DHCS issued a letter to the counties about a workaround for women enrolled in a Covered California plan with premium tax credits to remain in their health plans and not transition to Medi-Cal when they report a pregnancy.
The State expanded full-scope Medi-Cal for pregnant women from 60% FPL to 138% FPL. Pregnancy-related Medi-Cal, covering women between 138% and 213% FPL, has been considered minimum essential coverage (MEC), which would normally disqualify them from Covered California plans with APTCs.
There is an exception for women who are enrolled in APTCs and then become pregnant, making them eligible for MEC Medi-Cal. This workaround allows these pregnant women to keep their Covered California plan rather than being transitioned to Medi-Cal, if they choose. While a change request has been submitted to CalHEERS to fix this, it is tentatively scheduled to take effect in October 2016.
The M9 manual workaround involves informing affected women who have been impacted by the transition about their option to remain in Covered California. Pregnant women can either contact a County eligibility worker or Covered California to exercise this option. These women will be discontinued from Medi-Cal, and the pregnancy record will be removed from the CalHEERS account.
DHCS MEDIL I-16-03 (April 14, 2016).