Cal MediConnect (CMC) is a capitated duals demonstration program for California adults eligible for both Medicare and Medicaid. Enrollment began in 2014. CMC operates in seven counties and is part of a larger initiative called the Coordinated Care Initiative (CCI). Although LTSS is managed by health plans, the pre-demo structure of the LTSS system is largely maintained through managed care organization contracts with counties to provide In-Home Supportive Services. Populations excluded from the demonstration include those receiving institutional or Waiver services for intellectual or developmental disabilities, as well as participants in certain other Waiver programs.
Aside from CMC, the other component of CCI is a mandatory Medicaid managed care program for people opting out of CMC. In other words, dual beneficiaries in the seven counties can choose to continue receiving Medicare benefits in a fee-for-service arrangement, but their Medicaid benefits, including LTSS, will nonetheless be provided under a managed care model. This component of CCI operates as part of California's 1115 Waiver.
The Medicaid portion of the Cal MediConnect capitation rate is a single, blended rate that varies by county and depends on the mix of members in the following four categories: Institutionalized for more than 90 days, HCBS High, HCBS Low, and Communty Well/Healthy.
CLPC & U.C. Berkeley evaluation
of Cal MediConnect
CMC contract with managed care organizations:
CMC supplemental quality reporting requirements:
CMC memorandum of Understanding with CMS:
CMC demonstration proposal to CMS:
CMS approval and special terms & conditions for California's 1115 Waiver:
1115 Waiver extension request 2015:
California Medicaid Managed Care Quality Strategy:
Cal MediConnect Capitation Rates: