About the Cal MediConnect Plan
The Cal MediConnect Program is an important innovation in the nation's health care system to help out the nation's most low income individuals, those who qualify for both Medicare and Medi-Cal (dual eligible members). This voluntary program consolidates the overlapping properties of the present system. The California Department of Health Care Services (DHCS), in conjunction with the federal Centers for Medicare & Medicaid Services (CMS) are directly contracting with L.A. Care Health Plan, Health Net, CareMore, Blue Shield of California Promise Health Plan and Molina Healthcare for the Cal MediConnect program in Los Angeles County to make the process of insuring every citizen seamless and easy to understand. Cal MediConnect began voluntary enrollment in April 2014 in Los Angeles County.
How does the Cal MediConnect program provide better health care?
The goal of Cal MediConnect is to improve health care and help members stay longer in the comfort and security of their own homes and communities. The process has several checks and balances over a three month period to ensure recipients understand their options. Both members and health care providers will experience a streamlined process: one benefit package, one responsible and accountable health plan, and one payer. Cal MediConnect will coordinate all Medicare and Medi-Cal benefits under one health plan:
- Medical Care
- Prescription Medications
- Mental Health and Behavioral Health Care
- Long Term Services and Supports (LTSS)
- Connection to Social Services (like meal delivery)
Continuity of Care
If you now see providers who are not in the L.A. Care network, in certain cases you may be able to keep seeing them for up to 12 months. If your providers do not join the L.A. Care network by the end of 12 months, you will need to switch to providers in the L.A. Care network. You can continue to see your providers when:
- L.A. Care determines you have an existing relationship with your out-of-network provider. An existing relationship means you saw the out-of-network PCP or specialist at least once during the 12 months prior to the date of your initial enrollment with L.A. Care for a non-emergency visit.
- Your out-of-network provider is willing to accept the higher of L.A. Care’s contract rates or Medi-Cal FFS rates.
- Your out-of-network provider meets L.A. Care’s applicable professional standards and has no disqualifying quality-of-care issues.
- Your out-of-network provider is a California State Plan approved provider; and
- The provider supplies L.A. Care with relevant treatment information.
Members, their authorized representatives, or providers may make a direct continuity of care request to L.A. Care in writing or by telephone.
At any time, a member may change providers to a provider who is a member of an L.A. Care network.