What You Need to Know About California Medi-Medi Plans

On January 1, 2026, California completed the largest single-year transformation of dual-eligible health coverage in the country. Medi-Medi Plans, California's brand for federally classified Exclusively Aligned Enrollment Dual-Eligible Special Needs Plans (EAE D-SNPs), expanded from 12 counties at the start of 2025 to 41 counties statewide on January 1, 2026. Roughly 1.6 million dual-eligible Californians (those enrolled in both Medicare and Medi-Cal full benefits) now live in counties where coordinated, single-plan coverage is the default rather than an exception. Under the DHCS Matching Plan Policy implemented through All Plan Letter (APL) 24-013 (issued December 2024, operationalized January 1, 2025), full-benefit duals newly enrolling in Medicare Advantage in EAE counties must be auto-aligned to the matching parent organization's Medi-Cal Managed Care Plan, and existing non-aligned D-SNPs are now closed to new dual enrollment statewide, with most expected to wind down by 2028. This guide walks through what Medi-Medi Plans are, what the 2026 expansion changes, the Matching Plan Policy mechanics, the seven Medi-Medi Plans serving Los Angeles County, the 17 counties still without coverage (Partnership HealthPlan launches in 2027), what members can expect, and the Continuity of Care rights every dual-eligible Californian should understand before making an enrollment decision.

By Brevy Care Team · Last verified May 3, 2026

What Medi-Medi Plans Actually Are: The Federal-State Architecture

A Dual-Eligible Special Needs Plan (D-SNP) is a federally regulated category of Medicare Advantage plan, authorized under Section 1859 of the Social Security Act, that exclusively serves Medicare beneficiaries also enrolled in Medicaid. CMS rules require every D-SNP to coordinate with the state Medicaid agency through a State Medicaid Agency Contract (SMAC). What varies state-by-state is how integrated that coordination has to be.

D-SNPs come in four federally defined categories:

California chose the EAE model because it solves the longest-standing problem in dual-eligible coverage: fragmentation. A traditional dual-eligible adult might be enrolled in original Medicare Parts A and B (or a generic Medicare Advantage plan) at one insurer for Medicare benefits, and an entirely different Medi-Cal Managed Care Plan at a second insurer for Medi-Cal benefits, leading to two ID cards, two provider networks, two prior-authorization workflows, two grievance-and-appeal systems, two care coordinators, and persistent finger-pointing between Medicare and Medi-Cal about who covers what (durable medical equipment, transportation, behavioral health). The EAE D-SNP model collapses both sides into a single member experience.

When a Californian enrolls in a Medi-Medi Plan, they receive:

• All Medicare Part A and B benefits (hospital, doctor visits, skilled nursing facility, hospice).
• Medicare Part D prescription drug coverage through the same plan.
• Medicare Advantage supplemental benefits, the plan's flexible benefits package (transportation, dental, vision, hearing, OTC allowance, fitness, meal-after-hospital).
• All Medi-Cal LTSS benefits, In-Home Supportive Services (IHSS) coordination, HCBS waiver services where applicable, nursing-facility coverage, Community-Based Adult Services (CBAS), and Multipurpose Senior Services Program (MSSP) coordination.
• All Medi-Cal CalAIM benefits that the plan elects to offer, Enhanced Care Management (ECM) for eligible Populations of Focus, plus the 14 Community Supports and 15th Transitional Rent benefit.
• Medi-Cal pharmacy coordinated through Medi-Cal Rx (the carve-out remains in place even within Medi-Medi).
• Behavioral health, mild-to-moderate via the plan; serious mental illness through county BH plans (the BH-CONNECT carve-out applies); SUD through DMC/DMC-ODS county plans.
• One member ID card, one care coordinator, one provider network, one set of grievance and appeal procedures.

The federal framework comes from CMS D-SNP regulations under Section 1859 of the Social Security Act, with CMS's 2023 Final Rule establishing the EAE D-SNP category and authorizing state Medicaid agencies to require alignment as a condition of D-SNP operation in their markets (see the DHCS Medi-Medi Outreach page for California's implementation).

The 2025 -> 2026 Expansion: 12 Counties to 41 Counties

The expansion timeline tracks four years of careful sequencing.

2014-2022, Cal MediConnect (predecessor program). California's original dual-eligible integration program operated under a CMS Financial Alignment Demonstration. Cal MediConnect wound down December 31, 2022 as part of the CalAIM transition, with members migrating to D-SNPs effective January 1, 2023. For current Cal MediConnect history and county footprint, see the DHCS Medi-Medi Outreach page.

