In Alignment: CalAIM’s Plan to Coordinate Care for Dual Enrollees in Medicare and Medi-Cal
About the Series
This report is part of the series CalAIM for Seniors and People with Disabilities, which focuses on elevating experiences from California and other states to ensure CalAIM reforms impacting Medi-Cal’s seniors and people with disabilities build on past efforts to integrate and improve care.
Currently, only about 8% of California’s 1.6 million dually eligible enrollees (people enrolled in both Medi-Cal and Medicare) receive their benefits through a system that integrates those services. Instead, they typically receive these two sets of benefits from different delivery systems, which can result in uncoordinated, fragmented care that can be difficult to navigate.
California’s Department of Health Care Services is implementing an ambitious initiative to improve the care delivered by Medi-Cal called CalAIM (California Advancing and Innovating Medi-Cal). This initiative seeks to streamline care and improve outcomes for dually eligible Californians (among other populations), while also increasing administrative alignment for plans and the state.
To accomplish this goal, over the next several years, dually eligible Californians will have the option to enroll in Medicare Medi-Cal Plans (MMPs). MMPs are Dual Eligible Special Needs Plans — a type of Medicare Advantage plan — that are aligned with a Medi-Cal managed care plan from the same parent organization.
By 2026, all dually eligible Californians will have the option to enroll in MMPs; if they choose to, they will also be enrolled in the aligned Medi-Cal plan through a process that the Centers for Medicare & Medicaid Services calls “exclusively aligned enrollment.” The intent of aligned MMPs is for one plan to be responsible for coordinating across all Medicare and Medi-Cal benefits and to make it easier for dually eligible Californians to navigate both systems through comprehensive care management, streamlined member notification materials, a single insurance card for both plans, single provider directories and prescription formularies, and a unified grievances and appeals process.
This issue brief provides an overview of the planned transition to MMPs in California, describes evidence supporting why integrated, aligned care is better for dually eligible people, and shares lessons from several state leaders who were interviewed about their experiences integrating care for this population.