DHCS has updated its annual eligibility charts to reflect the 2017 federal poverty level ceilings for Medi-Cal and other health programs. The new FPLS are effective 1/1/17 for MAGI programs, 1/1/17 for MSP applicants and recipients without Title II income, 3/1/17 for MSP applicants and recipients with Title II income, and 4/1/17 for ABD FPL programs.
Note that the new monthly ABD FPL thresholds will be $1235 for an individual and $1663 for a couple.
DHCS ACWDL 17-10 (March 3, 2017).
As of 8/1/16, CalHEERS has been able to verify Part A entitlement through the Federal Data Hub. Medicare entitlement precludes MAGI New Adult group eligibility, though it does not preclude eligibility through the MAGI Parent/Caretaker Relative or pregnancy coverage groups when eligible.
New Medi-Cal applicants who are eligible for Medicare will be evaluated for Non-MAGI Medi-Cal programs. For New Adult MAGI beneficiaries who are become eligible for Medicare, the county shall evaluate for other MAGI programs. Beneficiaries shall be placed on a Soft Pause until a Non-MAGI Medi-Cal eligibility determination can be made.
DHCS ACWDL 17-08 (February 24, 2017).
As of 9/26/16, CalHEERS implemented a change to introduce the Carry Forward Status to reduce gaps in coverage while consumers transition between Covered California and Medi-Cal pending county eligibility determinations. The flag in CalHEERS triggers a new notice to inform individuals of CFS.
Previously, DHCS and counties used Express Lane aid codes in a batch process pending county final eligibility determinations during the Covered California annual redetermination or change in circumstances reporting. This, however, could result in a gap in coverage when, during the final eligibility determination, a person was found not to be eligible for Medi-Cal and was referred back to Covered California without retroactive coverage. This process has been discontinued.
Now, CalHEERS will automatically place individuals into CFS when redetermination of eligibility results in potential MAGI Medi-Cal eligibility. The individual will continue with Covered California coverage until the county completes a full Medi-Cal determination. CFS will apply when a consumer reports a change that results in MAGI eligibility, when a consumer is determined MAGI eligible during the renewal period, when a consumer reports a change after the renewal is complete, and when a consumer reports a change after Covered CA eligibility has gone into effect.
During the CFS process, counties must treat cases as a new application for benefits. Counties are required to send notices to affected beneficiaries. Applicants transitioning from Covered CA to Medi-Cal may be eligible for the three-month retroactive Medi-Cal coverage period.
DHCS ACWDL 17-07 (February 24, 2017).
Between 10/1/16 and 6/30/17, CalHEERS will assign MCAP-eligible pregnant women into aid code 0G. This will allow MCAP eligibles to receive full-scope Medi-Cal services through fee for service until the end of their post-partum period.
MCAP eligible pregnant women are those with MAGI incomes between 213 and 322 percent FPL. Prior to 10/1/16, these women were enrolled in contracted health plans with no copays or deductibles. Those still in health plans will continue receiving services that way until the end of the month of the 60th day following the end of their pregnancy. New MCAP beneficiaries are being enrolled in FFS.
DHCS MEDIL I 17-03 (February 7, 2017).
DHCS is piloting a new Asset Verification Program in order to detect unreported assets for Aged, Blind, and Disabled Medi-Cal participants who are not receiving SSI/SSP. Asset verification can be performed at any time a change of circumstances is reported or at any eligibility determination. The Program allows DHCS to obtain account balances at financial institutions over the previous five years.
During this pilot, DHCS will search financial accounts for up to 3000 beneficiaries, based on the first day of the month. Ten counties (including 2 LSNC Health counties) will receive AVP information, perform an ex parte review to determine discrepancies, and determine how many clients would normally receive a follow up contact due to the discrepancy. Counties will provide DHCS an estimate of number of beneficiaries affected.
The pilot began in late January 2017. In may 2017, DHCS will release pilot findings with implementation set to begin in fall 2017.
DHCS MEDIL I 17-05 (February 3, 2017).
DHCS has issued guidance on how Medi-Cal applications should be assessed during eligibility determinations. In this hierarchy, an application (which includes reporting change of circumstance, annual redetermination, and initial screening) should be determined by progressing through the chain of programs. Workers must determine eligibility at each group with potential eligibility, and the applicant must be placed into the program that is most beneficial.
First, the county must look at Mega Mandatory groups. These are programs that are categorical or mandatory under federal law, or the programs where eligibility for Medi-Cal is linked to eligibility for another program. If an applicant is not eligible here, the next check is with the MAGI programs, including MCAP and CCHIP. Next would the the Non-MAGI Optional Categorical programs, followed by Medically Needy/Medically Indigent programs, and Non-MAGI State Only programs.
If an applicant is not eligible for any Medi-Cal program at the MAGI stage, the applicant should be evaluated for APTC eligibility. Pregnant applicants have the option to enroll in either MCAP or Covered California, and may move from Covered California to MCAP during pregnancy and the post-partum period. Counties must evaluate all Medicare-eligible applicants for Medicare Savings Programs.
DHCS ACWDL 17-03 (January 25, 2017).