CMS is focusing on aligning the DSNP and Medi-Cal/Medicaid Plan under the same parent organization for ease of Care Coordination.

• No Quarterly Duals SEP effective 1/1/25
• Two (2) new Monthly SEBs effective 1/1/25
  • SEP # 1 (Duals Disenrollment) - LIS/Dual Eligible (DE) members may enroll into PDP stand alone disenrolling them from an MA or DSNP plan; returning to Original Medicare/FFS. Applies to ALL DSNP plans including:
    • Non EAE DSNP - WellCare Dual Liberty – Amador, Imperial, San Joaquin, Stanislaus, Tuolumne, Calaveras
    • EAE DSNP – WellCare Dual Align &Wellcare CalViva health Dual Align – Los Angels, Tulare, Sacramento, Fresno, Kings, Medera
  •  SEP #2 (Integrated Care) - LIS/Dual Eligible (DE) members may move/enroll into an integrated DSNP plan IF they are already enrolled or in the process of enrolling into the same parent organization’s Medi-Cal Plan. Applies ONLY to EAE DSNP Products/Plans including:
    • EAE DSNP – WellCare Dual Align &Wellcare CalViva health Dual Align – Los Angeles, Tulare, Sacramento, Fresno, Kings, Medera

• Wellcare Dual Liberty (HMO DSNP) - H3561- 001 - Kern,
  Placer and San Francisco
• WellcareDual Liberty (HMO DSNP) -  H3561-009 –Orange, Riverside, San Bernadino and San Diego 

Wellcare Dual Liberty (HMO DSNP) - H3561- 001 - Tuolumne and Calaveras counties

The Member can contact their Broker, Member Services or (800) MEDICARE

If a D-SNP member loses their Medicaid/Medi-Cal eligibility, they can remain on the D-SNP for a period of time (called “Deeming period”) giving them opportunity to regain their Medicaid/Medi-Cal eligibility.  If they do not regain their Medicaid/Medi-Cal eligibility, they are involuntarily disenrolled from the D-SNP plan. Wellcare by Health Net members have a 6 month deeming period.

CalViva Health is a Medi-Cal Managed Care Plan not affiliated or owned by Centene. They are the Local Initiative Health Plan for Medi-Cal managed care in Fresno, Kings, and Madera Counties (Central Valley).  CalViva Health is a full-service health plan contracting with DHCS to provide Medi-Cal Covered Services to Medi-Cal managed care enrollees under the Two-Plan model in all zip codes in Fresno, Kings, and Madera Counties. CalViva Health contracts with Health Net Community Solutions, Inc. on a capitated basis to provide and arrange for Medi-Cal Covered Services in all zip codes in Fresno, Kings, and Madera Counties.

To meet the goals of the CalAIM Program, CA Medi-Cal plans will be required to also have a Medicare Advantage D-SNP Plan. CalViva Health only has the Medi-Cal contract with the State and does not have any Medicare contracts with CMS. Since Health Net’s parent organization, Centene, has a Medicare Contract, CalViva Health and Wellcare by Health Net have partnered to provide an Exclusive Aligned Enrollment D-SNP plan in Fresno, Kings and Madera Counties for 2024

If a dual eligible beneficiary joins the Wellcare By Health Net D-SNP plan in Fresno, Kings, and Madera counties, they will be automatically assigned to CalViva Health for their Medi-Cal Managed Care Plan. 

D-SNP matching plan counties

The 17 counties with the Medi-Cal matching plan policy in 2024 are: 

 Alameda, Contra Costa, Fresno, Kern, Kings, Los Angeles, Madera, Orange, Riverside, Sacramento, San Bernardino, San Diego, San Francisco, San Mateo, Santa Clara, Stanislaus, and Tulare counties

Some D-SNP members are having to transition to a different D-SNP plan for 2024 because DHCS is requiring the health plans to consolidate all D-SNP plans into a single CMS H-contract. The Wellcare By Health Net D-SNP plan will be under the H3561 contract and the associated provider network.

