Medi-Cal: dual eligibles: pilot projects.

Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income persons receive health care benefits. The Medi-Cal program is, in part, governed and funded by federal Medicaid provisions. Existing federal law provides for the federal Medicare Program, which is a public health insurance program for persons 65 years of age and older and specified persons with disabilities who are under 65 years of age. Existing law, to the extent that federal financial participation is available, and pursuant to a demonstration project or waiver of federal law, requires the department to establish demonstration sites to develop effective health care models to provide services to persons who are dually eligible under both the Medi-Cal and Medicare programs. Under existing law, the department may require persons who are dually eligible to enroll in a Medi-Cal managed care plan that is established or expanded as part of a demonstration project, except as specified. Existing law also requires a person who is eligible for the California Program of All-Inclusive Care for the Elderly (PACE) , which provides specified long-term care services to qualified older individuals, to be presented with a PACE plan as an enrollment option, in areas where a PACE plan is available. This bill would authorize persons who are eligible for PACE to disenroll from a managed care health plan and enroll in a PACE plan at any time to receive their Medi-Cal and Medicare benefits. This bill would require managed care health plans to identify, in their assessments of enrollees, and notify certain beneficiaries of their potential eligibility for PACE.