DHCS issued an All County Letter to update counties about eligibility for pregnancy services.  Based on Section 1557 of the Affordable Care Act, SAWS will change its language for Medi-Cal NOAs about coverage of pregnancy services.  The programming will allow pregnancy to be selected for any person on a Medi-Cal case regardless of gender.  As of July 18, 2016, all persons, regardless of gender identity, may request eligibility on the basis of pregnancy when applying for public insurance programs.  CalHEERS is working on an update to reflect this change.

DHCS ACWDL 17-38 (December 4, 2017).

Currently, the Soft Pause feature of SAWS protects consumers from losing MAGI-based Medi-Cal eligibility when personal circumstances change.  The soft pause allows the county to run eligibility determinations for other programs while keeping the beneficiary on a MAGI aid code.  This generally happens when a MAGI beneficiary becomes eligible for APTCs, premium-based Medi-Cal, or limited scope/restricted/pregnancy-related Medi-Cal, or if the beneficiary becomes ineligible for MAGI Medi-Cal.

The county worker must screen the beneficiary for Non-MAGI programs before removing the soft pause or before sending the case for APTC evaluation.  If the individual is eligible for Non-MAGI Medi-Cal, the county can remove the soft pause to place the beneficiary into an appropriate aid code.  The same 90-day cure period applies to restore a beneficiary to a proper non-MAGI aid code if the individual did not respond to the Non-MAGI evaluation request.

County workers have the ability to remove the soft pause directly.  If an individual has been determined eligible for APTCs, the county worker can help the beneficiary complete plan enrollment in CalHEERS after removing the soft pause.

DHCS ACWDL 17-35 (October 5, 2017)

DHCS has reminded counties that women on Presumptive Eligibility for Pregnant Women should have their PE period extended when they submit the required application.  Currently, PE benefits last for up to two months beginning on the day of the PE determination.  Individuals must submit a Medi-Cal application to continue receiving benefits beyond the PE period.  The MEDS system automatically terminates PE benefits unless it notes a pending application.  Counties must ensure that such transactions are posted to MEDS to continue PE benefits until they make a final eligibility determinatio.

MEDIL I 17-17 (October 3, 2017).

In response to the Korean Community Center of the East Bay settlement, DHCS has issued new guidance to clarify procedures for discontinuing Medi-Cal cases for failure to respond at annual redetermination for MAGI and Non-MAGI cases.

In both MAGI and Non-MAGI cases, the county should use ex-parte resources to confirm continued eligibility.  If information is missing, the county should send an appropriate request for only the information that could not be verified (MC 216 for MAGI, or an appropriate non-MAGI renewal form).  If the beneficiary does not respond (and not just providing incomplete or insufficient information), the county must discontinue with an appropriate notice.  Sample language for these notices is included in the guidance.  Beneficiaries continue to have a 90-day cure period.

DHCS ACWDL 17-32 (August 31, 2017).

Per Federal law, DHCS is to provide all Medi-Cal beneficiaries with minimum essential coverage (MEC) a Form 1095-B on or before January 31 following the end of each tax year.  This information is also reported to the IRS electronically, as are any updates.  Beneficiaries are entitled to reprints upon request.  In this letter, DHCS provides a list of Medi-Cal programs and codes that are and are not considered MEC.

The letter outlines the responsibilities of various entities for providing assistance with 1095-B issues and reprints.  SSI/SSP-linked beneficiaries should be able to contact the County.  MCAP participants can contact Maximus, the contracting program responsible for 1095-B forms.  Counties will have access to a new MEDS screen to review 1095-B status and history.  All county workers are responsible to assist beneficiaries with 1095-B issues.

DHCS is using a modified 1095-B form to protect beneficiary information.  These forms are not required for tax filing, but should be kept as a record of eligibility.  If there is missing or erroneous information, DHCS will send notices requesting action; beneficiaries would then contact the county to review the information.  Forms and notices will be sent to the last known address, and the letter describes processes to deal with returned mail.

DHCS ACWDL 17-30 (August 15, 2017).

Post-Windsor (2013) and Obergefell (2015), counties must treat married same-sex spouses the same as married opposite-sex spouses for Medi-Cal eligibility purposes under both MAGI and Non-MAGI rules.  Rules applying to spouses for spousal impoverishment, undue hardship, long term care, and HCBS waiver programs shall apply the same to both same-sex and opposite-sex married spouses.  These changes are effective immediately.

DHCS will clarify rules regarding registered domestic partners, which were not affected by the Supreme Court decisions in Windsor or Obergefell.

DHCS ACWDL 17-27 (July 31, 2017).