2023, D-SNP Look-Alike Phase-Out. In coordination with CMS rules, California prohibited "look-alike" D-SNPs (Medicare Advantage plans that didn't meet the D-SNP integration requirements but enrolled dual-eligibles disproportionately). Carriers either upgraded to full D-SNP status or exited the dual market.

2024, Foundation Year. The Matching Plan Policy was developed through 2024 stakeholder processes including Justice in Aging, the California Health Advocates, the Western Center on Law & Poverty, and the Senior and Disability Action coalition. APL 24-013 was issued in December 2024 with a January 1, 2025 effective date.

2025, 12 Active Counties. The first wave of EAE D-SNP / Medi-Medi Plan operation went live in 12 counties: Fresno, Kings, Los Angeles, Madera, Orange, Riverside, Sacramento, San Bernardino, San Diego, San Mateo, Santa Clara, and Tulare. Throughout 2025, DHCS and CMS evaluated enrollment data, member experience surveys, and provider network adequacy. Default Enrollment Pilots launched in San Diego and San Mateo to test auto-enrollment of Medi-Cal-only duals into matching Medi-Medi Plans.

2026, Statewide Expansion to 41 Counties. Effective January 1, 2026, the EAE D-SNP / Medi-Medi Plan model expanded to 29 additional counties: Alameda, Alpine, Amador, Calaveras, Contra Costa, El Dorado, Imperial, Inyo, Kern, Mariposa, Marin, Merced, Mono, Monterey, Napa, Placer, San Benito, San Francisco, San Joaquin, San Luis Obispo, Santa Barbara, Santa Cruz, Solano, Sonoma, Stanislaus, Tuolumne, Ventura, Yolo, and Yuba.

Combined, 41 of California's 58 counties operate under the Matching Plan Policy as of 2026. The 17 counties NOT covered as of January 1, 2026 fall in three categories:

By the start of 2027, projections suggest 50+ counties will be in the Medi-Medi Plan framework, leaving only the most remote frontier counties (population <10,000) potentially uncovered.

The Matching Plan Policy: How APL 24-013 Reshaped Enrollment

The single most important administrative document in California's dual-eligible policy is DHCS All Plan Letter 24-013 ("Dual Eligible Special Needs Plan and Medicare-Medicaid Alignment Policy"), issued December 2024. Three operational principles structure the entire Medi-Medi Plan experience.

Principle 1, Matching Plan Auto-Alignment

In every EAE county, full-benefit dual-eligibles newly enrolling in Medicare Advantage are automatically aligned to the matching parent-organization Medi-Cal MCP. If a member chooses Anthem's Medicare Advantage D-SNP plan in Los Angeles, they are auto-enrolled in Anthem Blue Cross Medi-Cal on the Medi-Cal side. If they choose Kaiser's D-SNP, they get Kaiser Medi-Cal. The two enrollments cannot be split between different carriers in EAE counties.

This eliminates the single most disruptive scenario in legacy dual coverage: a member who chose a high-quality Medicare Advantage plan but found themselves stuck with an unaligned Medi-Cal MCO using different providers, different formularies, and different prior-auth workflows.

Principle 2, Non-Aligned D-SNPs Closed to New Enrollment

In EAE counties, D-SNPs without a matching Medi-Cal MCP cannot accept new full-benefit dual enrollment. Existing non-aligned D-SNP members may remain in their plan (the policy is non-disruptive for current enrollees), but the plan cannot enroll new duals. This is the policy lever that drives the 2028 sunset trajectory: as existing membership ages and migrates organically, non-aligned D-SNPs lose their enrollment base.

The narrow exception: dual-eligible members already enrolled in a non-aligned D-SNP as of December 31 immediately preceding the EAE designation may remain. Members with a pre-existing relationship may also be permitted to remain temporarily in narrow circumstances determined by DHCS.

Principle 3, Default Enrollment Pilot (San Diego and San Mateo)

The Default Enrollment Pilot adds a forward-looking auto-alignment for Medi-Cal-only members who are about to become Medicare-eligible (typically by aging into 65 or by qualifying for SSDI Medicare after the 24-month waiting period). Rather than letting these members fall into a gap period of original Medicare + uncoordinated Medi-Cal, the pilot auto-enrolls them into the matching parent organization's Medi-Medi Plan effective the first day of their Medicare entitlement.

