Updated March 2014, April 2014, May 2014, July 2015
In July 2012, California enacted the Coordinated Care Initiative (CCI) which included a three-year project to create a partnership between the state Medi-Cal program and the federal Medicare program. This partnership seeks to promote a coordinated and more efficient health care delivery system for seniors and people with disabilities who are eligible for both public health insurance programs. These “dual eligible beneficiaries” are eligible to enroll in this partnership program called Cal MediConnect.
The goal of the Cal MediConnect program is to improve care coordination for dual eligible beneficiaries by providing access to quality care to allow these beneficiaries to stay at home and in their communities for as long as possible. Through care coordination, the program intends to shift services from high-cost institutional care in hospitals and nursing homes to a more sustainable cost-efficient setting in home and community-based centers.
- Cal MediConnect is a voluntary three-year demonstration program for dual eligible beneficiaries. Under Cal MediConnect, both Medicare and Medi-Cal services are combined into a single coordinated health delivery plan. The program includes medical, behavioral health, nursing home care and home and community-based services. Dual eligible beneficiaries will be passively enrolled into a Cal MediConnect health plan for both Medicare and Medi-Cal benefits unless they elect to “opt out” of Cal MediConnect. If they “opt out,” they must select a Medi-Cal Managed Long-Term Supports and Services health plan to continue to receive Medi-Cal benefits.
- Medi-Cal Managed Long-Term Supports and Services (MLTSS)– All Medi-Cal beneficiaries, including dual eligible beneficiaries, must join a Medi-Cal managed care health plan to continue to receive Medi-Cal benefits, including long-term care (nursing home care) and fees not covered under Medicare. Dual eligible beneficiaries who do not enroll in a Cal MediConnect health plan must enroll in a Medi-Cal Managed Long-Term Supports and Services (MLTSS) managed care plan, unless they meet certain exclusion provisions.
Seven counties in California are included in the three-year Cal MediConnect project, including Los Angeles County. Enrollment into Cal MediConnect health plans or Medi-Cal Managed Long-Term Supports and Services health plans began in July 2014. As all of the Keiro nursing facilities are located in Los Angeles County, dual eligible beneficiaries who are currently residing in Keiro Nursing Home, South Bay Keiro Nursing Home, and Keiro Intermediate Care Facility are affected by this new program.
Each of the Keiro nursing facilities have different contracting provisions with the health plans participating in Cal MediConnect and Medi-Cal Managed Long-Term Supports and Services. If you have any questions about how your plan choice affects admission or current stay in one of the Keiro facilities, please contact that facility directly. Additional information regarding the CCI is available at www.calduals.org.