In alignment: CalAIM’s plan to coordinate care for dual enrollees in Medicare and Medi-Cal
- Collection:
- Health Policy and Services Research
- Series Title(s):
- Issue brief (California HealthCare Foundation)
- Author(s):
- Graham, Carrie, author Moffett, Torshira, author Glassberg, Hope, author Chapman, Athena, author
- Contributor(s):
- Center for Health Care Strategies, Inc. issuing body. Chapman Consulting, issuing body. Decipher Health Strategies, issuing body. California HealthCare Foundation, issuing body.
- Publication:
- [Oakland, California] : California Health Care Foundation, November 2022
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Dual MEDICAID MEDICARE Eligibility Managed Care Programs -- organization & administration California
- Genre(s):
- Technical Report
- Abstract:
- People who are eligible for both Medicare and Medicaid (“dually eligible”) often have complex care needs and account for a disproportionate share of spending in both programs compared to non-dually eligible people. Dually eligible Californians are disproportionately people of color compared with the state’s overall Medicare population and the state’s population as a whole; nationally, dually eligible people from communities of color have poorer experiences of care and worse health outcomes than those who are White. Dually eligible people typically receive their Medicare and Medicaid benefits from different delivery systems, which can result in uncoordinated, fragmented care that can be very difficult for a consumer to navigate. Currently, only about 8% of California’s 1.6 million dually eligible people receive their Medicare and Medicaid benefits through a system that integrates those benefits. California’s Department of Health Care Services (DHCS) is implementing an ambitious, multi-phased initiative to improve the care delivered by Medi-Cal called CalAIM (California Advancing and Innovating Medi-Cal). This initiative seeks to streamline care and improve outcomes for dually eligible Californians (among other populations), while also increasing administrative alignment for plans and the state. To accomplish this goal, over the next several years, dually eligible Californians will have the option to enroll in Medicare Medi-Cal Plans (MMPs). MMPs are Medicare Advantage Dual Eligible Special Needs Plans (D-SNPs) that are “aligned” with a Medi-Cal managed care plan (MCP) from the same parent organization. By 2026, all dually eligible people will have the option to enroll in these aligned plans through a process that the Centers for Medicare & Medicaid Services (CMS) calls “exclusively aligned enrollment” (EAE). The intent of aligned MMPs is for one plan to be responsible for coordinating across all Medicare and Medi-Cal benefits and to make it easier for dually eligible Californians to navigate both systems through comprehensive care management, streamlined member notification materials, a single insurance card for both plans, single provider directories and prescription formularies, and a unified grievances and appeals process.
- Copyright:
- Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY-NC-ND license. (More information)
- Extent:
- 1 online resource (1 PDF file (11 pages)).
- NLM Unique ID:
- 9918557482306676 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/9918557482306676