Yes, contact Provider Services at 800-929-9224  to confirm your participation as a dual eligible Special Needs Plan (D-SNP) provider in the H3561 network or any question about the transition. (This could
be different from the previous year's D-SNP network).

Wellcare By Health Net is assessing their networks to determine differences and working to ensure minimal disruption to members and
providers.

Should any of their current providers choose to not participate with the Wellcare By Health Net D-SNP program, members are eligible for continuity of care for 12 months following the transition.

Beneficiaries choosing any MA plan in the following counties will have automatic enrollment into the matching Medi-Cal plan if the MA carrier also has a Medi-Cal contract in that county 

Members new to a DSNP plan are eligible for continuity of care for 12 months following the transition. Please see the Provider Operations Manual here.

Can a DSNP member enrolled with Wellcare by HN who also has Health Net or CalViva Health for Medi-Cal see a Medi-Cal Network provider for Medicare covered services (such as Primary Care, Specialists and Facilities)?

ONLY if that provider is part of the DSNP Network.

The servicers covered only by Medi-Cal are:

• Long Term Care (LTC)
• Community Base Adult Services
• Medi-Cal Covered DME

The Community Resource/Supports may include, but is not limited to, the following services:  

• Asthma Remediation
• Community Transition Services/Nursing Facility Transition Services to a Home
• Day Habilitation Programs or Rehabilitation?
• Environmental Accessibility Adaptation (Home Modification)
• Housing Deposit (up to $6,000)
• Housing Tenancy and Sustaining Services
• Housing Transition Navigation Services (homeless, or about to become)
• Medically Tailored Meals
• Nursing Facility Transition/Diversion to Assisted Living Facilities
• Personal Care Services and Homemaker Services
• Recuperative Care (medical respite)
• Respite Services
• Short-Term Post-Hospitalization Housing
• Sobering Centers

Dual eligible Special Needs Plans (D-SNPs) enroll individuals who are entitled to both Medicare (title XVIII) and medical assistance from a state plan under Medicaid (title XIX). States cover some Medicare costs, depending on the state and the individual’s eligibility. States and health plans may vary in determining their eligibility categories.

A dual eligible beneficiary should join a D-SNP because it provides a more streamlined, hassle-free experience in navigating through benefits. This is because the plan provides care coordination services designed to help arrange services on the member's behalf, and often offers extra benefits beyond what beneficiaries can get from Original Medicare and Medi-Cal.

Each D-SNP plan may have different requirements.

For Wellcare by Health Net D-SNP plans, enrollees must be Full Benefit Dual Eligible, Qualified Medicare Beneficiary Plus and Specified Low-Income Medicare Beneficiary Plus.

Definitions of all types of Qualified Medicare Beneficiary programs are available on the Centers for Medicare & Medicaid Services Medicare-Medicaid Coordination Office website

Current D-SNP members will remain enrolled in the Wellcare By Health Net D-SNP plan even though their Medi-Cal managed care assignment is a different health plan.  The DSNOP contractor, Wellcare by Health Net is responsible to coordinate all Medicare and Medi-Cal covered services regardless of who is the Medi-Cal health plan.

Under exclusively alignment enrollment, members enroll in a dual eligible special needs plan (D-SNP) for Medicare benefits and in an Medi-Cal Managed Care Plan for Medi-Cal benefits, which are both operated by the same parent organization for better care coordination and integration.  

 Exclusively aligned enrollment D-SNPs offer an integrated approach to care and care coordination. The matching Medicare D-SNP and Medi-Cal plans will work together to deliver all covered benefits to their members. And as all members in the plan are also enrolled in the matching managed care plan, they can receive integrated member materials, such as one integrated member ID card. 

Enrollment into the exclusively aligned enrollment D-SNP will result in the member’s Medi-Cal plan changing to the same parent organization’s Medi-Cal managed care plan. The Medi-Cal plan is changed automatically by the State/DHCS who will send a notification in the mail to the member advising them of the auto assignment.  

Wellcare By Health Net’s parent organization is Centene, Inc. 

