Nonparticipating Providers Overview
The Department of Health Care Services (DHCS), in conjunction with the Centers for Medicare and Medicaid Services (CMS), is launching a three-year demonstration to enroll beneficiaries who are covered by both Medicare and Medi-Cal (dual eligibles) into managed care health plans. Enrollment in the Duals Demonstration, now known as Cal MediConnect, begins no sooner than April 1, 2014. Health Net is participating in Cal MediConnect in Los Angeles and San Diego counties.
Health Net's Dual Eligible program goal is to improve the quality of care its Medicare Advantage (MA) and Medi-Cal managed care members receive by providing access to seamless, integrated care. The key component of Health Net's Dual Eligible program is to promote better care and improve alignment and coordination of MA and Medi-Cal benefits.
The information on this page is designed to help nonparticipating providers and their staff become more familiar with the Dual Eligible Demonstration and Health Net's Dual Eligible program.
Participating Provider Groups, IPAs, and Hospitals who would like information regarding participating in Health Net's Cal Medi Connect network can contact Health Net's Provider Network Management Department by telephone at (818) 543-9178. Individual physicians interested in participating in the Cal Medi Connect should contact their affiliated Participating Provider Group or IPA to see if they are participating.
Network Participation Request
Ancillary providers who would like to request participation in Health Net’s Cal Medi Connect network may click on this link for further information.
Coordinated Care Initiative
The State of California's Coordinated Care Initiative (CCI) places focus and delivery of health care for seniors and people with disabilities. Coordinated care offers members an easier way to get what they need, when they need it.
Two major components of the Coordinated Care Initiative include:
- Cal MediConnect: A voluntary, program designed to coordinate medical, mental health and behavioral health, and long-term services and supports (LTSS) under one plan for members eligible for both Medicare and Medi-Cal.
- Managed Long-Term Services and Supports (MLTSS): Most Medi-Cal members, including those also eligible for Medicare are required to join a Medi-Cal health plan. LTSS benefits and wrap around services are then received through the members' health plan.