or settings
- All Medi-Cal managed care plans are encouraged to offer as many of the 14 pre-approved Community Supports as possible and are available to eligible Medi-Cal members regardless of whether they qualify for Enhanced Care Management services
- CalAIM Enhanced Care Management (ECM) available for initial populations of focus which include
- Individuals and families experiencing homelessness;
- High utilizers of avoidable ED, hospital, short-term SNF;
- Adults with Serious Mental Illness or needing Substance Use Disorder Services; and
- Individuals transitioning from incarceration
2023
- January 1: Statewide mandatory enrollment of full dual eligible beneficiaries into Managed Care Plans (MCPs) for Medi-Cal benefits, including dual eligible Long-Term Care (LTC) residents
- January 1: All MCPs will be responsible for the full LTC benefit at the following facility types and homes:
- Skilled Nursing Facility (SNF), both freestanding and hospital-based SNFs
- January 1: Medicare Medi-Cal Plans (MMPs) available in the following counties: Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo, and Santa Clara. All Cal MediConnect (CMC) members cross-walked to matching D-SNP and MCPs.
- January 1: Expanded populations of focus for ECM which include
- Adults eligible for LTC and at risk of institutionalization; and
- Nursing home residents transitioning to the community
- July 1: All MCPs will become responsible for the full LTC benefit at the following facility types and homes:
- Intermediate Care Facility (ICF)
- Intermediate Care Facility for Developmentally Disabled (ICF/DD);
- ICF/DD-Habilitative;
- ICF/DD-Nursing;
- Subacute Facility;
- Pediatric Subacute Facility
Additional Resources
CalAIM MLTSS & Duals Integration Workgroup
The CalAIM MLTSS and Duals Integration Workgroup serves as a stakeholder collaboration hub for this effort, including health plans, stakeholders, and the U.S. Centers for Medicare & Medicaid Services (CMS). This Workgroup provides an opportunity for stakeholders to provide feedback and share information about policy, operations, and strategy for the Department's transition plan for dual eligibles and the CCI transition within the CalAIM initiative.
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