Managed care plans are to contact county office liaisons to provide updated contact information for Medi-Cal beneficiaries. If the plan has received the beneficiary’s approval, the counties must incorporate these changes immediately. If the plan does not have the beneficiary’s approval, a county worker must verify the changes before making them. DHCS ACWDL 15-30 (9/22/15).
Summaries of select CalWORKs, CalFresh, Health and Housing Regulations
Author: John Tan
Medi-Cal backlog cases no longer batched for Accelerated Enrollment
DHCS has explained that the application batching process that allowed the state to mitigate some of the 2014 application backlog through Accelerated Enrollment (AE) has ended. DHCS is still required to send Rivera Notices of Inaction when an application is pending for 45 days or more. DHCS will continue to monitor how many applications remain pending after 45 days, with the possibility that AE batching may resume to help mitigate any further application delays. DHCS MEDIL I 15-27 (9/18/15).
Fixing Medi-Cal Aid Codes for Former Foster Youth
DHCS issued instructions to the counties to facilitate the appropriate Medi-Cal coverage of former foster youth through aid code 4M. Former foster youth are entitled to receive Medi-Cal through the age of 26. The current CalHEERS programming uses MAGI rules, resulting in some eligible former foster youth being assigned other aid codes or not at all.
The state is extracting data for the counties on affected former foster youth who should be assigned aid code 4M. Counties must use available information to verify former foster youth status, and then immediately enroll eligible individuals into the proper aid code and issue a NOA.
This letter applies to those currently receiving Medi-Cal with a different, non-cash aid linkage aid code, and those without an aid code but with eligibility for APTCs. The state will issue a separate letter for those former foster youth enrolled in a qualified health plan through Covered California. DHCS ACWDL 15-29 (9/16/15).
Limitations on Medi-Cal Presumptive Eligibility Enrollment
Based on CMS guidance, DHCS has implemented limitations on Presumptive Enrollment (PE) periods. PE portals will screen new applicants for any PE enrollment in the prior 12 months. Former foster youth, parents and caretaker relatives, and expansion group adults are permitted one PE enrollment per period. Children under 19 are permitted two such enrollments, while pregnant women may have one PE enrollment per pregnancy. Those who have exceeded their PE enrollments will be encouraged to apply for coverage. DHCS MEDIL I 15-26 (8/28/15).
Medi-Cal continuity of care guidelines for transitions into managed care
DHCS has issued guidelines for continuity of care requirements for Medi-Cal beneficiaries transitioning into managed care. The guidelines list timeliness and eligibility requirements for plans, beneficiaries and providers. The guidelines also include specific guidelines for transitions relating to Covered California transitions, SPD transitions, BHT and regional center transitions, pregnant beneficiaries and MER denials. The letter also mentions existing continuity of care provisions in state law. DHCS APL 15-019 (8/26/15).
New income guidelines for Pregnancy full-scope Medi-Cal expansion
As of August 1, 2015, CalHEERS is programmed for the expansion of full-scope Medi-Cal for pregnant women up to 138% FPL. These beneficiaries will be placed in aid code M7 and required to enroll in a managed care plan. DHCS will send a Notice of Change in benefits for those beneficiaries between 60-138% FPL allowing the option to sign up managed care plans; these beneficiaries can remain in fee for service through post-partum care. DHCS MEDIL I 15-25 (8/19/15).