DHCS issued guidance to the counties on how to treat certain disaster assistance payments for MAGI and Non-MAGI Medi-Cal programs.  Existing rules remain applicable for non-MAGI cases (see ACWDL 92-08, MEPM Article 9M, 22 CCR §§ 50481, 50535.5).  In MAGI Medi-Cal cases, most disaster assistance in federally recognized disasters are exempt as income depending on the source of payment:

• Payments from charitable organizations are considered gifts and are excluded from the tax household’s gross income.
• Payments from insurance are exempt as income in federally declared disaster areas, while insurance payments in non-federally declared disaster areas may count depending on whether they are taxable.
• Payments from federal or state government sources that are based on need are exempt, as are payments in qualified disasters from federal, state, or local government.

When a Medi-Cal beneficiary is temporarily living out of county due to displacement from disaster, the county must help that beneficiary with the Office of the Ombudsman.  DHCS ACWDL 15-36 (11/9/15).

As of August 1, 2015, the full-scope income limit for pregnant women increased from 60% FPL to 138% FPL, to be automatically applied through both CalHEERS and SAWS applications.

For new applicants, eligible pregnant women up to 138% FPL will be enrolled into full-scope Medi-Cal coverage through managed care.  Those between 139% FPL and 213% FPL will be eligible for pregnancy-related services through Medi-Ca.  Aid codes will be based on the applicant’s income and citizenship/immigration status.

Current (as of 8/1/15) pregnancy-only beneficiaries between 60% and 138% FPL received notices about the change on 9/14/15 and were given the option to remain in fee-for-service or switch to managed care.

DHCS ACWDL 15-35 (11/12/15).

Starting this week, DHCS is sending Medi-Cal beneficiaries information about the 1095-B that households will need to show minimum essential coverage for the year at tax filing.  The 1095-B forms themselves will be mailed out no later than January 31, 2016.  The letter includes English and Spanish language versions of the DHCS letter and a call center script.  DHCS MEDIL I 15-36 (10/30/15).

According to state law, counties are supposed to stop accepting older, non-single streamlined applications for Medi-Cal after January 1, 2016.  However, DHCS is requiring counties to continue to accept these older applications (including the SAWS 2 PLUS) and request any additional information necessary to make MAGI and non-MAGI determinations as appropriate until any remaining supplies are exhausted.  DHCS ACWDL 15-34 (10/28/15).

Counties must offer a 1095-B beneficiary notice to all households at application for insurance affordability programs including Medi-Cal.  The Notice will provide information about the Form 1095-B and remind all applicants to report all changes that may affect program eligibility to their county worker.  DHCS included English and Spanish language versions of the Notice.  DHCS MEDIL I 15-35 (10/26/15).

The State issued an urgent reminder to counties to review caseloads for share of cost cases (or potential share of cost cases denied due to assets) for MAGI eligibility.  These cases should be appropriately determined back to January 1, 2014, so that the state can issue proper 1095-B forms and get individuals signed up for Covered California where appropriate.  DHCS MEDIL I 15-29 (10/22/15).