For Centene plans in California, the exclusively aligned enrollment D-SNP plans will be: 

• Wellcare By Health Net D-SNP with a Health Net Medi-Cal plan in Los Angeles, Sacramento, and Tulare. 
• Wellcare By Health Net D-SNP with a CalViva Health Medi-Cal plan in Fresno, Kings, and Madera

Enrollment in the exclusively aligned enrollment D-SNP will trigger the Department of Health Care Services to reassign the member’s Medi-Cal plan to the same parent organization.

These plans will be available through various health plans in multiple counties throughout California.

Example:

1. Mr. Smith is a full dual beneficiary with Medicare fee-for-services and Plan A for his Medi-Cal managed care plan.
2. Mr. Smith applies for enrollment into Plan B’s exclusively aligned enrollment D-SNP to take advantage of care coordination and benefits. Mr. Smith can choose a primary care physician/participating physician group within Plan B’s provider network on his exclusively aligned enrollment D-SNP application.
3. When approved by the Centers for Medicare & Medicaid Services, Mr. Smith's Medi-Cal managed care plan will change automatically to Plan B's Medi-Cal managed care plan. 

Only D-SNP members who are in a new exclusively aligned county for 2024 will be automatically enrolled into exclusively aligned D-SNP plan/Medicare Medi-Cal plan effective January 1, 2024, if they do not elect another plan/option to receive their Medicare benefits.

For Wellcare by Health Net, this will occur in Fresno, Madera, Sacramento, and Tulare counties.

Only if one is offered in the service area where the beneficiary lives. Medicare.gov can help identify plans available in the Zip Code of the beneficiary.

No, only full benefit dual eligible beneficiaries will be able to enroll into an exclusively aligned enrollment D-SNP if there is one offered in their county of residence.

Only Dual Special Needs Plan (D-SNP) members who are in a new exclusive aligned county for 2024 will be automatically enrolled into exclusive aligned D-SNP plan/Medicare Medi-Cal plan effective January 1, 2024, if they do not elect another plan/option to receive their Medicare benefits.

• For Wellcare By Health Net, this will occur in Fresno, Madera, Sacramento, and Tulare counties.
• For D-SNP members in Fresno and Madera counties, their Medi-Cal plans will be assigned to CalViva Health for their Medi-Cal benefit.
• For D-SNP members in Sacramento and Tulare counties, their Medi-Cal plans will be assigned to Health Net for their Medi-Cal benefit.

A Medicare Medi-Cal Plan (MMP or Medi-Medi Plan) is a type of Medicare Advantage D-SNP plan. It is for people who have both Medicare and Medi-Cal. It combines Medicare and Medi-Cal benefits and Medicare prescription drug benefits into one plan.

Medi-Medi Plans will coordinate all benefits and services across both programs, including all Medicare and Medi-Cal covered services.

• One care team to coordinate care.
• One health plan to coordinate delivery of services, including medical supplies, transportation, and long-term services and supports.
• One set of benefits and a network of providers, including doctors, hospitals, clinics, labs, pharmacies, and medical equipment suppliers.
• Members may get extra benefits like dental, hearing, or vision coverage, in addition to what Medi-Cal covers (refer to the Member Handbook for the full benefit details).

Wellcare has two Medi-Medi plans: Wellcare By Health Net in the Los Angeles, Sacramento, and Tulare counties, and Wellcare CalViva Health Dual Align in Fresno, Kings, and Madera. 

• CalViva Health is a Medi-Cal Managed Care Plan not affiliated or owned by Centene. They are the Local Initiative Health Plan for Medi-Cal managed care in Fresno, Kings, and Madera Counties (Central Valley).  CalViva Health is a full-service health plan contracting with DHCS to provide Medi-Cal Covered Services to Medi-Cal managed care enrollees under the Two-Plan model in all zip codes in Fresno, Kings, and Madera Counties. CalViva Health contracts with Health Net Community Solutions, Inc. on a capitated basis to provide and arrange for Medi-Cal Covered Services in all zip codes in Fresno, Kings, and Madera Counties.

