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C-SNP Frequently Asked Questions

What is a Chronic Care Special Needs Plan (C-SNP)? How does a beneficiary qualify for a C-SNP plan?

The beneficiary must have at least one of the three chronic conditions as validated by a physician.

Chronic Care Special Needs Plan (C-SNP) is a type of Medicare Advantage Prescription Drug Plan (MAPD) designed to provide specialized care and tailored benefits for individuals with severe or disabling chronic conditions/diagnosis.

In which counties does Wellcare By Health Net have the C-SNP plans in 2026?

Wellcare By Health Net has C-SNP plan in Kern, Los Angeles, Orange, Riverside, San Bernardino, San Francisco, and San Diego.

Why should an eligible beneficiary with chronic conditions join a C-SNP?

A C-SNP is designed specifically for people living with certain chronic health conditions—such as diabetes, chronic heart failure, or cardiovascular disease. Unlike regular Medicare Advantage or Dual Eligible Special Needs Plans (D-SNPs), C-SNPs offer personalized care management and specialized provider networks tailored to the beneficiary’s condition. This means the care team understands the beneficiary’s health needs more deeply and can coordinate treatments, medications, and follow-up care more effectively.

If a CSNP member happens to be a dual eligible, the care team will also support coordination with the Medi-Cal covered benefits.

What is the new county for Wellcare By Health Net C-SNP for 2026?

  • Wellcare Specialty Simple Focus (HMO C-SNP) – H0562- 138 – San Francisco County

What role do C-SNP providers play in enrolling beneficiaries into the C-SNPs?

Providers/PCPs play a key role in enrolling eligible beneficiaries to C-SNPs. As a part of the enrollment process, the health plan will make an outreach to providers and PCPs to get attestation of the beneficiary’s chronic condition.

During the outreach, you can take one of 2 actions:

  • You provide a verbal attestation of the beneficiary’s conditions so that the C-SNP enrollment application can move forward, or
  • You can request a form to be faxed to you to complete and return within 3 business days as a form of attestation

For new C-SNP eligible patients, the health plan’s eligibility representative will outreach to the member and advise to set up an appointment with the PCP/provider so that the patient’s chronic condition could be verified.

What happens if the beneficiary does not meet the requirement to qualify for the C-SNP after I submit the attestation?

If the attestation is received from the provider/PCP and the applicant does not qualify to enroll in the C-SNP, the health plan will outreach to the applicant to advise that:

  • The disenrollment procedure will begin, or
  • They would need to get an attestation through alternate provider/PCP

Can a C-SNP member be dual eligible?

Yes.

Is it required for a member to be dual eligible to join C-SNP plan?

No, they do not have to be. They just need to meet the requirement to join a C-SNP plan.

What provider network does a C-SNP member use for Primary Care, Specialists and facilities through a Medical Group/PPG?

C-SNP network.

Can a new member continue to see a non-network provider when they join the C-SNP plan?

Yes. Members new to a C-SNP plan are eligible for continuity of care for 12 months from enrollment if certain circumstances are met. Please see the Provider Operations Manual.

Who do I contact if I want more information about joining the C-SNP provider network?

Non-participating providers can get more information about joining our plan here.

What if a member is seeing a primary care or a specialist provider who is not in our C-SNP network?

Advise the member to utilize the Find a Provider tool to look up participating providers within the C-SNP network, which can save the member of the out of network provider cost. You can also advise the member to contact the health plan by using the Member Services phone number on the back of their ID card for a provider search or PCP assignment.

Where should the providers route the Wellcare By Health Net C-SNP members when they have questions about Medicare and Medi-Cal benefits?

Inform the member to contact the health plan by using the Member Services phone number on the back of their ID card for any Medicare and Medi-Cal benefits related questions.

If any provider denies a service to a member, where should I direct the member?

Remind the member that any referral for services which require an approval will generate a written response to them. If denied, the member will be provided with their appeal rights.

Member can contact Member Services phone number on the back of their ID card for support.

Where should I direct a member who requests a transportation for medical appointments (or other allowable locations, i.e., pharmacy pick up)?