Members retain the right to opt out and choose original Medicare or a different Medicare Advantage plan, but the default minimizes the coverage-fragmentation risk during life-stage transitions. CMS approved the Default Enrollment Pilot in San Diego and San Mateo for 2025-2026 evaluation; expansion to additional counties is under active discussion.

Los Angeles County 2026: The Seven Medi-Medi Plans

Los Angeles County is by far the largest dual-eligible market in California (and one of the largest in the country). Seven Medi-Medi Plans operate in LA County for 2026:

Members can compare and enroll through Health Care Options (HCO) at 1-800-430-4263 or healthcareoptions.dhcs.ca.gov. Medicare's annual enrollment window and the Medicare Advantage Open Enrollment Period (see the Medicare sign-up page for current dates) are the primary windows for picking or switching plans. Dual-eligibles also have continuous Special Enrollment Period rights that allow plan changes more frequently than the general Medicare population, but California strongly discourages frequent switching due to Continuity of Care complexity. Confirm current enrollment windows with HCO or your local HICAP counselor before changing plans.

What Members Actually Experience: Before vs After

The clearest way to understand Medi-Medi Plans is through the lived member experience.

Before Medi-Medi (legacy fragmented coverage)

A 72-year-old Sacramento resident with early-stage dementia and Type 2 diabetes:

• Carries two ID cards, one for Medicare Advantage Plan A (covering hospital, doctor, Part D drugs), one for Medi-Cal MCP B (covering IHSS coordination, dental).
• Has two care coordinators who don't share medical records and call each other rarely.
• Sees a primary care physician who is in-network for Plan A but out-of-network for Plan B (Medi-Cal won't cover the PCP visit because it's already covered by Medicare; but if she needs a Medi-Cal-only service, the referral chain breaks).
• Has two prior-authorization workflows, one when her doctor orders a CT scan (Medicare side), one when she needs a wheelchair ramp (Medi-Cal HCBS side).
• Files two grievances if a service is denied, one through the Medicare appeals process, one through the Medi-Cal grievance and DHCS State Hearing process.
• Receives Enhanced Care Management referral but the ECM provider has to coordinate with two separate plans, doubling the documentation overhead.

After Medi-Medi (integrated coverage)

The same member enrolls in Anthem MediBlue Coordination Plus, Anthem's Medi-Medi Plan in Sacramento County:

• Carries one ID card.
• Has one care coordinator with full visibility into both Medicare and Medi-Cal benefits.
• Sees a primary care physician who is in-network for both sides by definition (the plan operates on a single network).
• Files one grievance through one integrated process.
• ECM coordination is delivered seamlessly across both Medicare and Medi-Cal, including coordination with IHSS hours, CalAIM Community Supports (e.g., Personal Care and Homemaker Services for help around the house), and Medicare Advantage supplemental benefits (e.g., the plan's transportation benefit for medical appointments).
• When she ages into needing nursing-facility care (long-term-care services kicking in), the plan handles the entire transition, Medi-Cal Long-Term Care benefit, Medicare hospice if applicable, share-of-cost calculations, and SNF placement, without the member having to coordinate between separate carriers.

The integration isn't just administrative convenience. It produces measurable improvements in care: Cal MediConnect (the predecessor program) demonstrated lower hospital readmissions, higher medication adherence, and better Patient-Reported Outcomes than fragmented coverage. EAE D-SNPs are projected to deliver similar or better results because the alignment requirements are stricter than Cal MediConnect's were.

CalAIM Integration Through Medi-Medi Plans

Because Medi-Medi Plans hold the Medi-Cal MCP contract on the Medi-Cal side, they deliver the full CalAIM program suite:

• Enhanced Care Management (ECM): The original nine Populations of Focus (2022-2025) were consolidated into 10 updated POF categories under the January 2026 ECM Policy Guide. Older adults at risk of nursing-facility admission, members with serious mental illness, members experiencing homelessness, members transitioning from incarceration, and members in nursing facilities are key POFs for dual-eligibles.

