Author: John Tan

Denials and Terminations of Caretaker Adult MAGI Medi-Cal Cases when Child Lacks Coverage

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Under current State and Federal regulations, a parent or caretaker relative with a dependent child under 19 living in the home does not qualify for MAGI Medi-Cal if the child does not have minimum essential coverage (MEC).

Applicants and beneficiaries can self-attest that a dependent child has MEC at the time of application, renewal, or change in circumstance unless the county has information that states otherwise.  If a County worker learns that a dependent child does not have MEC, the worker should do an ex parte review to confirm MEC status.

As with any other discontinuance or denial, the County must send a NOA with proper language.  DHCS has provided sample language for such notices.

DHCS ACWDL 18-01 (January 8, 2018).

Medi-Cal Pregnancy Services Available Regardless of Gender Identity

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DHCS issued an All County Letter to update counties about eligibility for pregnancy services.  Based on Section 1557 of the Affordable Care Act, SAWS will change its language for Medi-Cal NOAs about coverage of pregnancy services.  The programming will allow pregnancy to be selected for any person on a Medi-Cal case regardless of gender.  As of July 18, 2016, all persons, regardless of gender identity, may request eligibility on the basis of pregnancy when applying for public insurance programs.  CalHEERS is working on an update to reflect this change.

DHCS ACWDL 17-38 (December 4, 2017).

Resources for Denti-Cal Adult Dental Benefit Restoration

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As of January 1, 2018, the Department of Health Care Services has restored all optional adult dental benefits that had been eliminated in 2009.  DHCS issued an All Plan Letter to dental managed care plans with a benefits quick reference guide to describe the restored procedures.  DHCS Dental APL 17-009 (November 27, 2017).

California Pan-Ethnic Health Network, Justice in Aging, and Asian Americans Advancing Justice developed a pamphlet in English and Spanish to describe the change in benefits.  https://cpehn.org/blog/201801/what-you-need-know-restored-dental-benefits-adults-california.

Western Center on Law and Poverty also created a one-page flyer about the changes: https://wclp.org/wp-content/uploads/2018/01/Full-Restoration-of-Adult-Dental-Benefits-1pager-1.pdf

Medi-Cal Asset Verification

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Starting this month, DHCS will be sending counties new asset verification reports for screening specific Aged, Blind and Disabled Medi-Cal beneficiaries and applicants.  After a three-month pilot, counties will use these reports to detect any unreported assets from non-SSI receiving ABD cases.  The verification capacity will eventually be integrated into various statewide systems.

DHCS will start providing these reports for LTC annual redeterminations and will gradually expand to all ABD annual redeterminations by 2020.  DHCS will generate verification reports two months prior to the end of a beneficiary’s redetermination month.  These reports will contain liquid and non-liquid assets from various financial institutions during a lookback period of ten months.  If a beneficiary refuses to respond to an asset-related inquiry, their case may be discontinued.

DHCS ACWDL 17-37 (December 12, 2017)

Outpatient Mental Health Services through Medi-Cal Managed Care Plans

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A recent DHCS All-Plan Letter restated the responsibilities of managed care plan for providing medically necessary outpatient mental health services for those with mild to moderate impairments.  The APL also states the plans’ responsibilities to members with severe mental health impairments, including when to coordinate and refer to county mental health plans for specialty mental health services.  The letter clarifies responsibilities regarding children’s mental health services.  Finally, the letter provides a description chart for a side-by-side comparison of eligibility and service obligations for managed care plans and county mental health plans.

DHCS APL 17-018 (October 27, 2017)