Author: John Tan

Updates to Medi-Cal Aged and Disabled, Medicare Savings Program Thresholds

Posted on by

DHCS has updated the thresholds for the the Medi-Cal Aged and Disabled Federal Poverty Level program.  As of April 1, 2017, the monthly income limit for an individual is $1235 ($1005 + $230 disregard); the monthly income limit for a couple is $1664 ($1354 + $310 disregard).

DHCS ACWDL 17-19 (June 23, 2017)

Effective January 1, 2017, allocations, property limits, and premium amounts have been updated:

  • The SSI Standard Allocation is $368.
  • The SSI Parental Allocation is $735 for an individual (if one ineligible parent lives with a child), or $1103 for a couple (if both ineligible parents live with a child).
  • The Medicare Part A premium is $413 for those not receiving free Part A.  A beneficiary with 30-39 quarters has a reduced premium of $227.
  • The Medicare Part B premium is $109 on average for those held harmless, while it is $134 for those who are new to Medicare or not subject to hold harmless status.  The Part B deductible is $183.
  • The property limits for Medicare Savings Programs are $7390 for an individual and $11,090 for a couple.

DHCS ACWDL 17-20 (June 30, 2017).

Updates to the Online Single-Streamlined Application

Posted on by

The online application for Medi-Cal and other health insurance programs has been redesigned to group questions in a more logical fashion, using prior responses to display future questions on an as-needed basis for program eligibility determinations.

Additionally, the application has changed to conform with newer statutory and regulatory requirements.  Applicants are to be treated in a manner consistent with their gender identity.  They will be able to designate a choice without need for verification from the county.  Individuals can also be deemed pregnant regardless of gender identity.  Additionally, DHCS must collect voluntary information about sexual orientation and gender identity.  The application also removes requirements to collect Social Security numbers from non-applicants.

The updated online application adds questions about Indian Health Service access, military service, and personal injury lawsuits.  It also adds Medi-Cal notice information about non-discrimination, 10-day reporting requirements, and estate recovery to the signature page.

DHCS MEDIL I 17-08 (June 29, 2017).

Medi-Cal Non-Emergency Medical and Non-Medical Transportation

Posted on by

DHCS issued an All Plan Letter to clarify what transportation services plans must provide in non-emergency situations.

Subject to prior authorization, non-emergency medical transportation (NEMT) is a covered benefit when a member needs to obtain medically necessary services and when it is prescribed in writing by a provider.  Plans are required to authorize at minimum the lowest cost type of NEMT that is adequate for the member’s medical needs with no limits as long as the medical services are medically necessary and authorized.

NEMT is required when the member cannot take ordinary public or private means due to medical and physical condition and when transportation is required for obtaining medically necessary services.  Plans must ensure door-to-door assistance for members receiving NEMT services, and plans must provide transportation for a parent or guardian is the member is minor.  The letter discusses when plans must provide NEMT ambulance services, litter van services, wheelchair van services, and NEMT by air.  NEMT requests require a Physician Certification Statement that includes functional limitations justification, dates of service and mode of transportation needed, and a certification statement.

Effective July 1, 2017, non-medical transportation (NMT) expands from EPSDT to a managed care benefit for all members to obtain medically necessary services covered by the managed care plan.  This expands to cover NMT for all Medi-Cal services, including carved out services, starting October 1, 2017.  NMT requested must be the least costly method of transportation that meets the member’s needs.  NMT services must include round trip transportation for a member to obtain covered services, as well as mileage reimbursement when the member arranges for a private vehicle to get to an appointment.  The round trip is available for covered services, picking up prescriptions, and picking up medical equipment and supplies.  The provided NMT must be in a form and manner that is accessible for the member.

NMT services must be authorized prior to use.  Coverage includes the transportation costs for the member and one attendant, subject to authorization.  The member must attest to the plan that other transportation resources have been reasonably exhausted.

Plans are still required to meet timely access standards, either contractually or through Knox-Keene licensing.  The member’s need for NEMT or NMT services do not relieve the MCPs from complying with these obligations.

DHCS APL 17-010 (June 29, 2017)

Integration of Medi-Cal Access Program into Managed Care

Posted on by

The Medi-Cal Access Program (MCAP) provides full-scope Medi-Cal services for pregnant women between 213% and 322% of the federal poverty level.  Prior to October 1, 2016, MCAP-eligible pregnant women received services through managed care plans and were assigned aid code 0D.  Between October 2, 2016, and June 30, 2017, MCAP-eligible pregnant women have been assigned aid code 0G and receive services through Medi-Cal Fee-for-Service.  Starting July 1, 2017, MCAP-eligible pregnant women will be enrolled into managed care plans under aid code 0E.

All MCAP-eligible pregnant women receive full-scope services until the end of their post-partum eligibility period (the end of the month of the 60th day after the end of the pregnancy).

DHCS MEDIL I 17-07 (June 9, 2017).

Member Handbook Requirements for Medi-Cal Dental Plans

Posted on by

CMS’s new Managed Care Final Rule stipulates new requirements for enrollee handbooks effective July 1, 2017.  DHCS issued a Dental All Plan Letter to provide clarification and guidance of these rules.

Current DHCS contracts require plan communications to be written at a sixth grade reading level.  Under the new federal rule, dental managed care plans (DMCs) are to use the state-developed manual.  Manuals must be provided within a reasonable time after receiving notice of enrollment, and the content of the manual must allow the member to understand how to effectively use the dental plan.  The letter describes the content requirements.

DHCS Dental APL 17-002 (May 24, 2017)

MAGI Eligibility for DDS Waiver Participants

Posted on by

Participants in the HCBS-DD (Developmentally Disabled) Waiver can be eligible under any of the MAGI eligibility programs, including the Targeted Low-Income Children’s Program (TLICP) without a change to their aid codes.

The HCBS-DD Waiver allows Regional Center patients who would either be assigned a share of cost or be ineligible for Medi-Cal due to deemed income or assets of parents, spouses or others to qualify on their own income and assets.

DHCS ACWDL 17-15 (May 18, 2017).