DHCS has issued a letter to inform counties about the expansion of Medi-Cal to individuals under age 19 without satisfactory immigration status but who are otherwise eligible for the program. CalHEERS changes should be effective no sooner than May 15, 2016, with eligibility effective as of May 1, 2016 (assuming implementation of system changes occurs in May; effective eligibility will be pushed back according to when CalHEERS changes).
SB 75 does not implement new aid codes (the DHCS letter includes a crosswalk of aid codes as a reference), nor does it change any requirements to verify citizenship under federal regulations or state law. Counties, however, must not request verification from children who do not claim satisfactory immigration status. The SB 75 determination and transition does not reset a beneficiary’s annual redetermination date.
Individuals under 19 who do not have satisfactory immigration status are eligible for full-scope Medi-Cal under SB 75. Individuals who turn 19 on or before May 1, 2016, will not be considered eligible for full-scope benefits through the transition of current restricted-scope beneficiaries. The transition population is supposed to receive three notices: a general information notice, a notice of action, and a managed care plan enrollment notice.
New applicants will be able to submit an application through all current application pathways. Prior to SB 75 implementation, new applicants will be determined eligible for restricted scope eligibility and can then be considered part of the transition population for full-scope eligibility. Retroactive coverage is available for only those months when SB 75 is available; restricted scope retroactivity will be available in appropriate cases. New enrollees will receive a notice of action and a Health Care Options enrollment packet (in non-COHS counties).
The transition period is expected to begin no sooner than May 15, 2016. Once both CalHEERS and SAWS are ready, SAWS will identify eligible restricted scope individuals under age 19 and process the transition into full scope through CalHEERS and/or SAWS, then generate and send an appropriate NOA. New enrollees and transition population beneficiaries will be enrolled in managed care depending on whether the beneficiary resides in a COHS or non-COHS county, whether the beneficiary will be aging out within six months, and whether the beneficiary has a share of cost or other health coverage.
When SB 75 eligible individuals age out of the program, Counties must redetermine eligibility. A timely NOA is always required in these situations; if a beneficiary does not receive timely notice, counties will restore eligibility manually in SAWS until a proper and timely notice is issued.
DHCS ACWDL 16-12 (May 4, 2016).