Medi-Cal

Updated Guidance on Medi-Cal Failure to Respond NOAs

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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).

Medi-Cal 1095-B Forms and County Obligations

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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).

Treatment of Same-Sex Spouses in Medi-Cal Post-Windsor and Obergefell

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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).

Non-MAGI Medi-Cal Application Supplemental Forms

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For Non-MAGI Medi-Cal determinations, DHCS has provided supplemental forms and a flow chart to help evaluate cases for proper eligibility.  Non-MAGI evaluations are required when an applicant requests such a determination, when MAGI does not apply, or when there is potential non-MAGI eligibility for those not income-eligible for MAGI.

If an ex parte review reveals the need for additional information, county eligibility workers need to send applicable supplemental forms to get that information.  Workers must attempt to contact the applicant at least twice.

DHCS ACWDL 17-26 (July 20, 2017).

Medi-Cal Standards for Dental Anesthesia Services

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DHCS issued a Dental All Plan Letter to provide instructions on how to process TARs for intravenous sedation and general anesthesia services for dental procedures.  Providers must submit TARs or prior authorization requests for these services as of 11/1/15.  This letter includes six criteria and documentation requirements based on whether local anesthesia or conscious sedation had failed or was not feasible, as well as information about how the dental treatment plan affects what documentation must be submitted.

DHCS Dental APL 17-004 (June 28, 2017).

Updates to Medi-Cal Aged and Disabled, Medicare Savings Program Thresholds

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DHCS has updated the thresholds for the the Medi-Cal Aged and Disabled Federal Poverty Level program.  As of April 1, 2017, the monthly income limit for an individual is $1235 ($1005 + $230 disregard); the monthly income limit for a couple is $1664 ($1354 + $310 disregard).

DHCS ACWDL 17-19 (June 23, 2017)

Effective January 1, 2017, allocations, property limits, and premium amounts have been updated:

  • The SSI Standard Allocation is $368.
  • The SSI Parental Allocation is $735 for an individual (if one ineligible parent lives with a child), or $1103 for a couple (if both ineligible parents live with a child).
  • The Medicare Part A premium is $413 for those not receiving free Part A.  A beneficiary with 30-39 quarters has a reduced premium of $227.
  • The Medicare Part B premium is $109 on average for those held harmless, while it is $134 for those who are new to Medicare or not subject to hold harmless status.  The Part B deductible is $183.
  • The property limits for Medicare Savings Programs are $7390 for an individual and $11,090 for a couple.

DHCS ACWDL 17-20 (June 30, 2017).