The California Department of Health Care Services (DHCS) and the Centers for Medicare & Medicaid Services (CMS) selected Anthem Blue Cross (Anthem) to participate in a pilot program to integrate care for dual-eligible individuals (those eligible for both Medi-Cal and Medicare) by designing new approaches to better coordinate care for these beneficiaries. California’s dual-eligible demonstration is called the Cal MediConnect program.
The Cal MediConnect program aims to improve care coordination and access to quality care for dual-eligible beneficiaries, helping them stay healthy and at home as long as possible. Anthem partners with providers to help deliver high quality medical, social and behavioral health care, comprehensive case management and streamlined care coordination for our most vulnerable members.
Here’s what providers need to know about the Anthem Blue Cross Cal MediConnect program:
| Anthem has a contract with both CMS and DHCS to integrate Medicare and Medi-Cal managed care (Medi-Cal) benefits into one managed care plan called Cal MediConnect |
| Medicare-Medicaid patients (those with no share of cost for Medi-Cal or Medicare Parts A and B) may be eligible for Cal MediConnect. They will receive a letter from the state offering Cal MediConnect as an option. Prospective participants can actively enroll or allow passive enrollment into the program, or they can choose to opt-out of Cal MediConnect and keep their current plan(s). |
If your patients residing in Santa Clara or Alameda County choose to opt-out of Cal MediConnect, they will still need to enroll in a Medi-Cal managed care plan. All Medi-Cal services will be managed by either Anthem or another local plan in these counties. Dual-eligible members who have no share of cost will no longer be able to have traditional fee-for-service Medi-Cal in Santa Clara or Alameda County.
| Providers will have a dedicated local Anthem Blue Cross Cal MediConnect team to answer any questions about Cal MediConnect |
For more information, visit http://www.calduals.org
Contact Plans in Your Area
Cal MediConnect Pharmacy
Cal MediConnect Provider Manual
Cal MediConnect Forms
Cal MediConnect Quality Management