To meet the goals of the CalAIM Program, CA Medi-Cal plans will be
required to also have a Medicare Advantage D-SNP Plan. CalViva Health only has the Medi-Cal contract with the State and does not have any Medicare contracts with CMS. Since Health Net’s parent organization, Centene, has a Medicare Contract, CalViva Health and Wellcare by Health Net have partnered to provide an Exclusive Aligned Enrollment D-SNP plan in Fresno, Kings and Madera Counties for 2024

If a dual eligible beneficiary joins the Wellcare By Health Net D-SNP plan in Fresno, Kings, and Madera counties, they will be automatically assigned to CalViva Health for their Medi-Cal Managed Care Plan. 

Inform the member to contact the health plan by using the phone number on the back of their ID card for any Medicare and Medi-Cal benefits related questions.

• For D-SNP members in Fresno, Kings, and Madera counties, call 833-236-2366
• For D-SNP members in all the other counties, call 800-431-9007

Inform the member to contact Member Services for support.

• For D-SNP members in Fresno, Kings, and Madera counties, call 833-236-2366
• For D-SNP members in all the other counties, call 800-431-9007

Also remind the member that any referral for services which require an approval will generate a written response to them. And if denied, the member will be provided with their appeal rights.

Inform the member to contact Member Services for support.

• For D-SNP members in Fresno, Kings, and Madera counties, call 833-236-2366
• For D-SNP members in all the other counties, call 800-431-9007

 Also remind the member that any referral for services which requires an approval will generate a written response to them. And if denied, the member will be provided with their appeal rights.

Please see our Medi-Cal information in our Provider Library.

https://www.healthnet.com/content/healthnet/en_us/providers/support/calaim-resources.html

For Wellcare by Health Net DSNP members enrolled in Health Net Medi-Cal or CHPIV; search and submit a referral for community support here:

https://communitysupportsecm.findhelp.com/

For Wellcare by Health Net DSNP members enrolled in CalViva Health; search and submit a referral for community support here;

https://calvivahealth-ecm-cs.findhelp.com/Research the findhelp platform (www.findhelp.org), which can provide the member with
the Community Supports, and help the member get connected to the services. You can also submit a request for care coordination to Wellcare By Health Net using the referral form .

The Public Programs team will help our members connect to these Community Supports via help_referral@healthnet.com.

All providers are identified in the provider directory under “Other Facilities” Members can self-refer to the Community Support service.

The Community Resource/Supports may include, but is not limited to, the following services:  

a. Housing Transition Navigation Services (homeless, or about to become)

b. Housing Deposits

c. Housing Tenancy and Sustaining Services

d. Short-Term Post Hospitalization Housing

e. Recuperative Care (medical respite)

f. Respite Services

g. Day Rehabilitation

h. Nursing Facility Transition/Diversion to Assisted Living Facilities

i. Community Transition Services/Nursing Facility Transitions to a Home

j. Personal Care and Homemaker Services

k. Environmental Accessibility Adaptations (home modifications)

l. Meals/Medically Tailored Meals

m. Sobering Centers

n. Asthma Remediation

Care Coordination is the organization of a member’s care across multiple health care providers.to ensure the member receives safe, effective and appropriate care.

A Care Coordinator works with the member, the health plan and the member’s care providers to make sure the member gets the health care that is needed. The Care Coordinator works with the member to put together a care plan and determines who is on the care team to deliver, meet and manage the members health care. 

Providers can access their Provider Portal accounts, call the Wellness Case Management/Care Coordination Team at 1-833-340-0083 (M-F 8 am – 8pm Est), or email CenteneCMEscalationsMedicare@centene.com

The member can call Member Services who will help the member contact a care coordinator or with help changing a care coordinator.

