Author: John Tan

Recent DHCS Clarifications on Verifications and Paperwork

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Annual Redetermination Signature Requirements

DHCS is clarifying the signature requirements for the MAGI and Non-MAGI renewal forms, as well as the property supplement form.  The renewal form may be signed by handwriting,  electronic signature, or telephonic recorded signature. Beneficiaries may respond via the Internet, mail, phone, in person, or other electronic means.  Counties must accept electronic signatures. DHCS MEDIL I 18-13 (September 14, 2018).

Supplemental Income Verification

  • October 12, 2018 ACWDL 18-21

CDSS administers a commercial income verification service on behalf of counties for the CalFresh and CalWORKs programs.  Any recent reports from this service should be used to determine Medi-Cal eligibility as part of ex parte review. DHCS ACWDL 18-21 (October 12, 2018).

Social Security Number in MEDS for Children in the Child Welfare System

  • October 16, 2018 ACWDL 18-23

As a condition of eligibility, a Medi-Cal applicant must provide a Social Security Number to receive full-scope Medi-Cal.  Because of post-adoptive records, counties have inconsistencies in entry and maintenance of records.  DHCS directs counties to use the child’s existing SSN (if available) and CIN in MEDS throughout the child’s history in the child welfare system.  If the adoptive parents change the child’s SSN, the county should use the new SSN in MEDS. DHCS ACWDL 18-23 (October 16, 2018).

New Medi-Cal Authorized Representative Forms

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DHCS is providing counties with new documentation around designating an authorized representative for Medi-Cal.

  • Appointment of Authorized Representative Form (MC 382): provides an applicant/beneficiary with a way to appoint an AR, limit the AR’s scope, and authorize an individual or organization as AR.
  • Notice of Authorized Representative Appointment (MC 380): notifies the beneficiary and AR of appointment and scope of appointment.
  • Authorized Representative Standard Agreement for Organizations (MC 383): allows an individual acting on behalf of an AR organization to sign agreements.
  • Cancellation or Change to a Medi-Cal Authorized Representative Appointment Letter (MC 381): informs the applicant/beneficiary of cancellation or change in scope of AR appointment.

The current MC 306 Appointment of Representative form will no longer be acceptable after June 4, 2019. DHCS’s guidance includes examples about AR appointment and cancellation.

DHCS ACWDL 18-26 (December 4, 2018)

Expanding Guidance on Medi-Cal Spousal Impoverishment Rules

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The Affordable Care Act broadened the definition of an “institutionalized spouse” to include HCBS recipients and persons who have requested HCBS and generally reside at home or in the community. DHCS ACWDL 17-25 (July 19, 2018) initially extended spousal impoverishment rules from institutionalized spouses in long term care settings to applicants and recipients of other HCBS and waiver programs.  DHCS has clarified that the spousal impoverishment provisions apply to registered domestic partners.

Spousal impoverishment rules apply to the first month when a request for HCBS or IHSS has been made and the individual meets a nursing facility level care.  These rules must be applied to HCBS spouses who request IHSS and provide a verification form.  These provisions should be applied retroactively; DHCS provides examples of how to apply these rules.

The Letter walks through the process of applying spousal impoverishment rules to the HCBS spouse and community spouse.  First, the county needs to characterize property and apply any CSRA protections. Next, the county would calculate income. An eligible individual would be placed in a budget unit separate from the community spouse once the couple’s property meets the CSRA limit plus $2000.

The HCBS spouse will remain eligible (short of change in circumstance) unless and until the county denies the HCBS request.  At annual renewal, the HCBS spouse only needs to confirm continued HCBS participation. Continuous eligibility ends when the HCBS spouse or institutionalized spouse does not receive HCBS waiver services or inpatient care for a full calendar month.

If the community spouse applies for Medi-Cal, that spouse will need to spend down non-exempt countable property before the end of the month of application.  A spousal income allocation is still permitted.  However, if the community spouse requests HCBS, there is no longer a community spouse.  The letter also goes through applying these rules retroactively, including reimbursement through the Conlan process.

DHCS ACWDL 18-19 (August 21, 2018)

Medi-Cal Eligibility Exceptions due to Public Health Crisis or Disaster

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DHCS has issued guidance about the timeliness exceptions for processing applications and redeterminations in counties affected by a state or federally declared major public health crisis or natural disaster.

Applicants in affected areas requested expedited medical services shall not have their applications delayed.  Counties shall inform persons with immediate needs of available resources, expedite eligibility determinations, and accept self-attestation and electronic verification.

Any beneficiaries in affected areas shall have discontinuances delayed to the extent possible and be allowed additional time to provide required documents.  The County shall accept a signed and dated affidavit in place of requested verification documentation.  Those who were discontinued may have their benefits reinstated and given more time to provide information.

DHCS will waive premiums for state programs when a major public health crisis or natural disaster occurs.  Cash payments received for repair or replacement of lost, damaged, or stolen exempt property shall be treated as exempt property for nine months from the date of receipt (can be extended for good cause).

A beneficiary’s current health plan will be the point of contact for services out of county until an official change of address occurs.  Beneficiaries who are displaced may get assistance with transferring a case on a permanent or short-term basis.

DHCS ACWDL 19-01 (January 9, 2019)

Recent Changes to Medi-Cal Notice of Action Requirements

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Revised NOA for 250% Working Disabled Program Approval

DHCS has revised NOAs for Working Disabled Program approvals to clarify that couples do not need to pay separate premiums as a couple.  DHCS has also revised its EFT premium payment flyer for county use. DHCS ACWDL 18-18 (August 9, 2018).

NOAs for Beneficiaries Who Do Not Complete Non-MAGI Evaluation at Annual Renewal/Change in Circumstance

DHCS updated guidance to counties regarding MAGI discontinuance NOAs when the beneficiary is ineligible for MAGI, is potentially eligible for Non-MAGI, and the beneficiary does not complete the Non-MAGI evaluation when ex parte review is not successful.  The discontinuance NOA must indicate both why a beneficiary is not eligible for MAGI and why the county could not complete the Non-MAGI evaluation.  This guidance provide required language for such notices. DHCS ACWDL 18-24 (October 29, 2018).

Information Regarding Reporting Requirements on NOAs

DHCS is providing guidance about the requirement to include information about an applicant’s or beneficiary’s responsibility to report changes in circumstances on all MAGI and Non-MAGI NOAs that approve, change, or continue Medi-Cal eligibility.  The letter includes sample NOA snippets for various situations. DHCS ACWDL 19-02 (January 9, 2019).

NOA Requirements at Annual Renewal or Change in Circumstance Resulting in Resetting Annual Renewal Date

DHCS has issued updated requirements for NOAs for continuing eligibility at annual renewal and change in circumstances.  Federal regulations require counties to send NOAs when there are no changes to eligibility at annual renewal or following a change in circumstances resulting in resetting of the annual renewal date.  DHCS has provided sample language for these circumstances. DHCS ACWDL 19-03 (January 9, 2019).