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).

When a student attends college in a different county, the family needs to inform the county of this change.  The county will update only the student’s address in SAWS and MEDS.  This change will trigger change in health plans where applicable, and the student can pick a new health plan based on the student’s college address.  Until the student enrolls in a new plan, Medi-Cal benefits will be administered on a fee for service basis.  If a student returns home for a school break and needs services, the student will need to update the address of record.

DHCS has issued this guidance along with a Frequently Asked Questions.  DHCS MEDIL I 15-32 (10/20/15).