ECM is a whole person, interdisciplinary approach to care that addresses the clinical and non-clinical needs of members with the most complex medical and social needs. ECM is designed to be delivered by community-based ECM providers that are contracted with managed care health plans. Member care management, as well as coordination across Medicare and Medi-Cal benefits, is a primary function of D-SNPs

D-SNP Plans will work with ECM Providers, as needed, to transition a member from ECM to D-SNP Care Management once the member graduates from ECM as part of the Continuity of Care

Beginning on 1/1/2024, all D-SNPs must provide sufficient care management (“ECM-like care management”) exclusively through their D-SNP plan

There is significant overlap across the D-SNP model of care and ECM requirements which could result in duplication and confusion for Members and care teams if a Member receives care management from both programs.  For more information on Enhanced Care Management (ECM) and how it differs from DSNP, refer to the DHCS CalAIM policy Guide and the ECM policy guide.

https://www.dhcs.ca.gov/provgovpart/Documents/2024-DHCS-CalAIM-D-SNP-Policy-Guide.pdf

https://www.dhcs.ca.gov/CalAIM/ECM/Documents/ECM-Policy-Guide.pdf

To date, the Department of Health Care Services and Centers for Medicare & Medicaid Services have advised there will be no change to how they access their Medicare benefits.

Starting January 1, 2023, the Department of Health Care Services will require any new dually eligible beneficiary to enroll in a Medi-Cal managed care plan. For more information, visit the DHCS website.

The member will be assigned a contracted in-network provider (PCP under an affiliated PPG).

Depending on the member’s Medicare plan, the member’s Medi-Cal may be aligned with their Medicare plan under exclusively aligned enrollment if the parent company of the Medicare plan has both Medicare and Medi-Cal in the market. Alignment will only occur upon a
new enrollment or plan changes effective 1/1/24 or after in the counties where there is exclusively aligned enrollment [the twelve (12) EAE counties] or there is a Medi-Cal Matching Plan Policy in force. The members will be notified by the state of any changes to their Medi-Cal plans based on their Medicare plans. 

No, beneficiaries do not have to wait. They need to be in the Medicare service area AND be a full dual eligible member to join/enroll into the D-SNP plan. This also applies to the Exclusively Aligned Enrollment counties; the alignment of the Medi-Cal plan when the address in the DHCS/Medi-Cal system reflects the county. 

If the member has transportation benefits through their Medicare Advantage/DSNP plan, those must be exhausted before accessing
the unlimited transportation benefits through their Medi-Cal managed care plan. 

• It is the annual review to determine beneficiary eligibility for the Medi-Cal program.  This process was put on hold in early 2020 -
  Q2 2023 due to the Covid-19 Public Health Emergency (PHE)
• For Wellcare, you must be a full dual eligible beneficiary to be in our DSNP Plan.  If a DSNP member loses their Medi-Cal Eligibility because they no longer qualify for full scope Medi-Cal, they will be placed in six (6) month “deeming period” to allow them more time to regain their Medi-Cal eligibility.  A series of three (3) notices are sent throughout the deeming period advising them they need to regain their Medi-Cal eligibility to stay on the DSNP plan and if they do not regain their Medi-Cal eligibility, they will be involuntarily disenrolled from the plan (with an SEP to join another plan).

• DSNP Plans may have different or additional benefits aimed at a dual eligible beneficiary that a traditional Medicare Plan or a “look alike” plan may not
• DSNP plans are required to coordinate all care for their member under the State Medicaid Agency Contract (SMAC) regardless of the Medi-Cal plan the member is in (aligned/matched or not)
• DSNP plans have a Model of Care (MOC) which requires concentrated efforts to improve the care of their membership; reportable to the National Committee for Quality Assurance (NCQA)
• Traditional Medicare Plan or a “look alike” plans are not required to coordinate anything for the member so the member may come to you, their broker, for support on coordination.

Wellcare did have a look alike plan, but as part of the 2021 Medicare Advantage and Part D Final Rule (CMS-4190-F1), the Centers for Medicare and Medicaid Services (CMS) finalized new contracting limitations for D-SNP LAL plans at 42 CFR § 422.514(d) and (e): any non-D-SNP Medicare Advantage Part D plan with 80% or more full Medicaid members (full duals) will not be renewed for the 2023 plan year. The
health plans who have the Look Alike plans for 2024 probably have less than 80% of the total enrollees in the non-SNP plans, which is below the threshold set by CMS. This allows certain health plans to retain and sell Look Alike plans. However, CMS reviews the plan’s January membership every year and will not renew a contract with the plan that is not a SNP and has the enrollment consisting of 80 percent or more of total enrollees in the non-SNP plans. By doing so, CMS is looking to eliminate the Look Alike plans from the market. 

