Medi-Cal Managed Care Changes In January 2023: Information For Medicare Providers

The document was released on December 19, 2022, by the California Department of Health Care Services (DHCS). It presents the state's intention to enroll all Medicare-Medicaid dual eligibles currently in fee-for-service Medicaid into Medicaid managed care for their Medicaid services. DHCS clarified how this will affect organizations providing Medicare services for these individuals.

Medi-Cal (California's Medicaid program) managed care plans are responsible for reimbursing applicable Medicare deductibles for dual-eligible individuals up to the Medi-Cal fee-for-service rate, even for out-of-network physicians. As a result, the transition will not affect . . .