DHCS is directing managed care plans to treat Medical Exemption Requests as automatic requests for continuity of care for those Medi-Cal beneficiaries transitioning into managed care.  MCPs must treat every exemption listed in data reports as an automatic continuity of care request.  MCPs must attempt to contact beneficiaries via letter and two calls, and must begin processing requests within five days. DHCS All-Plan Letter 15-001 (1/14/15).

DHCS issued a letter to guide counties on how to handle Covered California cases transitioning to Medi-Cal after Covered California’s annual redetermination process, which will always run at the same time each year.  When Covered California determines that a beneficiary may now be income-eligible for Medi-Cal, it will forward the information to the counties for final determination.

Those found eligible, conditionally eligible, or pending eligible are sent to the county for appropriate verification.  Eligible cases were granted  temporary full-scope Medi-Cal eligibility as of January 1, 2015, and assigned to the same health plan where possible.

DHCS’s letter included talking points on the transition process and sample notices/letters to consumers.  DHCS ACWDL 15-01 (1/7/15).

DHCS issued a letter with directions on how the county should deal with refunds of TLICP premiums or waivers due to beneficiary request or retroactive eligibility for non-premium aid codes.  When a beneficiary requests prospective discontinuance in writing, counties must request the refund or waiver on the beneficiary’s behalf even if the beneficiary claims not to have paid the premium.  When retroactive eligibility for free Medi-Cal is determined, the county must submit a request to Maximus (the administrative vendor) for refund/reimbursement.  Note that a beneficiary may continue to receive premium due invoices after discontinuance due to the billing cycle.  DHCS ACWDL 14-43 (1/5/15)

DHCS issued an All-Plan Letter providing requirements for continuity of care for Medi-Cal beneficiaries that are transitioning into managed care plans from fee-for-service Medi-Cal.  The requirements allow for the option to continue treatment for up to 12 months with an out-of-network Medi-Cal provider for Medi-Cal services.  The letter also covers issues relating to outpatient mental health services, transition from Covered California to Medi-Cal, transition of Seniors and Persons with Disabilities, and coverage of behavioral health treatment for children with autism.  DHCS APL 14-021 (12/29/14).

DHCS issued a letter explaining a new state policy to grant accelerated enrollment (AE) to Medi-Cal applicants who have not had an eligibility determination within the statutory 45-day timeline.  During Covered California’s 2015 open enrollment period, DHCS will implement a new batch process to provide AE for those in the backlog.  The batch process will occur weekly and will target those who have made applications starting November 15, 2014, and going through February 15, 2015.  These applicants will be given fee-for-service Medi-Cal through aid code 8E until a final eligibility determination is made.  DHCS MEDIL I 14-61 (12/31/14).

DHCS issued a MEDIL providing the counties a job aid to outline the requirements for the 90-day cure period for the Medi-Cal renewal process.  The cure period begins from the date of a NOA for discontinuance.  The job aid states that this process applies for both MAGI and Non-MAGI beneficiaries and will treat as timely any required information received within the 90-day cure period.  MEDIL 1 14-60 (12/10/14).