What physicians need to know about Cal MediConnect

Cal MediConnect is a California health program for individuals who qualify for both the Medicare and Medi-Cal programs, (dual eligible members). It is designed to facilitate improved health care, and is extensive in its impact on the physician-patient relationship. It’s therefore important to recognize what physicians need to know about Cal MediConnect.

Cal MediConnect offers a co-ordinated approach to Medicare and Medi-Cal benefits, because they are simplified under one plan. It covers prescription drugs, medical, and long term services and support.

In-network physicians

Patients that sign up for the Cal MediConnect, must get their covered services from in-network physicians. Therefore a physician that is in-network can continue seeing patients, if they are enrolled in the program.

Out-of-network physicians

However, a physician that is out-of-network can only continue seeing Cal MediConnect patients for a period of 6 months. If a patient is being treated under Medicare for a serious condition, the physician can request an extension of time to complete covered services. Physicians have to make a ‘continuity of care’ request, which is governed by specific requirements.

Out-of-network physicians can choose to retain that status, or decide to contract with a Cal MediConnect plan. Those who opt not to sign on, are likely to have their patients eventually redirected to an approved provider.


Physicians can continue to treat dual eligible patients who choose to opt out of Cal MediConnect, as a Medicare Fee-for-service (FFS) physician. Physicians should bill for Medicare services for these patients in the normal manner.

If you are a physician and you need more information on how you and your medical practice will be impacted by Cal MediConnect, contact Nelson Hardiman, LLP, Los Angeles. Call us at 310-203-2800, or send an email to info@nelsonhardiman.com.

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