24-1309m Find Out What's Changing for Partial Dual Eligible Medi-Cal Members in 2025

Date: 12/20/24

Senate Bill 311 makes California a Part A buy-in state

Effective January 1, 2025, per California Senate Bill 311, the state’s Medi-Cal program will pay Medicare Part A premiums for eligible individuals who are not automatically enrolled in Medicare Part A.

How this affects patients, physicians and other providers

Patients who were previously ineligible for Medicare Part A will now have access to Medicare fee-for-service hospital benefits and related services. These patients were likely ineligible for Medicare A because they worked an insufficient number of quarters to qualify.

Because these beneficiaries will now be eligible for Medicare Part A, B, D and are fully covered by Medi-Cal, they will be eligible for Medicare Advantage plans, including Dual Eligible Special Needs Plans (D-SNPs). As a result, physicians and other providers may experience an increase in patients who have D-SNPs.

In 2025, the Plan will offer D-SNP Plans in many counties, including Los Angeles, Sacramento, Tulare, Fresno, Kings, Madera, Amador, Calaveras, Tuolumne, Imperial and Stanislaus. In these counties, eligible members who formerly had only Medi-Cal may now qualify for help paying for Medicare Part A and become covered by a D-SNP.

Additional information

Providers are encouraged to access the provider portal for real-time information, including eligibility verification, claims status, prior authorization status, plan summaries, and more.

If you have questions regarding the information contained in this update, contact Community Health Plan of Imperial Valley at 833-236-4141. Behavioral Health providers can call 844-966-0298.

 

This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, Ancillary Providers, Community Supports (CS) Providers, Enhanced Care Management (ECM) Providers, and Behavioral Health Providers.

This information applies to Medi-Cal in Imperial county.