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Medi-Cal coverage for people enrolled in both Medi-Cal and Medicare is changing for many Californians next year.
On Jan. 1, 2023, Medi-Cal health coverage for those also enrolled in Medicare will change from fee-for-service Medi-Cal to Medi-Cal managed care in certain counties. It’s estimated this upcoming change will impact 325,000 duallyeligible patients not already enrolled in a Medi-Cal plan.
Currently, over 1.1 million patients with Medicare and Medi-Cal are enrolled in a Medi-Cal managed care plan for their Medi-Cal benefits based on county enrollment. The policy of enrolling dually eligible people into a Medi-Cal managed care plan for their Medi-Cal benefits will be implemented statewide in the remaining counties.
Those counties are Alameda, Alpine, Amador, Butte, Calaveras, Colusa, Contra Costa, El Dorado, Fresno, Glenn, Imperial, Inyo, Kern, Kings, Madera, Mariposa, Mono, Nevada, Placer, Plumas, Sacramento, San Benito, San Francisco, San Joaquin, Sierra, Stanislaus, Sutter, Tehama, Tuolumne, Tulare, and Yuba.
The Department of Health Care Services (DHCS) recently sent 60-day notices to impacted members and will send another notice in late November.
Medicare providers of people transitioning into Medi-Cal managed care for their Medi-Cal benefits should note — they do not have to join a Medi-Cal plan to keep billing Medicare services. Also, dually eligible patients can choose any Medi-Cal plan in their county, even if their Medicare provider is not in the Medi-Cal plan.
This transition doesn’t change a member’s Medicare benefits. It also doesn’t require a member to join a Medicare Advantage or dual special needs plan product. Medicare provider payment amounts will not change as a result of this transition.
However, generally speaking, Medi-Cal managed care plans are responsible for all applicable Medicare deductibles and coinsurance for duallyeligible individuals, whether the provider is in or out of network, and should be billed appropriately.
For more information, visit the DHCS website. Provider questions can be submitted to OMII@dhcs.ca.gov.
Medi-Cal coverage and health plan enrollment questions can be directed to DHCS Health Care Options at (800)430-4264, or the Health Care Options website.
