DHCS issued a letter providing information about AB 720, which requires counties to suspend rather than terminate Medi-Cal benefits for all inmates regardless of age who were Medi-Cal beneficiaries at the time they became inmates of a public institution.  County boards of supervisors may designate an entity to assist county jail inmates with insurance applications, as being an inmate shall not preclude the county from processing a Medi-Cal application from such an applicant.

An inmate’s Medi-Cal benefits must be suspended until the day an eligible inmate is no longer an inmate of a public institution (reinstate) or one year from the date he/she becomes an inmate (terminated), whichever is sooner.  Redetermination will still occur, and eligibility changes should be entered as appropriate.

Additionally, the letter addresses the Medi-Cal Inmate Eligibility Program application process.  MCIEP covers acute inpatient hospital services to eligible inmates if those services are provided off the grounds of the correctional facility.  The inmate must meet all Medi-Cal eligibility requirements.  The county will process applications received by a designate county entity for MAGI and non-MAGI programs.  Inmate cases might get pended in CalHEERS, so counties must take steps to complete the eligibility process.  If the inmate has a suspended case, the county must lift the suspension before MCIEP eligibility begins.

DHCS released an all-county letter to clarify how to handle Medi-Cal applications from pre-release state inmates.  The full letter is available here.

CDCR pre-release staff is to identify potential Medi-Cal eligible inmates nearing parole and offer assistance with applying for Medi-Cal prior to release. Since January 2014, CDCR had done this through paper applications submitted directly to Covered California.

To ensure that applications do not get lost, CDCR will submit pre-release applications to specific county points of contact 60-90 days prior to inmate’s release. Counties will accept the applications and enter the inmate’s information into SAWS, which will run the case through CalHEERS BRE for MAGI. Counties will take necessary steps to complete the eligibility determination. Finally, pre-release applicants will be provided with their county’s eligibility worker’s contact along with a BIC.

Earlier this week, DHCS released instructions on resetting redetermination dates for those Medi-Cal beneficiaries who retain eligibility due to a change in circumstances.  The letter can be found here.

Where the county is responsible for Medi-Cal case management. beneficiaries shall be granted a new 12 month period of eligibility if they retain eligibility after a change of circumstances redetermination.  This is applicable only when the change is to an eligibility data element, such as income or household composition.  If the beneficiary is protected by a consumer protection program (e.g., CEC, TMC, etc…), the redetermination date will not reset.  Change of circumstances applies to changes reported in other public benefit programs as well.

DHCS is providing guidance to ensure continuing eligibility for children during 2014 annual redeterminations as pre-ACA coverage transitions to ACA MAGI coverage.   The full letter is available here.

Children currently enrolled in pre-ACA Medi-Cal coverage that would no longer be eligible under MAGI rules at their 2014 redetermination must remain on Medi-Cal (including any premiums or cost sharing) until their 2015 redetermination date (2101(f) protection).  This applies to children receiving Medi-Cal on or before 12/31/13 and losing eligibility at their 2014 MAGI redetermination.  They will be shifted to a new ACA children aid code.

The letter provides the applicable aid codes, scenarios, and exceptions to 2101(f) protection.

 

This week, the Department of Health Care Services has issued guidance to counties about verifying income for pending Medi-Cal cases.  Those cases currently pending in SAWS are first to be rerun through the federal data hub when available.  If the information available in the hub is not reasonably compatible with the income reported in the application, counties are to do an ex parte review for that information.  If the county cannot verify income through ex parte review, the county is to mail a three ten-day requests for verification before denying the application; this is a temporary change from the normal two requests in order to deal with the backlog of pending applications.

For more information, the full letter is available here.

DHCS issued guidance on how Medi-Cal NOAs are being generated by CalHEERS and SAWS beginning 4/15/14.  The full letter is available here.  Two sets of NOAs will be released:

1. A “one-time batch” of NOAs from pre-enrollment and pre-CalHEERS/SAWS interface (applications filed 10/1/13 to 1/20/14) and post-interface (1/21/14-3/10/14)
2. Ongoing as part of regular processing of NOAs dating from 3/11/14 onwards

The letter identifies some issues that may cause confusion among Medi-Cal beneficiaries:

1. Both CalHEERS and SAWS may issue separate NOAs regarding MAGI and Non-MAGI Medi-Cal, respectively.  SAWS will reflect the correct eligibility category.
2. CalHEERS NOAs may have the wrong coverage effective date, using the date of eligibility determination instead of the correct effective date of eligibility.
3. CalHEERS is generating NOAs for each month of eligibility or conditional eligibility in certain circumstances.