DHCS is not raising the community spouse resource allowance or the maximum spousal income allocation under the Medicare Catastrophic Coverage Act. These limits will remain at $119,200 and $2981, respectively. ACWDL 15-38 (12/18/15).
Summaries of select CalWORKs, CalFresh, Health and Housing Regulations
Medi-Cal
Medi-Cal 1095-B forms issued
Beginning January 4, 2016, DHCS started to issue 1095-B forms to Medi-Cal beneficiaries as proof of minimum essential coverage for 2015 tax returns. Mailings were sent on a rolling basis on county and zip code. The MEDIL includes the mailing schedule and cover letter samples. MEDIL I 15-43 (12/31/15).
Medi-Cal managed care coverage of BHT for children with autism
DHCS has provided new guidance on how Medi-Cal managed care plans cover BHT services to beneficiaries under 21 through EPSDT. Beginning 2/1/16, BHT services for those who received them at regional centers prior to 9/15/14 will transition to managed care plans over a six-month period. For those who do not meet regional center criteria, managed care plans must cover medically necessary services upon enrollment.
For those transitioning from regional centers, plans must automatically generate a continuity of care request and proactively contact providers to begin the process. Plans must offer up to 12 months of continuity in accordance to existing contract requirements. BHT services will not be discontinued until a new treatment plan has been completed and approved by the plan. If continuity of care cannot be reached, the plan must transition the beneficiary in-network and ensure no gap or change in services occurs. Plans are supposed to contact beneficiaries starting 12/1/15 on a rolling basis over the transition period.
To receive BHT services, a Medi-Cal beneficiary must be under 21, have a diagnosis of autism spectrum disorder based on a comprehensive diagnostic evaluation, have a recommendation for BHT from a licensed physician/psychologist, be medically stable, and be without a need for 24-hour monitoring. BHT services must be medically necessary and provided and supervised under a plan-approved behavioral treatment plan developed by a contracted and credentialed qualified autism service provider. DHCS APL 15-025 (12/3/15).
Updated family member base allocation amount for 2015-2016
DHCS issued a letter updating the family member base allowance amount from $1967 to $1991, effective July 1, 2015. This allowance is used to determine how much a long-term care beneficiary may allocate to family members living with a community spouse. DHCS MEDIL I 15-40 (12/7/15).
Fixes for Former Foster Youth who enrolled in Covered California
Former foster youth (FFY) up to the age of 26 may be eligible for Medi-Cal under the Affordable Care Act, though CalHEERS has only recently implemented the proper software. DHCS issued a letter to clarify how to fix the situation for FFY who enrolled in a qualified health plan (QHP) through Covered California.
DHCS was to reach out to FFYs enrolled in a QHP about their potential eligibility for Medi-Cal, informing them that counties would evaluate for Medi-Cal. If the county verifies an FFY status, no further verification is required. FFYs can either elect to be enrolled into Medi-Cal coverage (under aid code 4M) until age 26, or they can enroll in unsubsidized Covered CA coverage. The county will assist FFY with disenrolling from a QHP after enrolling the individual into Medi-Cal. DHCS ACWDL 15-37 (11/30/15).
How to treat disaster-related payments for Medi-Cal eligibility
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).