California

California Capitated Financial Alignment Model Demonstration (Cal MediConnect)

SPOTLIGHT & RELEASES

10/29/2019 - California Department of Health Care Services (DHCS) released its Advancing and Innovating Medi-Cal (CalAIM) proposal. CalAIM offers CMS, the state, and stakeholders the opportunity to build on what works well in Cal MediConnect and apply it statewide using Medicare Advantage Dual Eligible Special Needs Plans (D-SNPs). DHCS plans to transition Cal MediConnect into the new statewide infrastructure by 2023.

CMS welcomes feedback on the proposed D-SNP structure at MMCOcomments@cms.hhs.gov. We look forward to working with the state, plans, and stakeholders to maximize integration of Medicare and Medi-Cal in this statewide infrastructure, expanding access to integrated care for 1.2 million dually eligible Californians.

10/2/2019 - Three-way Contract (PDF) & Summary of Contract Changes (PDF)
08/14/2019 - California Medicare-Medicaid Plan Quality Withhold Analysis Results for Demonstration Year 3 (PDF)

Key Dates

March 27, 2013 - CMS and California sign MOU

December 18, 2013 - CMS, California, and participating plans execute three-way contract

April 1, 2014 - Start of passive enrollment in San Mateo County and opt-in enrollment in Los Angeles, Riverside, San Bernardino and San Diego Counties 

May 1, 2014 - Start of passive enrollment in Riverside, San Bernardino and San Diego Counties

July 1, 2014 - Start of passive enrollment in Los Angeles County

January 1, 2015 - Start of passive enrollment in Santa Clara County

July 1, 2015 - Start of enrollment in Orange County 

January 1, 2018 - CMS, California, and participating plans execute three-way contract

September 1, 2019 - CMS, California, and participating plans execute three-way contract

Cal MediConnect Model

On March 27, 2013, the Department of Health and Human Services announced that the State of California will partner with the Centers for Medicare & Medicaid Services (CMS) to test a new model for providing Medicare-Medicaid enrollees with a more coordinated, person-centered care experience, along with access to new services.

Under the demonstration, also called "Cal MediConnect," California and CMS will contract with Medicare-Medicaid plans to coordinate the delivery of and be accountable for covered Medicare and Medicaid services for participating Medicare-Medicaid enrollees. 

More Information from CMS:

Information for Plans:

Information for Beneficiaries and Providers:

Information from the state of California:

Funding Support:

Page Last Modified:
10/30/2019 06:17 AM