New instructions on Medi-Cal enrollment for former foster care children

DHCS issued a letter outlining the handling of former foster care youth in the Mandatory Coverage Group (MCG) and Optional Coverage Group (OCG) for Medi-Cal applications and enrollment.  Applicants in these categories are supposed to be provided with a simplified eligibility determination and enrollment process through the use of self-attestation.  Instructions, frequently asked questions, and the application form are included with the letter.

DHCS defines MCG as those youth who were receiving Medi-Cal in foster care under the responsibility of any state of tribe on their 18th birthday or a later age.  OCG includes youth that were not receiving Medi-Cal benefits while in foster care on their 18th birthday and are between ages 18-21.  DHCS ACWDL 14-41.

Change to Medi-Cal Appointment Period for Authorized Representatives

DHCS issued a letter on November 26, 2014, reminding counties that the appointment of authorized representatives now lasts until a change is made.  This change could be the applicant/beneficiary modifying/cancelling the authorization, the appointment of a new representative, the representative withdrawing, or a change in the law.  Previously, the appointment period lasted for a year.  DHCS MEDIL I 14-57.

Initial Guidance on Short-Term Negative Action for MAGI Medi-Cal Cases

DHCS is providing counties initial guidance on dealing with MAGI Medi-Cal cases where all individuals on the case need to be denied or terminated from the program.  The letter outlines five steps:

  1. Counties will identify pending and active cases that should be denied or terminated where all members on the case are MAGI Medi-Cal within three priority areas: duplicate applications, failure to complete redetermination, and failure to complete determination.
  2. SAWS will receive the county lists and send them to CalHEERS.
  3. SAWS or MEDS will take negative action through a backend data fix.
  4. SAWS will generate and send NOAs.
  5. CalHEERS will take negative action using a backend data fix.

The letter includes a list of negative actions (Attachment A) and an overview of the different systems (Atttachment B).  DHCS MEDIL I 14-56

Medi-Cal Efforts to Deal with Individuals Pending in the Application Backlog

This letter notifies counties of the DHCS-required process for reducing the pending backlog of Medi-Cal cases.   DHCS will cull through lists for a preliminary determination of eligibility, which counties will then evaluate by December 1.  DHCS will then start granting preliminary eligibility coverage included on these lists.  DHCS MEDIL I 14-55, 14-55 E