Provider FAQ (Frequent Asked Questions)

Provider FAQ

What is Cal MediConnect?

Cal MediConnect (formerly known as the Duals Demonstration Program) is a three-year pilot program developed by the Centers for Medicare and Medicaid Services (CMS) and the California Department of Health Care Services (DHCS) to integrate medical care, long-term care, mental health and substance abuse programs and social services under a single coordinated care plan for people who are dually eligible for Medicare and Medi-Cal.

What is the goal of Cal MediConnect?

The goal of Cal MediConnect is to help keep seniors and people with disabilities healthy and/or living longer at home by delivering coordinated and patient-centered care, including Long-Term Services & Supports (LTSS), through a streamlined system.

Under this model, both beneficiaries and physicians will experience a simplified process with one benefit package, one responsible and accountable health plan and one payer. Beneficiaries will be able to access all the services they need under one health plan.

Who are the Dual Eligibles?

A "dual eligible" beneficiary is someone who is eligible for both Federal Medicare benefits and State Medicaid benefits (note: in California, Medicaid is also known as Medi-Cal).

In California, there are about 1.1 million dual eligibles, with most of them being aged 65 and older.

In general, dual eligibles tend to be elderly or disabled individuals with low incomes and one or more chronic condition.

What benefits and services are covered under Cal MediConnect?

Benefits and services include, but are not limited to:

  • All Medicare services
  • All Medi-Cal services
  • Long-Term Services & Support (LTSS), including In-Home Supportive Services (IHSS), Community-Based Adult Services (CBAS), long-term custodial care in nursing facilities and Multipurpose Senior Services Program (MSSP) services
  • Mental health and substance abuse programs
  • Assistance accessing social services

Why should my patients join this new program?

With one health plan responsible for coordinating their medical care, long-term care, mental health and substance abuse care and social service needs, your patients will experience high-quality care and enhanced benefits as well as a simpler healthcare experience.

Coordinated care also removes the uncertainty you and your patients may currently experience in trying to determine whether Medicare or Medi-Cal should be contacted for care.

Why should physicians participate in the Cal MediConnect program?

Care1st's network providers can expect to experience consistent financial stability and administrative simplification by receiving regular payments from a single payer with one billing address and one telephone number for questions and assistance.

Can I continue to see my patients if they enroll in the program?

If you do not contract with a Care1st participating medical group or IPA, you can continue to see your dual eligible patients for approximately six to 12 months through the health plans' continuity of care guidelines, upon request by your patients.