DHCS issued clarification about the CalHEERS issues regarding scope of services for certain immigrants.  The new release of CalHEERS uses two data fields for scope of services.  If both fields (Citizen and Eligible Immigrant) are marked “no” or left blank, CalHEERS will grant restricted scope benefits.  Counties have been instructed to ensure that workers do the appropriate verifications.  Counties also must assess how much of a problem has occurred and fix problems as appropriate, including providing a proper notice.  DHCS MEDIL I 15-20 (8/11/15).

DHCS has issued clarification in cases where individuals are pending AE and the County doesn’t deny the application.  Counties are reminded that they must ensure that the individuals excluded from the 45-day AE process due to pending negative action should be included in county exclusion lists.  These applicants should still receive Rivera notices unless the denial action will be completed before the NOI would otherwise be mailed.  DHCS ACWDL 15-28 (8/6/15).

The State is implementing a new CalHEERS release.  In this letter, DHCS provides an overview of new major functionalities of this release.  Counties will now be able to initiate negative actions (denials/discontinuances).  Additionally, CalHEERS is supposed to reduce the number of MAGI Medi-Cal NOAs at application and change of circumstance.  DHCS MEDIL I 15-19 (8/3/15).

DHCS has set priorities for counties to process Medi-Cal batch applications.  Counties are to resolve batch transactions that DHCS has not batched in weekly 45-day accelerated enrollment (AE) batch runs.  Then, counties need to review Rivera Notice of Inaction individuals.  Next, counties would process applications within the required 45 day timeframe.  Finally, counties should process full eligibility determinations for those batched in aid code 8E.

DHCS MEDIL I 15-15 (7/13/15).

DHCS recently issued guidance around Medi-Cal residency requirements for students either from out-of-state who attend California schools or California residents who attend out-of-state schools.  If otherwise eligible, those students who come to California to attend school may apply for Medi-Cal (all other eligibility rules apply).  Similarly, Medi-Cal beneficiaries who leave California to attend school can continue their Medi-Cal eligibility assuming they are still otherwise eligible.  These beneficiaries may also apply for Medicaid in the state in which they attend school.

Parents/caretakers and households would also retain Medi-Cal eligibility if the only child or one child attends school out of state.  Medi-Cal will only cover emergency services as long as the provider agrees to accept Medi-Cal.  DHCS ACWDL 15-23 (7/9/15).

DHCS updated the MC 216 Pre-Populated Renewal form to replace a question about fluctuating income.  The forms are available in all threshold languages.  DHCS MEDIL I 15-14 (5/19/15).