ENROLLMENT IN MEDI-CAL MANAGED CARE PLANS

Patients with Medicare and Medi-Cal:

Enrollment in Medi-Cal Managed Care Plans

For your patients that have both Medicare and Medi-Cal (Medi-Medi), they will soon need to enroll in a Medi-Cal managed care plan. This change does NOT restrict their choice of Medicare providers, or their choice of Original Medicare vs. Medicare Advantage. Medi-Medi patients can continue seeing their Medicare providers, regardless of which Medi-Cal plan they enroll in. Medicare providers do NOT need to enroll in Medi-Cal plans to see Medi-Medi patients.

The California Department of Health Care Services (DHCS) is making this change to make Medi-Cal coverage more consistent throughout the state – over 1.1 million patients with Medicare and Medi-Cal (over 70 percent) are already enrolled in a Medi-Cal managed care plan.

DHCS recently sent notices to Medi-Medi patients that need to choose a Medi-Cal plan. In San Joaquin County, Medi-Medi patients can choose either Health Net or Health Plan of San Joaquin for their Medi-Cal plan.

How should providers educate their front office and billing staff about this transition? • Medicare providers do NOT have to join a Medi-Cal plan to continue billing Medicare. • Medi-Medi patients can choose any Medi-Cal plan, even if their Medicare provider is not in the Medi-Cal plan. • Provider payment amounts will NOT change when a Medi-

Medi patient joins a Medi-Cal plan.

What should provider front office and billing staff tell MediMedi patients about this transition? • Joining a Medi-Cal plan does NOT limit access to

Medicare providers or change Medicare benefits. • Joining a Medi-Cal plan does NOT impact patient choice of Original Medicare or Medicare Advantage.

How will Medicare provider billing change when a MediMedi patient joins a Medi-Cal Plan? • Providers continue billing Medicare as usual. • In general, Medi-Cal Managed Care plans are responsible for all applicable Medicare deductibles and coinsurance for dual-eligible individuals, whether the provider is in or out of network, and should be billed appropriately.

Where is this enrollment change happening? • For people with both Medicare and Medi-Cal, Medi-Cal coverage will change to Medi-Cal managed care in the counties listed below. In all other counties, Medi-Cal is already provided through Medi-Cal managed care plans: • 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 counties.

How do Medi-Medi patients choose a Medi-Cal plan? • Medi-Cal plan choices depend on the county, and whether the patient is already in a Medicare Advantage plan. Patients can learn more by visiting the Health Care Options (HCO) website or calling 1-800-430-4263.

How do I find out more about this change? • For more information, please visit this webpage at the

California Department of Health Care Services: Statewide

Medi-Cal Managed Care Enrollment for Dual Eligible

Beneficiaries • Patient questions should be directed to DHCS Health Care

Options at 1-800-430-4264, or the Health Care Options website. • For additional questions from Medicare providers related to this transition, please email OMII@dhcs.ca.gov.

Julio Narvaez M.D. Andrew Chen M.D. Alan Nakanishi M.D. Pamela Tsuchiya M.D. On-Tat Lee M.D. Hana Rha O.D. AamunAamun GaGarcrchaha O.O.D.D.