Who Qualifies?


 The following information explains who qualifies for IEHP DualChoice Cal MediConnect Plan (Medicare - Medicaid Plan): 

People with BOTH Medicare (Part A and B) and Medi-Cal

Included Population

With mandatory enrollment for Medi-Cal benefits, including Long-Term Services and Supports (LTSS) benefits and Passive enrollment for Medicare benefits.

  • With ESRD - subsequent diagnosis
  • With a Share of Cost - in skilled nursing facility, MSSP, or IHSS and continuously certified to meet share of cost 
  • With American Indian Medi-Cal
  • With HIV/AIDS

Excluded Population

  • With partial Medicare benefits
  • With other health coverage, including private insurance and non-Medicare public insurance, such as through the Veterans Administration
  • Under age 21
  • Who have End Stage Renal Disease (ESRD) (Medi-Medis who develop ESRD after enrollment in the Demonstration or are currently enrolled may remain enrolled)
  • Who receive services through a California regional center or a state developmental center
  • Home-and Community-Based Service 1915 (c) Waiver Enrollees: Nursing Facility/Acute Hospital Waiver Service, HIV/AIDS Waiver Services, Assisted Living Waiver Services, and In-Home Operations Waiver Services
  • Residing in a rural zip code excluded from managed care. Visit Service Area for additional information.
  • Intermediate Care Facility (ICF)-Developmentally Disabled resident
  • Share-of-Cost Medi-Cal members residing in the community and not continuously certified

      Exempt from passive enrollment

  • PACE enrollees
  • Medicare Advantage and Special Needs Plan beneficiaries
  • AIDS Healthcare Foundation

 IEHP DualChoice Cal MediConnect Plan (Medicare-Medicaid Plan) is a Health Plan that contracts with both Medicare and Medi-Cal to provide benefits of both programs to enrollees.

Information on this page is current as of September 30, 2016

H5355_CMC_17_07258 Approved