It is a part of the federal regulations from 2021. Starting in 2021, if CMS identifies a plan as a look alike, they were sent a notice to transition those members in the look like plan to the D-NSP plan. Since then, CMS has been reviewing the January membership each year, and CMS will not renew or enter into a contract for an MA plan that is not a SNP and has the enrollment consisting of 80 percent or more of total enrollees in the non-SNP plans. 

We believe the D-SNP plan is a better choice because member receives care coordination regardless of the Medi-Cal plan the member is in, which allows for a minimal member abrasion. The “Look Alike” plan is not required to coordinate anything for the members, so the member may come to you, brokers/producers and their medical providers, for support on care coordination.

Another benefit of being enrolled in a D-SNP over a Look Alike plan is  prevention of balance billing. Balance billing is when a beneficiary is billed for the 20 percent of co-insurance not covered by traditional Medicare or FFS. DHCS prohibits Medicare providers to bill dual eligible beneficiaries for Medicare cost sharing, which means the members cannot be charged for co-pays, co-insurance, or deductibles.

• Medi-Cal is the CA name for the CA Medicaid program
• Qualified based on Low Income or Disability
• Medi-Cal is payer of last resort if the member has multiple coverages
• Application process through Medi-Cal or Covered CA 
• As of 1/1/23, all full duals must enroll into a Medi-Cal Managed Care Health Plan (can choose the health plan). That means if someone is on Medi-Cal FFS and ages into Medicare or qualifies because of disability, they will be assigned to a Medi-Cal Managed Care Plan.
• Enrollment/disenrollment is facilitated by the State Enrollment Broker, Health Care Options, via “Choices Form”
• Generally, joining a Medi-Cal plan will not affect beneficiary choice of Medicare Advantage plan or Original Medicare.
  • There are specific enrollment policies for specific counties in CA where enrollment into a Medicare Advantage plan will impact the Medi-Cal plan the member is assigned to  such as the Exclusive Aligned Enrollment Policy and the Matching Plan Policy
• Medicare providers do not need to be in the Medi-Cal plan network to continue to provide Medicare covered services/benefits. See here for more details
• Each county can have a different “model ” determining the health plan options

• Make sure they are full scope Medi-Cal with NO share of cost (SOC)
• Ensure the beneficiary’s doctors, specialists, facilities, etc. are in the network (this is the # 1 reason someone disenrolls from the plan)
• Ensure their residential address with the State/Medi-Cal matches their address they are providing on the DSNP application
• Complete the Health Risk Assessment (HRA).  This provides the plan with critical and current health issues and social needs so we can ensure 

• Through their Medi-Cal Managed Care Plan (MCP)
  • i) Long Term Care (LTC)
  • ii) Community Bases Adult Services (CBAS) aka adult day health care
  • iii) Medi-Cal Covered DME (incontinence supplies)
  • iv) Community Supports (CS); these may vary by health plan and county.  If the member is with Health Net or CalViva Health for their Medi-Cal MCP, the list of Community Supports can be found here 
  • v) Transportation; unlimited
• Though Medi-Cal Fee for Service (FFS) aka Medi-Cal carved-out services
  • i) In-Home Support Services (IHSS)
  • ii) Medi-Cal Dental (basic dental)
  • iii) Specialty Mental Health & Substance Use Disorder Services; county contacts here 
  • iv) Multipurpose Senior Services Program (MSSP)
  • v) Medi-Cal Rx 
  • vi) Home and Community-Based Waiver Programs (HCBS)

Yes, Diabetic supplies including meters, test strips, and lancets are fully covered when a member presents both their D-SNP member ID card and their State of California Medi-Cal card at the pharmacy since their supplies are covered 80% from Medicare, and 20% from Medi-Cal RX program. Please remind your member to present their State of California Medi-Cal card, not their Medi-Cal managed plan ID card while at the pharmacy. The Pharmacy is responsible to submit the secondary claim to Medi-Cal RX and ensure that the member is not charged.

