Medi-Cal & Medicare Dual Eligible Resources - Health Consumer Alliance (HCA)

Welcome to the Medi-Medi Dual Eligible Resource Page!

Here in California, the Department of Healthcare Services (DHCS) partners with the HCA to run the statewide Medicare Medi-Cal Ombudsman Program (MMOP).

Through this partnership, we provide education and advocacy for people who have both Medicare and Medi-Cal – also know as “dual eligibles”.

The MMOP helps beneficiaries in Dual Special Needs Plans, including Medicare Medi-Cal plans (MMPs), Medi-Cal and Medicare Advantage (matched or non-matched) plans, Fully Integrated Dual Eligible Plans, and the Program of All-Inclusive Care for the Elderly or PACE .

The MMOP supports these individuals with all aspects of being a dual-eligible, including eligibility, questions about coverage, how to enroll, and what to do if a barrier to accessing care happens.

The MMOP can also help with filing complaints and appeals with a health plan and provides ongoing support throughout the process, from start to finish.

To learn more about the MMOP and available services, please take a look at the valuable resources we have gathered on this page.

For more information, or to speak to your local MMOP advocate, please call us toll-free at 1-855-501-3077. We are here to help!

The National Health Law Program has released this issue brief providing an overview of the rules and processes for notice, grievances, and appeals that apply to Medi-Cal plans. Download the publication, here.

Justice in Aging’s new resource, Dual Eligible Special Needs Plan (D-SNP) State Medicaid Agency Contract Toolkit, provides advocates and State Medicaid Agency policymakers with principles and corresponding template language to develop SMACs that are responsive to the needs of the dually eligible populations that they serve. Stakeholders are encouraged to use this tool to advance their priorities, utilizing and tailoring the components that are most appropriate for their state’s integrated environments.

As part of Justice In Aging’s recently launched project to build capacity and educate advocates about dual populations in Dual Eligible Special Needs Plans or D-SNPs, this fact sheet provides an overview of California’s D-SNP landscape, including the number and characteristics of people who are dually eligible in the state. To review other state’s D-SNP profiles, please visit Justice In Aging’s D-SNP Data Landscape page . The Health Consumer Alliance (HCA) services the Medicare Medi-Cal Ombudsman Program (MMOP) – which provides support to dual eligible members of Medi-Medi plans, DSNPs, and PACE programs, helping these consumers to overcome barriers to accessing needed health care benefits and services.

The Health Consumer Alliance Quality of Care Chart provides valuable information on healthcare providers and facilities, helping consumers make informed decisions about their care. Find out how to use this resource effectively.

Use this fact sheet to discover helpful resources for older adults in California dealing with mental health challenges.

Starting in 2026, Medi-Medi plans will be available in most counties across California, with phased enrollment continuing beyond 2026. Please see here for more information.

This fact sheet provided by DHCS explains how to join a Medi-Medi Plan.
Medicare Medi-Cal Plan Fact Sheet – English
American Sign Language Interpretation (Video)
Spanish – Medicare Medi-Cal Plans Fact Sheet
Lengua de Señas Mexicana interpretación (Vídeo)
Additional translations are available below.
Hmong – Kev Nkag Koom rau in Daim Phiaj Xwm Medi-Medi Fact Sheet
Vietnamese – HAM GIA MỘT CHƯƠNG TRÌNH MEDI-MEDI
Traditional Chinese/Cantonese – 加入Medi-Medi計劃
Russian – Присоединение к плану Medi-Medi
Khmer/Cambodian – ការចូូលរួម្មកុ�ង Medi-Medi Plan
Arabic – االنضمام إلى خطة MEDI-MEDI
Farsi – پیوس

Medicare providers (like doctors and hospitals) cannot bill dual eligible beneficiaries for Medicare cost sharing. This is known as balance billing, or “improper billing,” and is illegal underboth federal and state law.

Durable Medical Equipment (DME) is certain items your doctor orders for use in your own home. Learn more about these benefits, here.

This cover letter is to be used for D-SNPs that are transitioning from Medicare Medi-Cal Plans (MMPs) to D-SNPs that do not offer exclusively aligned enrollment. Effective January 1, 2024

The California Health Care Foundation reports almost 15 million California residents are currently enrolled in Medi-Cal. Medi-Cal benefits are crucial to California residents’ ability to access healthcare, especially the elderly and disabled.