Eligibility Requirements

We would like to help answer your questions about Cal MediConnect. We will be glad to help you make the right health care decisions for you and your family.

To be a member of Health Net Cal MediConnect, you must:

  1. Live in the Health Net Cal MediConnect service area (Los Angeles and San Diego counties).
  2. Be age 21 or older.
  3. Have full Medi-Cal coverage, and
    • Be enrolled in Medicare Parts A and B, and
    • Be eligible for Part D.
  4. Have no cost-share.
  5. Or, if you have cost-share, you must
    • Be in a Medi-Cal-funded nursing facility, or
    • Be enrolled in the Multipurpose Senior Services Program (MSSP), or
    • Be getting In-Home Supportive Services (IHSS)

Best Available Evidence (BAE) For Low Income Subsidy (LIS) members

There are times when Centers for Medicare and Medicaid Services (CMS) does not have the right information about a Medicare beneficiary's LIS status. This means that the wrong information can be given to Health Net or your plan sponsor.

CMS created the Best Available Evidence (BAE) policy in 2006 to deal with this issue. The policy requires plan sponsors to offer the right amount of cost-sharing for low-income beneficiaries when CMS reports the wrong LIS information.

Go to the CMS.gov website