CalAIM-Aligned Medi-Medi Plans for Duals Are Expanding to 29 Counties on January 1: Are Health Plans Ready?
October 31, 2025 | By Jaya Gazula and Sarabeth Zemel, JD
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Every day, more than 1.7 million Californians navigate the complexities of being dually enrolled in Medicare and Medi-Cal. These “duals” — older adults and individuals with disabilities who qualify for and are enrolled in both Medicare and Medi-Cal — often experience fragmented and uncoordinated care across the two distinct benefit programs.
Navigating separate health plans to access benefits and services creates unnecessary complexity for patients and providers alike, contributing to administrative burdens and higher costs.
Making a Change to Improve Care and Lower Costs
On January 1, 2026, California will take a transformative step toward fixing that fragmentation through the expansion of aligned Dual-Eligible Special Needs Plans (D-SNPs) in 29 counties.
The launch of these new Medi-Medi Plans (MMPs), also referred to as Exclusively Aligned Enrollment Dual Eligible Special Needs Plans (EAE D-SNPs), through CalAIM marks a defining opportunity to improve care for one of the state’s most vulnerable populations and lower overall health care costs.
The new plans combine Medicare and Medi-Cal benefits into one plan that provides all Medicare benefits and wraparound Medi-Cal services, as well as specialized care coordination. If implemented effectively, MMPs have the potential to ensure that duals receive highly integrated care that enhances their health and care experience.
The success of MMPs in California will depend on the active participation of physician organizations on the front lines caring for duals, particularly those that provide value-based care through capitated models (i.e., providers receiving a fixed, pre-set payment for each patient), delegated models (i.e., plans assigning responsibilities to the medical group along with the capitated payment), or taking on financial risk for health care services.
These providers already have established relationships with dual-eligible patients, play a central role in managing their health care, and have the infrastructure and expertise to effectively manage patient health. The participation of capitated and delegated providers in MMPs is important to meaningful integration that improves the experience and health of duals.
Guidance for Policymakers, Health Plans, and Providers
To inform this statewide effort to better align care for duals from the perspective of capitated and delegation medical providers, Transform Health was engaged by America’s Physician Groups (APG), with support from the California Health Care Foundation (CHCF), to develop a three-part issue brief series for policymakers, health plans, and providers.
The issue briefs draw on interviews with 20 physician organizations collectively serving more than 200,000 dual-eligible Californians, providing practical insights and recommendations for policymakers, health plans, and medical providers implementing MMPs. The briefs highlight operational and clinical insights to inform California’s success in implementing aligned D-SNPs.
Insights from the Field
Providers expressed strong support for the goals of integrated care and recognized the potential for EAE D-SNPs to improve patient outcomes and care delivery. However, they also identified several implementation challenges that must be addressed to ensure success.
Key Challenges:
- Medical providers and care teams often lack visibility into plan-based or third-party care coordinators, including Enhanced Care Management (ECM), California Integrated Care Management (CICM), Community Health Worker (CHW), and Community Supports personnel. This leads to service gaps, duplication of care, and confusion about who is responsible for assisting shared members.
- Health plans’ provider portals and member lists often differ in format and content, and they can lag in flagging changes to members’ coverage and contact information.
- Payment alignment across provider types and hospital systems, as well as adequate rates for preventive and primary care, remain key challenges.
At the same time, providers emphasized tangible solutions that could strengthen alignment and improve readiness for 2026.
Key Opportunities:
- Develop a centralized, real-time database for MCPs, medical providers, community-based ECM and Community Supports providers, and members to verify and update contact details, leveraging evolving technology within DHCS’ Population Health Management initiative.
- Facilitate regular joint operating meetings can clarify expectations, responsibilities, and compliance obligations, and provide a consistent platform for communication.
- Use standardized contracts and delegation agreements, including coded Division of Financial Responsibility (DOFR) templates to support value-based contracting.
Charting the Path Forward
To realize the full promise of EAE D-SNPs, multi-stakeholder collaboration will be essential. The provider organizations we spoke with through this project made recommendations for DHCS, health plans and providers to work together to:
- Build interoperable data systems and analytics tools that support coordination across providers and systems.
- Delegate care management responsibilities to provider organizations to strengthen care coordination and improve health outcomes, but sustainable impact depends on aligning incentives to ensure these providers are meaningfully engaged within the EAE D-SNP network.
- Establish forums for providers to participate meaningfully in DHCS and health plan implementation design and share best practices statewide.
These actions are critical to advancing the goals of CalAIM, California’s broader effort to transform Medi-Cal into a more equitable, coordinated, and whole-person system of care. With thoughtful implementation, EAE D-SNPs can position California as a national leader in integrating care for individuals dually eligible for Medicare and Medicaid.
What’s Next?
As California prepares for the 2026 expansion of MMPs, policymakers, plans, and providers can leverage these issue briefs as actionable tools for designing and implementing policies, processes, and care models that meet the needs of duals.
Explore the full series:
Say informed: Join the CalAIM MLTSS and Duals Integration Workgroup led by DHCS.
Work with us: Transform Health partners with health plans and providers to translate these policy shifts into action-strengthening MMP implementation, compliance, and member experience. Book a free discovery call to learn more.
Transform Health is an Inc. 5000-ranked national private health care consulting firm with a mission to drive systems change to build healthy communities.