Dual eligible beneficiaries in 31 counties will transition to Medi-Cal managed care on Jan. 1

December 13, 2022

As part of CalAIM, California’s broad Medi-Cal managed care delivery system and payment reforms, the California Department of Health Care Services (DHCS) will transition 325,000 dual eligible beneficiaries in 31 counties to Medi-Cal managed care effective January 1, 2023.

This transition will not impact patients’ Medicare coverage, nor will it change dual-eligible beneficiaries’ benefits or providers. DHCS sent notices about this change to affected beneficiaries on November 1 and December 1.

Per the DHCS Medi-Cal Managed Care Provider Fact Sheet, Medi-Cal plans are responsible for reimbursement of applicable Medicare deductibles for dual-eligible individuals up to the Medi-Cal fee-for-service rate, even if the physician is out-of-network with the Medi-Cal managed care plan. The annual Medicare deductible for 2023 is $226.

According to DHCS, this transition to Medi-Cal managed care will increase the level of care coordination and support offered to dual eligibles, while maintaining beneficiary choice for Medicare providers and plans. The transition will only impact dual eligible beneficiaries – individuals with both Medicare and Medi-Cal – not already enrolled in Medi-Cal managed care.

Currently over 70% (more than 1.1 million) of dual eligible beneficiaries are already enrolled in Medi-Cal managed care plans.

CMA will be hosting a webinar on January 12, 2023, where DHCS staff will provide an overview of and answer questions about the duals transition. You can see additional details and register here.

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