Effective March 1, 2025, HPSM Medi-Cal members who become newly eligible for Medicare Parts A & B will be automatically enrolled in CareAdvantage D-SNP. This new process is part of the Department of Health Care Services (DHCS) Medicare Advantage Default Enrollment Pilot. HPSM is proud that DHCS chose us as one of only three health plans in California for this pilot. Default enrollment has also been used in 12 states and Puerto Rico since 2023 with proven success.
Approximately 40 HPSM Medi-Cal members will be enrolled in CareAdvantage on March 1st. Going forward, Medi-Cal members will continue to be enrolled in CareAdvantage as they become eligible (for example, when they turn 65 or due to qualifying disability). This will make members’ healthcare better with easy transition to a comprehensive health plan featuring enhanced benefits, coverage and care coordination.
How providers can keep seeing their transitioning patients
As a result of default enrollment, CareAdvantage network providers who want to see more patients will potentially benefit by getting more referrals. Members enrolled via Default Enrollment will be assigned to the same HPSM Medi-Cal providers if they're also contracted with CareAdvantage. However, non-CareAdvantage providers who want to keep seeing their affected patients have several options:
Get continuity of care (COC)
As part of the pilot, DHCS stipulates that HPSM Medi-Cal members who are default-enrolled in CareAdvantage can get continuity of care with their current providers for up to 12 months. Members can get COC by calling the CareAdvantage Unit.
- We sent letters to all affected members 60 days in advance of the implementation date, so your patients should already know they will be enrolled in CareAdvantage by default. These letters included new CareAdvantage member ID cards as well as instructions for requesting COC and (for those who want to remain Medi-Cal members) opting out of default enrollment before March 1st or within 90 days of enrollment.
- Both network and non-network providers currently seeing HPSM Medi-Cal members can keep seeing those members after March 1st through COC. Providers who accept Medicare and Medi-Cal can simply send HPSM a bill for services. Providers who do not accept Medicare and Medi-Cal can request a letter of agreement (LOA) with HPSM to continue seeing affected members
Apply to HPSM’s CareAdvantage network
If a member is granted COC and wants to continue seeing you past the extension period, apply to HPSM’s CareAdvantage network. You can then accept additional CareAdvantage patients and enjoy benefits that include:
- Competitive reimbursement rates. Providers in our Medi-Cal network earn 80% of the Medi-Cal rate during the COC period. But contracted CareAdvantage providers are paid 100% of the rate.
- No annual deductible.
- No referral authorization required for outpatient services.
- One local contact for questions.
Apply to HPSM’s CareAdvantage network by completing our online application. Under request type, choose “Joining as rendering Provider(s) to an existing Provider Group.” If you have any questions, contact HPSM Provider Services.
Help your affected patients transition to CareAdvantage providers
This is a good option for those who don’t want to join HPSM’s CareAdvantage network. You can still request COC, but after that period, your affected patients will transition to CareAdvantage providers.
If you have questions about default enrollment, email Provider Services.
