COVID-19 CMSP access to care

The County Medical Services Program Governing Board (CMSP) has issued instructions regarding access to care because of COVID-19.  Counties must delay discontinuances and negative actions for CMSP because of COVID-19.  This delay is effective for 90 days.

Denied Medi-Cal applicants who are age 21-64, not disabled and over income for MAGI-based Medi-Cal should be screened for CMSP eligibility and provided the CMSP Supplemental Application.  The CMSP Supplemental Application may be signed by telephonic signature.

Covered California’s special enrollment period because of COVID-19 will not be considered open enrollment for purposes of CMSP eligibility determinations.

CMSP will provide coverage for COVID-19 testing for all CMSP members at no cost.  Share of Cost requirements will be waived for any provider office, urgent care center, and emergency room visits to receive COVID-19 testing at contracted and non-contracted providers within California.  (CMSP Letter 20-02, March 31, 2020.)

Expanded eligibility and services under CMSP

As of May 1, 2016, the County Medical Services Program (CMSP) is changing some of its eligibility requirements and benefits.  CMSP provides limited-term health coverage for indigent residents in 35 mostly rural California counties.  These changes should be operational in C-IV counties by May 23, and in CalWIN counties by May 9.

Eligibility Changes

The CMSP Eligibility Manual has been revised with new provision taking effect after May 1, 2016.  Among the changes that have been made:

  • Increasing the cap on income eligibility from 200% FPL to 300% FPL
  • Eliminating the asset test and share of cost for those with incomes up to 138% FPL (in line with MAGI Medi-Cal)
  • Increasing the asset limit for those with incomes between 138% FPL and 300% FPL to $20,000 for individuals and $30,000 for couples
  • Reducing the share of cost for those with incomes between 138% FPL and 300% FPL by 75%
  • Establishing a one-month retroactive eligibility period that replaces the ten-day pre-enrollment eligibility period
  • Revising the term of enrollment to six months

Note that the CMSP application process is supplemental to the Medi-Cal application.  The time period for counties to complete all processing will be 75 days.  Undocumented recipients will still be primarily limited to restricted scope benefits.

CMSP ACL No. 16-02 (April 27, 2016).

Benefit Changes

As of May 1, 2016, CMSP members with a share of cost will qualify for a new CMSP Primary Care Benefit in addition to the CMSP Standard Benefit.  Under this new Primary Care Benefit, eligible members will receive:

  • Up to three medical office visits with a primary care doctor, specialist, or other selected services with no share of cost or copay
  • Preventive health screenings with no copay or share of cost
  • Specific diagnostic tests and minor office procedures with no copay or share of cost
  • Prescription drug coverage up to $1500 in prescription costs, with a $5 copay

Benefits must be provided during the Primary Care Benefit eligibility period (members will get a special card in addition to the standard CMSP card and BIC) by a contracted CMSP provider with a reservation.

The Primary Care Benefit will begin the first of the month following approval for CMSP eligibility with no retroactive coverage provided.

CMSP ACL No. 16-03 (April 27, 2016).

Change in Third Party Administrator for CMSP Benefits

As of April 1, 2015, CMSP medical and dental benefits will be authorized by Advanced Medical Management, taking over for Anthem Blue Cross.  On March 3, 2015, beneficiaries were mailed notices regarding this transition.  CMSP ACL 15-02 (3/3/15).

AEVS responses and the Medi-Cal Provider Operations Manual will be updated to reflect this change as of April 1, 2015.  DHCS MEDIL I 15-06 (3/6/15).

CMSP ACL 14-08: CMSP Policy on Determination of Other Health Coverage Under Covered California (10/15/14)

The CMSP Governing Board issued this letter to update its current policy regarding Covered California eligibility to reflect Open Enrollment dates of November 15, 2014, to February 15, 2015.

The policy is largely unchanged.  If a CMSP application is received during the period between the first day of Covered California open enrollment and 15 days before the end of open enrollment, that application is considered “subject to the Covered California open enrollment period.”  As such, CMSP applicants who are not eligible for Medi-Cal must provide evidence of application for and first month’s premium payment of Covered California participation.  Those applicants not subject to the open enrollment period (here, starting 2/1/15) must provide evidence of termination from Covered California for lack of monthly premium payment and lack of eligibility for a special enrollment period.

CMSP ACL 13-06: Eligibility Appeal & Grievance Process for Path2Health and CMSP – UPDATE

This letter provides the new number that consumers can use to request hearings and make grievances related to Path2Health and CMSP.  The number is (800) 548-5880 and connects applicants/enrollees to the CMSP Governing Board.  The Governing Board will send a form with the hearing request/grievance information to a county designee who must then confirm receipt of the information by fax and log the information.  A copy of the form that the Governing Board will use is an attachment to the letter, available here.  Counties are also reminded that they are to treat verbal requests for hearings and grievances in the same manner that they treat written requests and grievances.