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
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
- 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