Members should contact the transportation vendor directly using the phone number listed on their ID card. Or they can also call Member Services for assistance.

How do I help a C-SNP member who is unable to ambulate on own and requires a higher level of transportation such as a wheelchair van?

Members should contact the transportation vendor directly using the phone number listed on their ID card. Or they can also call Member Services for assistance.

Who does office/member call if the drug is NOT on the formulary and needs to be treated as an exception in order to get covered?

Submit the prescription request to the pharmacy. It should go through the normal prior authorization process for exception.

Where should I direct a member who needs to apply and qualify for In Home Support Services?

You can help the member receive the benefit by getting a referral from case management in one of three ways:

Where should I direct a member who needs access to Community Based Adult Services (CBAS - adult day care)?

You can help the member receive the benefit by getting a referral from case management in one of three ways:

What is the preferred diabetic testing supplies brands for 2026?

The preferred diabetic testing supplies brands for 2026 are Accu-Check and True Metrix. You can also get continuous blood glucose monitors like Dexcom and Freestyle Libre with Prior Authorization.

How does a member get access to post acute or chronic meals?

You can help the member receive the benefit by getting a referral from case management in one of three ways:

What is Care Coordination?

Care coordination is the organization of a member’s care across multiple health care providers to ensure the member receives safe, effective and appropriate care.

How is Care Coordination delivered?

A care coordinator collaborates with the member, the Health Plan, and the member's healthcare providers to ensure the member receives the necessary care. They work with the member to create a care plan and identify the team members responsible for delivering, coordinating, and overseeing the member's healthcare.

As a provider, what is my role in helping a member get access to Care Management or Care Coordination?

You can help the member receive Care Coordination or clinical case management in one of three ways:

How do providers refer members to access Care Management and Disease Management Programs or receive more information about these programs?

You can help the member receive Care Coordination or clinical case management in one of three ways:

Can a member self-refer for a care coordination?

Yes, Members may self-refer by calling the Care Management toll-free line at 833-340-0083.

What benefits do C-SNP members who are dual eligible have access to under Medi-Cal Benefit?

The Medi-Cal benefit includes: Long Term Care (LTC), Community Based Adult Services (CBAS), Community Supports, Durable Medical Equipment (DME), and Medi-Cal covered transportation.

The Community Resource/Supports may include, but is not limited to, the following services:

  1. Housing Transition Navigation Services (homeless, or about to become)
  2. Housing Deposits
  3. Housing Tenancy and Sustaining Services
  4. Short-Term Post Hospitalization Housing
  5. Recuperative Care (medical respite)
  6. Respite Services
  7. Day Rehabilitation
  8. Nursing Facility Transition/Diversion to Assisted Living Facilities
  9. Community Transition Services/Nursing Facility Transitions to a Home
  10. Personal Care and Homemaker Services
  11. Environmental Accessibility Adaptations (home modifications)
  12. Meals/Medically Tailored Meals
  13. Sobering Centers
  14. Asthma Remediation

How does the member access Medi-Cal covered benefits?

You can help the member in any of these ways below:

  • Providers can submit a request for a care coordination through the Provider Portal.
  • Providers can use the findhelp platform to submit referrals to request Community Support benefits.
  • Providers can contact our Care Management team by calling the phone number 833-340-0083 or sending an email to help_referral@healthnet.com.
  • Providers can advise the member to contact the Member Services number on the back of the card.

When and how will members/beneficiaries be made aware of plan or benefit changes for the coming new plan year?

Members will be notified of the new plan year changes by mail via the Annual Notification of Changes (ANOC) in September and/or the standard non-renewal notice sent in October.

The Annual Notification of Change will outline specific changes in benefits between the current year and the next plan year.

Advise your patients to ensure their Medicare plan has their current address and phone number so they receive the information.

As a contracted provider, how will Wellcare By Health Net let me know about general updates throughout the year?

Providers will receive communications throughout the year as needed, such as service areas expansion, plan name changes, new vendors for member supplemental benefits and more. Providers are also encouraged to access the C-SNP Resources for Providers page online for the most current resources and updates, as the page is updated regularly.

Last Updated: 12/19/2025