D-SNP Historical Information

The Cal MediConnect Plan (Medicare-Medicaid plan) in California is transitioning on December 31, 2022.

Effective January 1, 2023, Cal MediConnect members will be transitioned to exclusively aligned enrollment in dual eligible Special Needs Plans (D-SNPs) and matching Medi-Cal managed care plans in the same organization that provides their Cal MediConnect Plan.

Wellcare by Health Net participates in Cal MediConnect in Los Angeles and San Diego counties.

Under the California Advancing and Innovating Medi-Cal (CalAIM) initiative, the California Department of Health Care Services is transitioning the Coordinated Care Initiative (CCI) to a statewide Managed Long-Term Services and Supports (and D-SNP structure). The Department of Health Care Services will work with health plans, stakeholders, and the Centers for Medicare & Medicaid Services to transition and expand integrated care statewide. This policy is intended to help meet the statewide goals of improved care integration and person-centered care, under both the CalAIM initiative and the California Master Plan for Aging.

Formally, this is part of California Assembly Bill (AB) 133.

The following Medi-Cal covered services accessed through Medi-Cal fee-for-service are not impacted by this change:

• In-Home Support Services or providers.
• County specialty mental health and substance use disorder services or providers.
• Multi-Purpose Senior Services Program services or providers.
• Medi-Cal Covered Rx Services or Providers "Medi-Cal Rx."
• Medi-Cal Dental Services or Providers "Denti-Cal" Plans.
• Home and Community-Based Waiver Services or providers.

Beneficiaries will continue to receive these services from the same providers they do today without interruption.

Members in Cal MediConnect today do NOT need to do anything to enroll into the matching plans.

The transition will be coordinated by the Centers for Medicare & Medicaid Services, Department of Health Care Services and the member's Cal MediConnect Plan. Members will have options to transition to Medicare Advantage D-SNP plans offered by the health plan.

Members will get all services through their current Cal MediConnect Plan until December 31, 2022. On January 1, 2023, they will automatically start getting services through the matching plans instead.

Members will start getting communications about this change in October 2022. Ask your patients to ensure their Cal MediConnect Plan has their current address and best phone number so they receive the information.

If members have questions about their current coverage in 2022, help them contact Member Services using the phone number on the back of their ID card.

No. The non-renewal notice going out in October will include the plan options available to Cal MediConnect members if they do not want to be transitioned into the exclusively aligned enrollment D-SNP.

See Exclusively Aligned Enrollment (EAE) D-SNP Plans for more information.

Just like Cal MediConnect, D-SNPs have Models of Care which require the use of HRAs, individualized care plans and interdisciplinary care teams for their members.

Note: D-SNPs have a different version of the HRA.

Providers should expect to remain engaged with the members they currently support and throughout the transition to a D-SNP.

Effective January 1, 2023, all Health Net Cal MediConnect members will be transitioned to an exclusively aligned enrollment D-SNP and matching Medi-Cal plan.

The standard non-renewal notice will be sent to members in October 2022. A reminder notice will be sent in November 2022. Plan materials for 2023 will be sent in December 2022, including a new ID card.

Reassure them they will not lose their health insurance. The Plan will communicate with them via mail in October 2022.

Ask your patients to ensure their Cal MediConnect Plan has their current address and best contact phone number so they receive the information.

The non-renewal notice going out in October 2022 will include the Plan's options available to the Cal MediConnect member. Dual eligible beneficiaries have options on how they receive their Medicare and Medi-Cal benefits.

The member may be enrolled in a D-SNP look-alike (LAL) plan through December 31, 2022.

If they are not in a D-SNP LAL plan, their Annual Notice of Change will advise of any changes applicable to their benefits/plan for 2023.

D-SNP look-alike (LAL) plans (sometimes called "mirror" plans) are Medicare Advantage plans that are designed specifically to attract dual eligible beneficiaries who have secondary coverage through Medi-Cal.

As part of the 2021 Medicare Advantage and Part D Final Rule (CMS-4190-F1), the Centers for Medicare and Medicaid Services (CMS) finalized new contracting limitations for D-SNP LAL plans at 42 CFR § 422.514(d) and (e): any non-D-SNP Medicare Advantage Part D plan with 80% or more full Medicaid members (full duals) will not be renewed for the 2023 plan year.

Generally, a member may not know if they are enrolled in a D-SNP LAL plan.

The Wellcare By Health Net plans offered in 2022 and identified by the Centers for Medicare & Medicaid Services as D-SNP LAL plans are the following:

• Wellcare Plus Sapphire I (HMO) H0562-122
• Wellcare Plus Sapphire II (HMO) H3561-002

Transitions into the exclusively aligned enrollment D-SNP will trigger the Department of Health Care Services to reassign the member's Medi-Cal managed care plan to the same parent organization.

For Wellcare By Health Net, this will occur in Los Angeles, Riverside, San Bernardino and San Diego counties. This means that the members Medi-Cal plan will become Health Net's Medi-Cal plan.

Example:

1. Mr. Smith live in Los Angeles County and has a D-SNP LAL with Plan A, and for his Medi-Cal managed care plan he has Plan C.
2. Mr. Smith is transitioned to Plan A’s exclusively aligned enrollment D-SNP, effective January 1, 2023.
3. Mr. Smith's Medi-Cal managed care plan will change automatically to Plan A's Medi-Cal managed care plan, effective January 1, 2023, to align for better care coordination.

Updated 9/9/2022

Members will be notified of 2023 plan changes by mail via the Annual Notification of Change (ANOC) in September and/or the standard non-renewal notice sent in October 2022.

The ANOC will outline specific changes in benefits between the current year (2022) and the next plan year (2023). The standard non-renewal notice provides option for enrollment into other plans for the member.

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

Reassure them their Medicare D-SNP LAL will communicate with them via mail in October 2022.

Advise them to make sure their Medicare plan has their current address and best phone number so they receive the information.

Yes. As a new D-SNP member, they are subject to the D-SNP Model of Care requirements and will be required to have an updated D-SNP HRA and individualized care plan.

The D-SNP HRAs for the transitioning D-SNP LAL members will be completed by Wellcare By Health Net.