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Dual Medi-Cal Enrollment and Medicare Advantage Enrollment in the Medicare Population in California Counties
This data set accompanies the Profile of the California Medicare Population chartbook, published by the Office of Medicare Innovation and Integration in February 2022, and available at (https://www.dhcs.ca.gov/services/Documents/OMII-Medicare-Databook-February-18-2022.pdf). The three data files in this data set were analyzed from federal administrative data (the Medicare Master Beneficiary Summary File) for beneficiary characteristics as of March 2021. These datasets include: Medicare enrollment, Medicare Advantage enrollment (and its converse fee-for-service Medicare enrollment), dual Medi-Cal eligibility and enrollment (and its converse Medicare-only enrollment), by county. Medicare Savings Program enrollees were considered Medicare-only and not dually enrolled in Medi-Cal. All Medicare Part C beneficiaries, including PACE, Cal MediConnect and Special Needs Plans, were considered to have Medicare Advantage. DHCS partnered with The SCAN Foundation and ATI Advisory in 2021 and 2022 to develop a series of chartbooks that provide information about Medicare beneficiaries in California. This work is supported by a grant from The SCAN Foundation to advance a coordinated and easily navigated system of high-quality services for older adults that preserve dignity and independence. For more information, visit www.TheSCANFoundation.org.
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Medi-Cal Managed Care Capitation Rates – Two-Plan Model
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This dataset displays reimbursement rates paid to Medi-Cal Managed Care health plans in Two-Plan model counties by State Fiscal Year. In Two-Plan model counties, the Department of Health Care Services (DHCS) contracts with a local initiative (county organized) and a commercial plan.
Eligible Individuals Enrolled in Medi-Cal Managed Care COHS Health Plans
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This dataset includes the number of newly eligible individuals enrolled in a Medi-Cal Managed Care County Organized Health System (COHS) Health Plans by reporting period. COHS is a Medi-Cal managed care health plan model that operates in 22 California counties. Each COHS is created by a county board of supervisors and governed by an independent commission. In COHS counties, a single plan serves all Medi-Cal beneficiaries enrolled in managed care. This dataset is part of public reporting requirements set forth by the California Welfare and Institutions Code 14102.5.
Medi-Cal Managed Care Capitation Rates – Two-Plan Model
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This dataset displays reimbursement rates paid to Medi-Cal Managed Care health plans in Two-Plan model counties by State Fiscal Year. In Two-Plan model counties, the Department of Health Care Services (DHCS) contracts with a local initiative (county organized) and a commercial plan.
Medi-Cal Enrollment by Eligibility Group
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This dataset includes the total number of individuals enrolled in Medi-Cal by eligibility group: Modified Adjusted Gross Income (MAGI), non-MAGI, and Children’s Health Insurance Program (CHIP). The groups are defined by the Centers for Medicare and Medicaid Services (CMS) Performance Indicators (CMSPI) reporting requirements. The Department of Health Care Services (DHCS) submits eligibility and enrollment data regarding Medicaid and CHIP monthly to CMS. The enrollment data represents enrollment totals as of 60 days after the eligibility month (indicated as “Reporting Period” in the dataset). CMS publishes the state total enrollments on the CMSPI website. The total enrollment comprises of individuals who are eligible for full scope Medi-Cal by MAGI – Child, MAGI – Adult, Non-MAGI Child, Non-MAGI Adult, and CHIP eligibility groups. DHCS does not report to CMS the total enrollment in limited scope Medi-Cal or state-only funded programs (indicated as the “Non-CMSPI” in the dataset).
Medi-Cal Enrollment by Eligibility Group
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This dataset includes the total number of individuals enrolled in Medi-Cal by eligibility group: Modified Adjusted Gross Income (MAGI), non-MAGI, and Children’s Health Insurance Program (CHIP). The groups are defined by the Centers for Medicare and Medicaid Services (CMS) Performance Indicators (CMSPI) reporting requirements. The Department of Health Care Services (DHCS) submits eligibility and enrollment data regarding Medicaid and CHIP monthly to CMS. The enrollment data represents enrollment totals as of 60 days after the eligibility month (indicated as “Reporting Period” in the dataset). CMS publishes the state total enrollments on the CMSPI website. The total enrollment comprises of individuals who are eligible for full scope Medi-Cal by MAGI – Child, MAGI – Adult, Non-MAGI Child, Non-MAGI Adult, and CHIP eligibility groups. DHCS does not report to CMS the total enrollment in limited scope Medi-Cal or state-only funded programs (indicated as the “Non-CMSPI” in the dataset).
Covered California Enrollees by Rating Region
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This dataset includes the number of eligible individuals selected and enrolled in a Covered California qualified health plans (QHPs) by rating region and by reporting period. California is comprised of 19 rating regions, and each region has different pricing and health insurance options. Covered California reported data is from the California Healthcare Eligibility, Enrollment and Retention System (CalHEERS) and includes eligible individuals who selected and enrolled in a QHP, and paid their first premium. This dataset is part of public reporting requirements set forth by the California Welfare and Institutions Code 14102.5.
Number of Individuals Transitioned from Covered California Qualified Health Plans to Medi-Cal
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This dataset includes the number of individuals transitioned from Covered California Qualified Health Plan (QHP) eligibility to Medi-Cal enrollment commencing with the 2016 Quarter 4 Report. The individuals in this dataset represent Covered California clients, regardless of QHP enrollment status, who are in a Carry Forward Status (CFS) after reporting a change making them potentially eligible for MAGI Medi-Cal during a reporting period. The total number of individuals transitioned from Covered California includes Medi-Cal eligible individuals who did not have Medi-Cal eligibility in the month prior to the reporting period. This is a new dataset as a result of implementing the Covered California QHP Carry Forward Status indicator in release 16.9 and is part of public reporting requirements set forth by the California Welfare and Institutions Code 14102.5.
Newly Eligible Individuals enrolled in Medi-Cal Managed Care Health Plans
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This dataset includes the number of newly eligible individuals enrolled in a Medi-Cal Managed Care Health Plans by type of enrollment by reporting period. Medi-Cal Managed Care program contracts for health care services through established networks of organized systems of care emphasizing primary and preventive care. Newly eligible Medi-Cal beneficiaries must choose a Managed Care health plan within 30 days of Medi-Cal enrollment, or they will be enrolled in a Managed Care health plan by default. This dataset is part of public reporting requirements set forth by the California Welfare and Institutions Code 14102.5.
Number of Individuals Transitioned from Covered California Qualified Health Plans to Medi-Cal
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This dataset includes the number of individuals transitioned from Covered California Qualified Health Plan (QHP) eligibility to Medi-Cal enrollment commencing with the 2016 Quarter 4 Report. The individuals in this dataset represent Covered California clients, regardless of QHP enrollment status, who are in a Carry Forward Status (CFS) after reporting a change making them potentially eligible for MAGI Medi-Cal during a reporting period. The total number of individuals transitioned from Covered California includes Medi-Cal eligible individuals who did not have Medi-Cal eligibility in the month prior to the reporting period. This is a new dataset as a result of implementing the Covered California QHP Carry Forward Status indicator in release 16.9 and is part of public reporting requirements set forth by the California Welfare and Institutions Code 14102.5.
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