MedicaidCoverageMedium impact
24-1308m Find Out What's Changing for Partial Dual Eligible Medi-Cal Members in 2025
Health Net·CA·Prior Authorization
Effective date
Jan 1, 2025
We identified it
Jun 20, 2026
Summary
Effective January 1, 2025, California's Medi-Cal program will pay Medicare Part A premiums for eligible individuals under Senate Bill 311, making them eligible for Dual Eligible Special Needs Plans (D-SNPs). Healthcare providers in specified California counties may see an increase in patients with D-SNP coverage who previously only had Medi-Cal.
Action Required
By January 1, 2025: Billing team must verify patient eligibility through the provider portal for real-time information, as former Medi-Cal-only patients may now have D-SNP coverage. Update eligibility verification processes to check for new D-SNP enrollment in Los Angeles, Sacramento, Tulare, Fresno, Kings, Madera, Amador, Calaveras, Tuolumne, Imperial and Stanislaus counties. Contact CalViva Health at 888-893-1569 for questions or 844-966-0298 for Behavioral Health providers.