Provider D-SNP Frequently Asked Questions

CA Department of Health Care Services (DHCS) is requiring (PDF) the state specific D-SNP only contracts for 2024, which requires transition of both Wellcare CA members in H contract H5087 and Wellcare By Health Net members in H contract H0562 to be moved to contract H3561 effective January 1, 2024.

All Wellcare D-SNP members will need to use the providers contracted under H3561. There are impacts to the provider network. If you are a contracted provider with Wellcare By Health Net for 2024, please refer to the Wellcare By Health Net Provider Resource Page to access more detail information.

Reach out to your provider team to confirm your participation as a dual eligible D-SNP provider in the 2024 D-SNP Plan Network.

Wellcare 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 D-SNP program, members are eligible for continuity of care for 12 months following the transition.

Use your existing provider services contact number.

Under exclusively alignment enrollment, members enroll in a dual eligible special needs plan (D-SNP) for Medicare benefits and in a 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.

Wellcare’s parent organization is Centene, Inc.

For Centene plans in California, the exclusively aligned enrollment D-SNP plans will be Wellcare D-SNP with a Health Net Medi-Cal plan in Los Angeles, Sacramento, and Tulare Counties.

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 an exclusively aligned enrollment 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, this will occur in Los Angeles county.

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.

Members will be notified of 2024 plan changes by mail via the Annual Notification of Changes (ANOC) in September 2023.

The Annual Notification of Change will outline specific changes in benefits between the current year (2023) and the next plan year (2024).

Advise your patients to ensure their Medicare plan has their current address and best contact phone number so they receive the information.

Providers will receive communications related to this transition throughout 2023, and after the transition occurs, as needed. Providers are also encouraged to access the D-SNP Resources for Providers page online for the most current resources and updates, as the page is updated regularly.

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. Wellcare D-SNP plan will be under the H3561 contract and the associated provider network.

Reach out to your provider team to confirm your participation as a dual eligible D-SNP provider in the H3561 network. (This could be different from the previous year's D-SNP network)

Wellcare 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 D-SNP program, members are eligible for continuity of care for 12 months following the transition.

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 required any new dually eligible beneficiary to enroll in a Medi-Cal managed care plan. For more information, visit the DHCS website.