Coordinated Care Initiative - Cal MediConnect

The federal Medicare program and the state MC program have partnered to start the Coordinated Care Initiative (CCI) to improve care for California’s seniors and people with disabilities who are dually eligible for both of the public health insurance programs, MC and Medicare. These individuals are referred to as dual eligibles.

The CCI includes two parts, Cal MediConnect and Managed Medi-Cal Long-Term Services and Supports (MLTSS).

Cal MediConnect

Optional enrollment into an integrated managed care that combines Medicare and MC benefits. A client’s medical, some behavioral health, long-term institutional, and home and community-based services will be combined into a single health plan.

MLTSS

Mandatory enrollment of all MC clients (including those dually eligible for both MC and Medicare (Duals) who have opted out of Cal MediConnect or who are not eligible for Cal MediConnect) into a MC managed care health plan to receive all their MC benefits, including Long-Term Services and Supports (LTSS), one of which is In-Home Supportive Services (IHSS).

Note: All recipients of IHSS will receive their benefits as a MC managed care benefit.

CCI Implementation

The Cal MediConnect program is a three-year Duals Demonstration Project which will be implemented in the following eight counties: Alameda, Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo, and Santa Clara.

Dual Eligible Enrollment

The state will automatically enroll all dually eligible clients (Medicare and MC) into a Cal MediConnect health plan unless the client actively chooses not to join (i.e. opt out) and notifies the state of this choice. The state will send eligible clients multiple notices describing their choices, including a Guidebook and Choice Form that allows those individuals to make a decision.

Opting Out

This is when an eligible client chooses not to join a coordinated health plan and decides to keep his/her Medicare benefits separate by choosing a MC health plan only. Clients who enroll in a Cal MediConnect health plan may change health plans at any time.

Note: Opting out applies only to Medicare benefits. Clients must still get their MC benefits through a managed care health plan.

Dual Eligibles Who Do Not Enroll into a Cal MediConnect Health Plan

For dually eligible clients (Medicare and MC) who do not enroll into a Cal MediConnect Health Plan, the state will require enrollment into a MC managed care health plan for all MC LTSS and any Medicare deductibles or costs. These dual eligible clients who enroll in a MC managed care health plan only will not have a change to their Medicare benefits. They can still go to their Medicare doctors, hospitals, and providers.

MC ONLY Clients

The state requires mandatory enrollment into a MC managed care health plan. MC ONLY clients MUST get all their MC benefits, including LTSS, through a MC managed care health plan.

Most people with only MC already are enrolled in a MC managed care health plan, which will now include LTSS through their health plan.

CCI Health Plan Providers

In Santa Clara County, there are two CCI health plan providers:

Santa Clara Family Health Plan

New Members: 1-877-723-4795
TTY: 1-800-735-2929

Anthem Blue Cross

New Members: 1-855-817-5785
TTY: 1-800-855-2880

Cal MediConnect Ombudsman

Clients enrolled in Cal MediConnect who need:

Help with their services or plan,
Assistance with resolving enrollee problems/complaints,
Assistance with filing appeals,

Can reach the Cal MediConnect Ombudsman services by calling:

Phone: 1-855-501-3077
TTY: 1-855-847-7914
Monday - Friday, 9am - 5pm

Program of All-Inclusive Care for the Elderly (PACE)

PACE provides all Medicare and MC benefits plus extra services to help seniors who have chronic conditions live at home. If clients are 55 years old or older and they need a higher level of care to live at home, they may be able to join PACE. The Santa Clara County PACE plan is On Lok Lifeways.

On Lok Lifeways 1333 Bush Street
San Francisco, CA 94109 Main Phone: (415) 292 - 8888
Fax: (415) 292 - 8745
Toll Free: 1-888-886-6565
TTY: 1-415-292-8898
Website: www.onlok.org

See Cal MediConnect FAQs for frequently asked questions and answers about Cal MediConnect.