Medi-Cal “Matching Plan Policy" for Dual Eligible Beneficiaries
Return to Integrated Care for Dual Eligible BeneficiariesSome people qualify for both Medicare and Medi-Cal and are “dual eligible" beneficiaries. Like all Medicare beneficiaries, dual eligible beneficiaries can choose whether to receive care through
Original Medicare, or enroll in a Medicare Advantage (MA) plan, sometimes called “Part C" or “MA Plans." In California there are several types of Medicare Advantage; plan options vary by county.
For Medi-Cal benefits, most dual eligible beneficiaries are enrolled in Medi‑Cal managed care plans. Enrollment in a Medi-Cal managed care plan does not impact Medicare benefits or provider access.
Some plans provide integrated care, across both Medicare and Medi-Cal benefits. The My Care My Choice website provides information about integrated care options in each county, and local HICAP organizations can also provide assistance.
Medi-Cal Matching Plan Policy
To address the challenges for beneficiaries of coordinating across different health plans for Medicare and Medi-Cal benefits, DHCS has a Medi-Cal matching plan policy in 12 counties.
Under this policy, a beneficiary's Medicare plan choice is the lead, and the Medi-Cal plan follows. This means that for dual eligible beneficiaries that choose to enroll in a MA plan in those counties, their Medi-Cal plan must align with their MA plan choice, if there is a Medi-Cal plan affiliated with their MA plan. The Medi-Cal matching plan policy does not change or impact a beneficiary's MA plan choice. The beneficiary notice is
here.
Note: For additional information on the 2023 policy, view the
Medi-Cal Matching Plan Policy Scenarios slides. These slides provide visuals on four common scenarios that generally apply to dual eligible beneficiaries.
The 12 counties with the Medi-Cal matching plan policy are: Alameda, Contra Costa, Fresno, Kern, Los Angeles, Riverside, Sacramento, San Bernardino, San Diego, San Francisco, Santa Clara, and Stanislaus counties.
For beneficiaries with questions about the Medi-Cal matching plan policy, please contact Medi-Cal Managed Care Health Care Options:
Home | Medi-Cal Managed Care Health Care OptionsAdditional contact information is available at the
Medi-Cal Health Care Options website.
Note: In certain counties, there is only one Medi-Cal plan serving all beneficiaries. All dual eligible beneficiaries in the county, regardless of Medicare plan choice, are enrolled in the same Medi-Cal plan. These counties are: Del Norte, Humboldt, Lake, Lassen, Marin, Mendocino, Merced, Modoc, Monterey, Napa, Orange, San Luis Obispo, San Mateo, Santa Barbara, Santa Cruz, Shasta, Siskiyou, Solano, Sonoma, Trinity, Ventura, and Yolo counties.
