Medi-Cal

Certain IHSS/HCB caregiver wages are MAGI exempt

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DHCS clarified its MAGI Income and Deductions chart to account for recent IRS clarification about live-in caregiver wages.  Caregiver wages paid under certain IHSS and Home and Community Based Waivers are not counted for MAGI determinations when paid to a provider who lives with the Medi-Cal beneficiary receiving personal care services.

This exemption applies to:

  • In-Home Operations Waiver
  • Nursing Facility/Acute Hospital Waiver
  • Personal Care Services Program
  • In-Home Supportive Services Plus Option
  • Community First Choice Option
  • In-Home Supportive Services – Residual Program

DHCS MEDIL I 16-17 (September 21, 2016).

Changes to Medi-Cal estate recovery

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Effective January 1, 2017, SB 833 changes rules regarding Medi-Cal estate recovery.  DHCS will be limited to recovering for nursing facility services, home and community-based services, and related hospital and prescription drug services when beneficiaries receive nursing facility and/or home and community-based services.

Other important changes include:

  • An additional hardship waiver if DHCS determines that enforcement of the claim would result in substantial hardship to other dependents, heirs, or survivors of the decedent.  Subject to federal approval, “substantial hardship” can include consideration of a homestead of modest value, defined as “a home whose fair market value is 50 percent or less of the average price of homes in the county.”
  • Prohibition of recovery from the estate of a deceased beneficiary who is survived by a spouse or registered domestic partner.
  • Setting how a voluntary post death lien accrues interest
  • Allowing eligible Medi-Cal beneficiaries to request a copy of the amount of recoverable Medi-Cal expenses once per calendar year for $5.

The estates of Medi-Cal beneficiaries who pass on or before December 31, 2016, will be subject to existing estate recovery rules.

DHCS MEDIL I 16-16 (September 21, 2016).

Changes to CalHEERS and determination of immigration status

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Recently, DHCS updated CalHEERS and how the system determines program eligibility based on immigration status.  The update removed a question asking applicants whether they are an “eligible immigrant” and added a drop-down option for those who do not have a specifically identified document or status.  Instead, the updated CalHEERS asks applicants to select from a list of statuses.  Counties should only follow up with an MC 13 when necessary to determine status or when an applicant selects “Document or status not listed” for both document and status choices.

This update should not change how CalHEERS determines Medi-Cal eligibility, which will be conditional for up to 90 days to verify status unless “Document or status not listed” is selected.  Those applicants must get an MC 13 from the county, and the county cannot delay or deny the application if an applicant fails to respond to the MC 13.

This update will not be implemented in SAWS, so county workers will need to be able to address some of the issues that will come up when a status is not verified by the Federal Hub.  DHCS’s county letter describes these situations.

DHCS ACWDL 16-21 (September 14, 2016).

Preserving Medi-Cal eligibility for Foster Youth who run away from placements

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DHCS has issued a letter to clarify eligibility guidelines for foster care youth who leave court-ordered placements.  While loss of contact with the youth may discontinue foster care payments, that youth may be in other Medi-Cal aid codes and must not be discontinued simply due to loss of contact.

During ex parte review of Medi-Cal cases, workers should determine if the foster care youth is still under jurisdiction of the court; if so, the youth should be placed in the appropriate Medi-Cal only aid code not associated with a foster care payment.  If the foster care youth is still under the court’s jurisdiction, that youth should stay in the appropriate aid code regardless of whether the youth is located.  Foster care youth are not required to enroll into managed care unless in a COHS county.

The letter runs down scenarios about whether a foster care youth is located, where that youth is located, and whether the youth is under jurisdiction of the court.

DHCS ACWDL 16-20 (September 1, 2016).

Adult Immunizations as a Medi-Cal Pharmacy Benefit

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DHCS has issued a letter to Medi-Cal managed care plans to instruct plans to include adult immunizations on plan formularies.  A pharmacist may administer immunizations according to plan protocols as long as the pharmacist completes an immunization training, is certified in basic life support, and comply with all state and federal recordkeeping and reporting requirements.

DHCS APL 16-009 (August 31, 2016).