All Medi-Cal managed care plans are required to coordinate the care and placement of beneficiaries who need long term care services. Plans in non-COHS counties are responsible for all medically necessary long term care services provided from the time of admission into a long term care facility and up to one month after the month of admission. For beneficiaries requiring a longer LTC stay, plans must submit a disenrollment request to DHCS to be effective the first day of the second month after admission. Non-COHS plans are required to coordinate transfer to the Medi-Cal Fee for Service program and notify the beneficiary of the change. The request cannot be submitted before a beneficiary is placed into long term care, and plans are still responsible for coordinating care, including coordinating placement in the LTC facility.
Plans in COHS counties are required to covered all medically necessary LTC services regardless of length of stay in the facility. LTC is a contractual obligation for these plans.
People who become Medi-Cal eligible while in long term care are not eligible for plan enrollment.
DHCS APL 17-017 (October 27, 2017)