This letter provides guidance to counties on: 1) processing pending CalHEERS applications for individuals with current Medi-Cal eligibility; 2) ex parte review of pending CalHEERS Medi-Cal applications using existing CalWORKS and CalFresh cases; and 3) verifying state residency and remote identity proofing procedures until the CalHEERS/SAWS interface is functional. The letter is linked here.
Summaries of select CalWORKs, CalFresh, Health and Housing Regulations
Author: Amy Williams
DHCS ACWDL 14-01: Low Income Health Program Transition to Medi-Cal
Enrollees in the Low Income Health Program (LIHP) prior to December 31, 2013 have been and will continue to be administratively moved to MAGI Medi-Cal by DHCS until the end of March 2014. These individuals were given a transition aid code which will remain in place until the next scheduled redetermination unless the enrollee makes a new application or reports a change in circumstance that requires a new eligibility determination. For more information on the LIHP transition to Medi-Cal, view the letter here.
DHCS MEDIL 13-15: Temporary Eligibility for Medi-Cal Pending Cases
This letter grants presumptive temporary MAGI Medi-Cal eligibility (aid code 8E) to individuals who applied through the California Healthcare Eligibility, Enrollment and Retention System (CalHEERS) and whose applications have been delayed due to the delay in functionality of interface between CalHEERS and the Statewide Automated Welfare Systems (SAWS). The letter also provides instructions for how to complete these applications once the interface is live. Read the entire letter here.
DHCS ACWDL 13-26: Increase in SGA Wage from $1,040 per month to $1070 Effective 1/1/14
The letter notifies counties that the federal SGA amount will increase effective 1/1/14 and instructs counties that were unable to implement the change by 1/1/14 to retroactively redetermine Medi-Cal eligibility based on disability if a case has been denied erroneously or budgeted incorrectly. Click here to access the letter.
DHCS All-Plan Letter 13-023: Continuity of Care for Medi-Cal Beneficiaries Who Transition From Fee-For-Service Medi-Cal into Medi-Cal Managed Care
This one is pretty self-explanatory. Click here to review the circumstances in which Medi-Cal beneficiaries are entitled to continuity of care, what continuity of care entails, and the processes for providing services through continuity of care.
DHCS All Plan Letter 13-021: Medi-Cal Managed Care Plan Responsibilities for Outpatient Mental Health Services
Prior to 2014, Medi-Cal beneficiaries enrolled in a Medi-Cal Managed Care Plan (MCP) received services within the scope of their primary care provider’s (PCP’s) practice through their PCP and received specialty mental health services for serious mental illness through the county Mental Health Plan (MHP). Effective January 1, 2014, Medi-Cal Managed Care Plans are responsible for providing certain mental health services through the plan’s provider network to beneficiaries with mild to moderate impairment of mental, emotional, or behavioral functioning resulting from a mental health disorder even when those services are outside the PCP’s scope of practice. The letter, available here, delineates the MCP’s responsibilities for referring to, and coordinating with MHPs for the delivery of mental health services.