California's Coordinated Care Initiative
The Coordinated Care Initiative (CCI) is a new state program that changes the delivery of health care services to individuals receiving both Medicare & Medi-Cal (Dual Eligibles) living in eight California counties: Alameda, Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo, and Santa Clara.
To really understand what the CCI is and who is affected, you have to travel back in time to 2010 and the passage of the Affordable Care Act (ACA). The ACA created a Medicare-Medicaid Coordination Office (MMCO) charged with improving coordination of health benefits for individuals with both Medicare and Medicaid (dual eligibles). Dual eligibles are among the highest need and highest-cost demographic in our health care system.
California enacted legislation to move forward with a demonstration project integrating Medicare and Medi-Cal benefits into managed care plans for dual eligibles living in eight California counties.
The CCI is an umbrella program that encompasses three major changes:
Mandatory enrollment in Medi-Cal managed care. With few exceptions, all Medi-Cal beneficiaries in the eight counties will be mandatorily enrolled in a managed care plan for their Medi-Cal benefits.
Integration of Long-term services and supports (LTSS). LTSS will be integrated into the Medi-Cal managed care benefit package. Accordingly, health plans will be responsible for providing In-Home Supportive Services, Community Based Adult Services, Multi-Purpose Senior Services Program benefits, and nursing facility benefits.
Cal MediConnect. Most dual eligibles will be automatically enrolled into a Cal MediConnect plan that combines their Medicare and Medi-Cal benefits. Beneficiaries will have one card and will access all of their Medicare, Medi-Cal, including LTSS, through the health plan.
Approximately 418,000 dual eligible beneficiaries will be automatically enrolled into Cal MediConnect if they do not affirmatively choose not to participate in the program. Those who decide not to participate in Cal MediConnect will still have to enroll in a managed care plan for their Medi-Cal benefits.
If you need to select a new plan, you will receive three different notices, sent 90, 60 and 30 days ahead of your enrollment date.
You do not need to do anything until you receive your notices.
To repeat, if you are eligible for Cal MediConnect, here are your options:
Enroll in Cal MediConnect. Combine your Medicare and Medi-Cal benefits under one plan.
Keep your Medicare the way it is now – choose a Medi-Cal plan only.
Enroll in PACE. Only certain Medi-Medi beneficiaries are eligible for PACE; you must be 55 or older, live in your home or community setting, need a high level of care, and in a ZIP code served by a PACE health plan with openings.