The Lomeli settlement agreement requires Department of Health Care Services (DHCS) to send written notice to SSI/SSP applicants and recipients about the opportunity to receive retroactive Medi-Cal coverage for the three month period prior to the SSI/SSP application month. This change will help ensure that SSI/SSP beneficiaries do not miss the window to request retroactive coverage. The letter instructs Counties how to process retroactive eligibility requests. Beneficiaries should also be informed about the opportunity to seek reimbursement for medical costs incurred during the retro period and disability evaluation period. [Download]
Summaries of select CalWORKs, CalFresh, Health and Housing Regulations
Author: Jennifer Smith
ACWDL 11-32: 2011/2012 Family Member Base Allocation Amount (08/16/11)
The letter provides the updated family member “base allocation amount,” which is used to determine how much a long-term care (LTC) Medi-Cal beneficiary may allocate to family members. Effective July 1, 2011, the base allocation amount is $1839 for family members living with the community spouse of the LTC beneficiary. [Download]
ACWDL 11-33: Deemed Eligibility and Continued Eligibility for Infants (08/25/11)
This letter modifies policies for deemed eligibility (DE) and continued eligibility (CE) for infants. This letter supersedes ACWDL 09-17.
An infant born to a Medi-Cal eligible woman at the time of birth has deemed eligibility for Medi-Cal until age one year. The infant is deemed eligible regardless of the infant’s living arrangements. The letter provides additional guidance about specific share-of-cost scenarios. Infants may stay enrolled in Medi-Cal through age one regardless of increases in family income. Counties must conduct a redetermination for the infant as it approaches age one. Counties may terminate a family with a deemed infant from Medi-Cal due to loss of contact but may also reinstate deemed eligibility if contact is re-established.
Review the letter for additional guidance on DE and CE for infants. [Download]
ACWDL 11-34: Section 1931(b) and new CalWORKs Time Limits As a Result of Senate Bill 72 (08/17/11))
This letter clarifies that beneficiaries experiencing a CalWORKs reduction or termination as a result of SB 72 should maintain Medi-Cal eligibility. SB 72 reduced the CalWORKs time-on-aid for adults from 60 months to 48 months. If any beneficiary becomes ineligible for CalWORKs solely because of the time limit changes, the county must transition these individuals to Section 1931(b) Medi-Cal and use the CalWORKs case information for the Medi-Cal case file until the next annual re-determination. [Download]
ACWDL 11-36: The Extension of the Qualifiying Individual (QI) Program Sunset Date to December 31, 2011 (09/16/11))
This letter extends the sunset date for the Qualified Individual (QI) program to December 31, 2011. The QI program pays the Medicare Part B premium for those with income below 135 percent of the federal poverty level. [Download]