Building Provider Networks for Enrollees in Both Medicare and Medi-Cal

For Californians enrolled in both Medicare and Medi-Cal (known as dually eligible enrollees), navigating two separate health care systems can lead to fragmented and poorly coordinated care, significantly impacting their health outcomes and overall care experience. As part of CalAIM (California Advancing and Innovating Medi-Cal), the California Department of Health Care Services (DHCS) is pursuing several strategies to address these issues. Central to these strategies is the introduction of Medicare Advantage Dual Eligible Special Needs Plans (D-SNPs) managed by the same organizations that run Medi-Cal managed care plans, rather than two different organizations. These plans, known as Exclusively Aligned Enrollment (EAE) D-SNPs or "Medicare Medi-Cal Plans," were launched in 2023. They are now in place in 12 counties, and will be expanded to many additional counties in 2026. By having one organization oversee both Medi-Cal and Medicare benefits, these aligned plans aim to reduce fragmentation and improve coordination of services for dually eligible enrollees.