Medicare AdvantageCoverageMedium impact
24-1309m 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
Starting January 1, 2025, California's Medi-Cal program will pay Medicare Part A premiums for eligible individuals, making them eligible for Dual Eligible Special Needs Plans (D-SNPs). This will result in an increase of patients with D-SNP coverage in specific California counties.
Action Required
By January 1, 2025: Billing team must prepare for increased D-SNP patient volume in Los Angeles, Sacramento, Tulare, Fresno, Kings, Madera, Amador, Calaveras, Tuolumne, Imperial and Stanislaus counties. Update eligibility verification processes to check for D-SNP coverage for patients who previously had only Medi-Cal. Use provider portal for real-time eligibility verification. Contact Community Health Plan of Imperial Valley at 833-236-4141 for questions or 844-966-0298 for Behavioral Health providers.