California’s transition to statewide Managed Long-Term Services and Supports (MLTSS) and Dual Eligible Special Needs Plans (D-SNPs) in 2023 represents an important step forward as part of the larger California Advancing and Innovating Medi-Cal (CalAIM) initiative. The forthcoming changes related to care coordination for 2024 will include exclusively aligned enrollment (EAE) D-SNPs – also known as Medi-Medi Plans – for the first time in Fresno, Kings, Madera, Sacramento, and Tulare counties. The Medi-Medi Plan is a type of Medicare Advantage plan for people who have both Medicare and Medi-Cal benefits. The Medi-Medi Plan coordinates all benefits and services across both Medicare and Medi-Cal. In addition to the inclusion of these five new counties, the Department of Healthcare Services (DHCS) has taken additional steps around D-SNP care coordination to support dually eligible beneficiaries with improved access to integrated care, especially around Dementia and Alzheimer’s care, palliative care, and oral health.

D-SNP Model of Care

DHCS introduced D-SNP only H Contracts as part of the transition to statewide MLTSS and D-SNP. Plans are assigned an “H Number” by the Centers to Medicare and Medicaid Services (CMS.) D-SNP only H contracts are intended to ensure all D-SNPs in California comply with state-specific requirements, as well as Medicare D-SNP Model of Care requirements. These requirements will support California’s goal of more clear monitoring of state-specific quality metrics and spotlights the importance of the D-SNP Model of Care (MOC), which includes care coordination standards for beneficiaries. All D-SNPs that submitted a new MOC for 2024 had to reflect these state requirements and populate and submit the California Specific Model of Care Matrix Document to DHCS in February 2023.

Dementia and Alzheimer’s Care

The 2024 D-SNP Care Coordination guidance also speaks to Dementia and Alzheimer’s care. Nationally, 20% of dual eligible members have Alzheimer’s or other dementias, which is higher than the general population over the age of 65 (10.7%). Providers serving dually eligible beneficiaries are encouraged to use available training and resources from the new Dementia Care Aware initiative to detect cognitive impairment in members. Even without a formal Alzheimer’s or dementia diagnosis, if the member has documented dementia care needs, the individualized care team must include the member’s caregiver and a trained dementia care specialist to the extent possible and as consistent with the member’s preferences.D-SNPs are required to have trained specialists for dementia care for members with multiple conditions, behavioral issues, high utilization, living alone, or functional impairment. D-SNPs must also include dementia care specialists in the development of the member's individual care plan consistent with the member's preferences.

Palliative Care

Palliative care -- specialized medical care for people living with a serious illness – is focused on providing relief from the symptoms and suffering of the illness and can be provided along with curative treatment. The goal is to improve the quality of life for both the member and the family.Starting in 2024, all D-SNPs, including Medi-Medi Plans (EAE-D-SNPs), must offer palliative care services to dually eligible members, as described in as described in All Plan Letter (APL) 18-020 and the SB 1004 Medi-Cal Palliative Care Policy. DHCS encourages D-SNPs to prioritize the referral to and effective coordination of palliative care services. Palliative care providers and community organizations that offer these services should be included in the D-SNP’s provider network. General eligibility and disease-specific eligibility are outlined in the 2024 CalAIM D-SNP Policy Guide.

Coordination with Dental Benefits

In 2024, D-SNP members may have dental benefits from both their D-SNP and Medi-Cal and, acknowledging the importance of oral health and dental benefits, all D-SNPs are required to coordinate these benefits for their members. The state-specific requirements are in addition to all existing federal Medicare Advantage requirements described in the Medicare Communications and Marketing Guidelines (MCMG). In addition to coordinating benefits, D-SNPs are required to include information about Medi-Cal Dental benefits in any materials that provide member information about D-SNP Supplemental Dental Benefits. Specific examples of information that should be included are outlined in the 2024 CalAIM D-SNP Policy Guide.

Aurrera Health Group’s Role

The transition to Statewide MLTSS and D-SNP continues to move forward as California works to achieve the transformative goals of CalAIM. Looking ahead, Aurrera Health Group will continue to support DHCS with policy development and stakeholder engagement as they stand up additional D-SNPs in new counties and continue to expand integrated services to more dually eligible beneficiaries throughout California.

Authors

Jessica Layton [Senior Policy Consultant]

Mary Russell [Principal]

Advancing Care Coordination: What’s Ahead for California’s Dual Eligible Members