Duals Demonstration Program (Cal MediConnect Program)

What is the Duals Demonstration Program (Cal MediConnect Program)?
The Duals Demonstration Program is a three-year program for people with both Medicare and Medi-Cal. IEHP may be participating in the Duals Demonstration Program, a major component of California’s new Coordinated Care Initiative (CCI).  IEHP DualChoice (Medicare – Medicaid Plan) may be the name of IEHP’s Duals Demonstration Program.

What are the goals of this program?
The goal is to improve care by integrating the following healthcare services:

  • Medicare and Medi-Cal benefits
  • Long-term care
  • Behavioral health
  • Home and community-based services (HCBS) such as In-Home Supportive Services (IHSS), Community-Based Adult Services (CBAS) and Multipurpose Senior Services Program (MSSP).

When will this program start?
The Demonstration will begin no earlier than April 2014. People with both Medicare and Medi-Cal will be enrolled during their birth month.

Who will be eligible?

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

People with BOTH Medicare and Medi-Cal

Included Population

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

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-Medi’s 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.
  • Intermediate Care Facility (ICF)-Developmentally Disabled resident.
  • Share-of-Cost Medi-Cal members residing in the community and not continuously certified.
  • PACE enrollees.
  • Kaiser’s Special Needs Plan beneficiaries.

What will be the impact to the Inland Empire?
IEHP DualChoice (Medicare – Medicaid Plan) will be available in both Riverside and San Bernardino counties where 80,000 people with Medicare and Medi-Cal are eligible for the program. IEHP estimates that about 46,000 people will join IEHP for the Medi-Cal benefits and over 17,500 will join us for their Medicare benefits as well.

Plans and Benefits
IEHP DualChoice (Medicare – Medicaid Plan) will integrate healthcare services to better coordinate care and improve health. The cost for services will be $0. 

How will we keep partners and community organizations engaged?
IEHP collaborates with Molina Healthcare and formed the Inland Empire Coordinated Care Initiative Advisory Committee as the main advisory committee to engage local stakeholders in the development and implementation of the CCI.