Author: John Tan

DHCS ACWDL 14-28: Elimination of the Deprivation Requirement for Medi -Cal Linkage for the Modified Adjusted Gross Income Parent/Caretaker Group and the Aid to Families with Dependent Children-Medically Needy Program (7/7/14)

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DHCS released this letter to clarify that the previous deprivation of requirement was eliminated as of January 1, 2014, as part of the implementation of the Affordable Care Act.  Prior to January 1st, family linkage to 1931(b) or AFDC-MN programs was established when a child was deprived through absence, death, incapacity or unemployment/underemployment of at least one parent in the child’s family.  With the ACA, Parent/Caretaker and AFDC-MN eligibility is established when the parent/caretaker lives with the child for whom s/he provides care.

The letter also discusses the effects of this rule change on pregnant women, stepparents, and Sneede v. Kizer cases.  DHCS provides 8 examples on determining program linkage.

DHCS APL 14-007: Dual-Eligible Special Needs Plans (6/26/14)

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The Department issued this letter to Medi-Cal Managed Care plans providing guidance on D-SNPs as the state adopts the Coordinated Care Initiative and Cal MediConnect for dual eligibles.  D-SNPs in non-CCI counties will continue to operate per contract.  Contracts for D-SNPs in CCI counties depend on whether that D-SNP is also a Cal MediConnect plan.

DHCS MEDIL I 14-38: Department of Health Care Services (DHCS) Waiver Change Information (6/25/14)

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DHCS released this letter to provide information about seven different DHCS Waivers constituting Home and Community-Based Services and Long-Term Care Services and Supports programs.  Waivers coming up for renewal this year are being renewed for a five-year period.  The letter describes each of the waiver programs and provides information on how to access Long Term Care services and how a client may apply for waiver services.

DHCS MEDIL I 14-35: Interim Non-Payment of Premium (NPP) Processes (6/18/14)

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This letter updates counties about the process they should use for terminating TLICP beneficiaries for non-payment of premiums.  For clients in non-payment of premium status, there are no redetermination requirements prior to sending a NOA to discontinue the client unless there’s a change in circumstances.  The letter also provides a sample discontinuance notice.

For clients in aid codes H3 and H5, counties will provide a timely notice and terminate eligibility through MEDS.  For clients in aid code 5D (Healthy Families Program transition), counties would need to submit a remedy ticket to DHCS after providing timely notice.

To cure the situation and prevent termination, clients must pay past premiums prior to date of discontinuance.  If client misses that date but pays within 30 days of date of discontinuance to cure, county must verify payment and reinstate or submit a remedy ticket.  After the 30 day cure period, the client would need to reapply; any owed amounts would be charged as part of the first month’s premium.

DHCS ACWDL 14-27: Additional Express Lane Enrollment Guidance (6/16/14)

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This letter clarifies questions about the CalFresh Express Lane Enrollment procedures for Medi-Cal, particularly about aid code 7S (those individuals eligible for Medi-Cal under pre-ACA rules).

  • Parents, guardians and caretakers relatives are to be put in aid code 7S as opposed to aid code 7U. These individuals will be eligible even if a child is not on CalFresh or Medi-Cal; the children only have to meet the age and residence requirements.
  • DHCS will transfer Medicare beneficiaries in Express Lane aid codes to aid code 7S.
  • Those who are found ineligible for CalFresh will be sent RFTHIs to determine Medi-Cal eligibility.

Additionally, the letter discusses discontinuance NOAs for Express Lane beneficiaries upon change of circumstances or expiration.  NOAs will be generated by SAWS, and beneficiaries will be referred for APTC/CSR determinations with a special enrollment period.

Finally, Express Lane enrolled individuals are eligible for retroactive months of coverage up to February 2014.  For determination of months before February, individuals will need to submit a RFTHI (for January 2014) or a full pre-ACA application (for December 2013 and before).