Yes, the members can continue to see their Med-Cal dentists for Medi-Cal covered dental services. 

D-SNP members have the flexibility to visit any dentist within Delta Dental’s Medi-Medi network. This network is comprised of dentists who are part of both the Medi-Cal and Delta Dental’s Medi-Medi networks. This guarantees that members enrolled in this plan can conveniently receive all their care from a single dentist. For more information, refer to the Delta Dental website.

For 2024, Wellcare’s D-SNP dental coverage is intended to supplement the Medi-Cal covered dental services and covers services which are NOT covered by Medi-Cal dental program.

Visit Delta Dental Provider Tools to verify patient eligibility and benefits. Additionally, each patient must receive a comprehensive written treatment plan. The accepted plan must be signed by the patient or their guardian and the treating dentist and submitted to Delta Dental for estimate and prior authorization

• They will need to see a dentist  who is in the applicable Medi-Cal Dental program 
• They will present their BIC card (the one with the poppies on it) to that dentist office 
• The dentist will bill Medi-Cal dental for the services covered under the Medi-Cal dental program 

Medi-Cal Dental covers the following: 

• Exams (Covered benefit once every 6 months) 
• Emergency Service 
• X-Rays 
• Teeth Cleaning  
• Fluoride Varnish  
• Deep Cleaning- Scaling and Root Planning
• Fillings
• Tooth Removal  
• Root Canals  
• Crowns (Crowns on molars or premolars (back teeth) may be covered in some cases) 
• Partial Dentures 
• Full Dentures 
• Denture Reline
• Sedation  
• See the Medi-Cal Dental Handbook for all details Medi-Cal Dental Handbook

• Each member is assigned to a dentist who takes BOTH Medi-Cal FFS Dental & Delta Dental upon enrollment (no dentist choice on the enrollment form/Acsend; network search only) 
• Each member receives a Delta Dental ID card & Letter advising of the Dentist assignment 
• The letter received gives instructions on how to change dentists, if necessary. The best way is to call our call center using Delta Dental’s dedicated Wellcare custom phone line.  Then the member can also get questions answered at the same time: 855-643-8515 (Delta Dental’s dedicated Wellcare Line) 

Contact Delta Dental directly at 855-643-8515 for more information.  

You can access the Wellcare D-SNP Dental Evidence of Coverage (EOC) and Summary of Benefits (SOB) or contact Delta Dental directly at 855-643-8515 for more information

No, they can still provide the Wellcare D-SNP covered dental services to the Wellcare D-SNP member.

There is NO “primary” payer! The members have two plans with different benefits that do not coordinate with each other.  

Two (2) claims are needed – One to Medi-Cal for Medi-Cal covered services, and a second claim to Delta Dental for the D-SNP plan covered services

Click here to learn more about how to be a part of the Delta Dental Medicare network

For dual eligible beneficiaries who choose to enroll in a Medicare Advantage (MA) plan in those counties, their Medi-Cal plan must align with their MA plan choice, if there is a Medi-Cal plan affiliated with their MA plan. The Medi-Cal matching plan policy does not change or impact a beneficiary's MA plan choice.

DHCS Matching Plan Policy

Beneficiaries choosing any MA plan in the following counties will have automatic enrollment into the matching Medi-Cal plan if the MA carrier also has a Medi-Cal contract in that county (https://www.dhcs.ca.gov/provgovpart/Pages/Medi-Cal-Matching-Plan-Policy-for-Duals.aspx)

Members will be notified of 2025 plan changes by mail via the Annual Notification of Change (ANOC) in September 2024 or the standard non-renewal notice sent in October 2024. For non-renewing plans with or without a transition to a new plan, the standard non-renewal notice will be sent to members in October 2024.

The Annual Notification of Change will outline specific changes in benefits between the current year (2024) and the next plan year (2025).

Advise members to ensure their Medicare plan has their current address and phone number so they receive the information.

Health Plans will communicate with you in the normal way they do today when there are changes or updates.  Watch for Provider and Producer Communications with important information such as service areas expansion, plan name changes, new vendors for member supplemental benefits and more,