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).

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).

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).

DHCS issued a letter reminding counties to process promptly information received after a discontinuance notice is sent but before the date of discontinuance or during the 90-day cure period.  Counties must restore Medi-Cal benefits even with an incomplete renewal form and follow ex parte review procedures to determine continued eligibility.  Only after the review and evaluation for all programs is a new discontinuance notice appropriate.  DHCS MEDIL I 15-22 (8/13/15).

DHCS issued a letter with the required Spanish-language Notice of Action language for failure to respond to requests for information at application or redetermination.  The letter also includes language counties should use to explain the 90-day cure period.  DHCS MEDIL I 15-21 (8/13/15).

This language should be used according the instructions from DHCS ACWDL 15-27.

DHCS issued a letter to address a known CalHEERS system defect where individuals without a social security number go through the system and return with pending eligibility from CalHEERS.  The defect occurs when an individual is processed for an eligibility determination request at intake, renewal, or change of circumstances.  The impacted populations are newborn infants, undocumented individuals, and those without SSNs, both existing MAGI beneficiaries and new applicants.

The letter gives instructions on how to deal with affected cases.  DHCS MEDIL I 15-23 (8/13/15).