• Community Supports (CS): All 14 CS plus the 15th Transitional Rent benefit are available through Medi-Medi Plans that elect to offer them. The most relevant CS for older dual-eligibles include:

  • Recuperative Care (post-hospital short-term housing with services)
  • Short-Term Post-Hospitalization Housing
  • Personal Care and Homemaker Services
  • Respite Services (for family caregivers)
  • Medically Tailored Meals
  • Sobering Centers
  • Day Habilitation Programs
  • Nursing Facility Transition / Diversion to Assisted Living
  • Asthma Remediation
  • Environmental Accessibility Adaptations (home modifications)
  • Housing Tenancy Sustaining Services
  • Housing Deposits
  • Transitional Rent (15th, federally first under §1115 Amendment 6, Dec 2024)

• Population Health Management (PHM): 4-tier risk stratification with CalAIM-defined Risk Stratification, Segmentation, and Tiering (RSST) methodology, reaches every Medi-Medi enrollee within 90 days of enrollment.

• Justice-Involved Pre-Release Services: Members transitioning from incarceration receive 90-days pre-release Medi-Cal services and post-release ECM engagement under the CalAIM §1115 demonstration.

• No Wrong Door for Behavioral Health: Members receiving BH-CONNECT services (effective 1/1/2025) have coordinated transitions between Medi-Medi Plan, county BH plan, and Medicare BH coverage.

Continuity of Care: Your Rights During a Transition

Members transitioning into a Medi-Medi Plan from a non-aligned D-SNP, original Medicare + Medi-Cal fee-for-service, or a different Medi-Medi Plan have federal and California Continuity of Care (CoC) rights that prevent disruption to existing care. Under DHCS continuity-of-care rules (see the DHCS Continuity of Care FAQ and the Medi-Cal Provider Manual), members can:

• Continue with existing out-of-network providers for up to 12 months if the relationship is established (defined as having seen the provider in the prior 12 months).
• Continue active treatment authorizations for at least 90 days including specialty care, surgical pre-authorizations, and ongoing therapy.
• Maintain ongoing prescriptions, DME, and home-health services through the plan's standard formulary-transition and continuity-of-care processes. Call the new plan's pharmacy line to confirm transition-fill rules before your existing supply runs out.
• Reset the 12-month CoC clock once if the member changes plans during the first 12 months of CoC, but it extinguishes after the second cycle.

CoC requests must be submitted to the new plan within 30 days of the plan transition; the plan has 30 calendar days to respond. The plan's response must include a written CoC determination letter; if the member disagrees, they may file a grievance and request a State Hearing.

The most important practical point: a member transitioning into a Medi-Medi Plan should call the new plan within the first 30 days and submit a CoC request listing every provider, specialist, prescription, and authorization currently in place. This single phone call prevents the vast majority of post-transition disruption.

Opt-Out: Your Rights If You Don't Want a Medi-Medi Plan

Auto-alignment is mandatory in EAE counties, but enrollment in any specific Medi-Medi Plan is voluntary. Members may:

• Opt out of auto-alignment at the time of Medicare enrollment, by choosing original Medicare instead of Medicare Advantage (in which case Medi-Cal coverage continues separately through fee-for-service or a non-aligned MCP). This is the only way to remain outside the EAE framework in an EAE county.
• Switch to a different Medi-Medi Plan during Medicare's annual enrollment window, the Medicare Advantage Open Enrollment Period, or any applicable Special Enrollment Period.
• Switch to original Medicare + traditional Medi-Cal during the annual enrollment or MA-OEP windows.

Note that opting out of Medicare Advantage entirely is a significant decision, original Medicare lacks the supplemental benefits (transportation, dental, OTC, fitness) that Medi-Medi Plans provide, and the member loses the integrated experience that the Matching Plan Policy is designed to deliver. Most California elder-law advocates (CANHR, Justice in Aging) recommend Medi-Medi enrollment as the default unless the member has specific clinical or geographic reasons to remain in original Medicare.

How Medi-Medi Plans Differ From Cal MediConnect (2014-2022)

For Californians who remember the predecessor program, Medi-Medi Plans look superficially similar but operate on a different legal and operational framework:

The two key improvements in Medi-Medi over Cal MediConnect: (a) no sunset date, the federal demonstration authority was time-limited; D-SNP authority is permanent; and (b) deeper carrier choice in the largest counties, Cal MediConnect had limited carrier selection; the EAE model under APL 24-013 supports more competing aligned plans.

