DHCS has updated the maximum income and property caps under the Medicare Catastrophic Coverage Act as of January 1, 2017. The community spouse resource allowance (CSRA) will be $120,900, while the spousal income allocation (or minimum monthly maintenance needs allowance, MMMNA) will be $3023.
DHCS ACWDL 16-25 (December 22, 2016).
As of July 1, 2016, the State has reinstated outpatient acupuncture services as a Medi-Cal managed care benefit. Acupuncture will be covered as needed to prevent, modify, or alleviate the perception of severe, persistent chronic pain resulting from a generally recognized medical condition. Services are limited to two sessions per month, though additional sessions may granted through medical necessity and prior authorization.
DHCS APL 16-015 (December 1, 2016).
DHCS issued an All Plan Letter providing instructions on what tobacco prevention and cessation services should be covered by managed care plans. DHCS points to the US Preventive Services Task Force in setting coverage requirements for both pregnant and non-pregnant beneficiaries, including:
APL 16-014 (November 30, 2016).
CDSS has issued instructions to counties implementing the decision and judgment in Riojas v. Vilsack and Lightbourne, 2016 WL 3566941. Riojas held that people in SSI suspense status are eligible for CalFresh.
CDSS instructed counties that, effective immediately, people who are not receiving a SSI payment are eligible for CalFresh as long as all other CalFresh eligibility criteria are met. Within two months counties must identify applications that were filed after August 30, 2016 that were denied solely because the applicant was in SSI suspense status and issue retroactive benefits to those people. Counties must also identify household members excluded solely because of their SSI suspense status on or after August 30, 2016, and, if otherwise eligible, issue retroactive benefits to those persons.
A change in SSI from active status to suspense status is not a mandatory mid-period report. However, if this change is reported, the county must add the household member effective the first day of the next month. If SSI status changes to active status and that change is known to the county, then the county must increase or decrease benefits effective the first day of the next month, or as soon as 10-day notice can be given. (ACL 17-09, January 27, 2017.)
CDSS has issued instructions about the definition of Permanent Resident Under Color of Law (PRUCOL) for purposes of eligibility for Cash Assistance Program for Immigrants (CAPI) benefits. One way that people can be eligible for CAPI is if they are PRUCOL. For CAPI purposes, PRUCOL refers to 12 categories of non-citizens. The twelfth category is a general classification for people who can show that USCIS knows they are in the United States and USCIS does not intend to deport them.
A non-citizen can demonstrate that USCIS is aware of their presence in the United States by showing correspondence with USCIS. Individuals who are subject to an order of deportation or who overstay their visas cannot qualify.
A non-citizen can show that USCIS does not intend to deport them by showing it is USCIS’ policy or practice not to deport aliens in the same category.
The Systemic Alien Verification for Entitlements (SAVE) system for verifying immigration status does not identify people as PRUCOL. Counties must determine whether people qualify as PRUCOL. (ACIN I-79-16, November 30, 2016.)
CDSS has issued new instructions about the Approved Relative Caregiver (ARC). These changes and all rules for the program are compiled in the ARC Implementation Guide. Prior All County Letters regarding the ARC program, except for ACL 15-54 about notices of action, are superseded by the ARC Implementation Guide.
CDSS highlights two changes to the ARC program. First, counties are to change from paying ARC benefits prospectively to calculating the days a child is actually placed and paying the caregiver in arrears. Counties are not required to take measures to mitigate financial hardship from this change but are “encouraged to do so if feasible.” Counties should make this change by June 30, 2017.
Second, ARC benefits will no longer be distributed using electronic benefits transfer.
The computer consortia must develop and submit plans to CDSS outlining the timeframe for making required programming changes. (ACL 16-92, December 23, 2016.)