12 Common Pitfalls

1. Auto-aligning to a Medi-Medi Plan and not submitting a CoC request within 30 days. This is the #1 source of post-transition disruption. Call the new plan immediately and list every provider, specialist, prescription, DME, and authorization in place.
2. Switching plans more than once per quarter. Dual-eligibles have generous SEP rights but each switch starts a new CoC clock, and the second switch within 12 months may reduce CoC rights to zero. Choose carefully.
3. Confusing "auto-alignment" with "no choice". Auto-alignment defaults the Medi-Cal carrier when Medicare is chosen, but the member always has the right to choose a different Medi-Medi Plan during the next enrollment window.
4. Assuming all Medicare providers are in the Medi-Medi network. Provider networks may be narrower than legacy Medicare Advantage networks because the same network must serve both Medicare and Medi-Cal lines. Verify each provider before the transition.
5. Forgetting that Medi-Cal Rx is a carve-out. Pharmacy benefits go through Medi-Cal Rx (the state's PBM contract with Magellan), not the Medi-Medi Plan's pharmacy network. The Medi-Medi card is for medical services; Medi-Cal Rx benefits use a separate process.
6. Missing the 90-day initial-enrollment switch window. Members can switch Medi-Medi Plans freely within 90 days of initial enrollment, without showing cause and without restriction. This is the easiest time to switch if the auto-aligned plan isn't a good fit.
7. Not coordinating with IHSS. IHSS coordination through Medi-Medi Plans is an improvement over fragmented coverage but it requires the member to inform the plan of their IHSS hours and provider. The plan's care coordinator can coordinate with the county IHSS social worker.
8. Missing Community Supports because the plan didn't tell you. Community Supports are optional for plans to offer and discretionary in selection. Ask the plan's care coordinator specifically: "Which CS are available on my plan?" Document the answer.
9. Assuming the plan covers everything Medicare and Medi-Cal cover. Some narrow-scope services remain carved out: county BH for SMI/SED/SUD, Medi-Cal dental (Denti-Cal), and some Regional Center services for I/DD. Confirm carve-out boundaries with the plan.
10. Choosing a non-aligned D-SNP because it has better Medicare Advantage benefits. In EAE counties, this option is closed to new enrollees as of 2025-2026. Members choosing this path must accept that the plan will be sunset by 2028 and they will need to migrate at some point.
11. Not asking about ECM eligibility. Many older dual-eligibles qualify for Enhanced Care Management, and may not know it. Eligibility extends to homeless members, members with serious mental illness, members transitioning from incarceration, members at risk of nursing-facility admission, and several other Populations of Focus. Ask explicitly.
12. Filing grievances through the wrong process. Medi-Medi Plans use an integrated grievance and appeal process, not separate Medicare-side and Medi-Cal-side processes. Use the plan's single grievance phone number on the back of the ID card.

The Bottom Line

If you remember nothing else from this guide, remember these six things:

1. Medi-Medi Plans are California's new default for dual-eligibles. As of 1/1/2026, 41 of 58 counties operate under the Matching Plan Policy. Most full-benefit duals will eventually be in a Medi-Medi Plan or original Medicare + non-aligned Medi-Cal, there is no third option in EAE counties.
2. Integration solves the single biggest problem in dual coverage: fragmentation. One ID card, one care coordinator, one provider network, one grievance process. The complexity of two separate systems disappears.
3. CalAIM benefits flow through Medi-Medi Plans. ECM, all 14 Community Supports plus Transitional Rent, Population Health Management, and Justice-Involved Pre-Release services are all delivered through the same plan as Medicare benefits.
4. Continuity of Care is your primary protection during transitions. A 30-day CoC request to your new plan locks in 12 months of out-of-network provider continuation. Don't skip this step.
5. The 17 non-EAE counties will follow. Partnership HealthPlan launches in 2027, and Regional Model rural counties will likely follow. The geographic gap is closing.
6. Choose carefully, but don't be afraid of the change. Auto-alignment defaults a plan, but you have the right to switch during the initial 90-day window, the Medicare annual enrollment window, MA-OEP, or applicable SEPs. Compare carriers based on provider network, pharmacy formulary, supplemental benefits, and Community Supports availability, and call the new plan immediately after enrollment to file a CoC request.

The 2026 expansion is the single largest improvement in California dual-eligible coverage in a decade. Used well, it transforms what used to be a fragmented, frustrating coverage experience into a single coordinated package of care.

California Medi-Medi Plans: 16 Resources Worth Knowing

Find personalized help understanding your Medi-Medi Plan options at brevy.com.