Medi-Cal

Medi-Cal Discontinuance Notices for Overincome, Ineligible Beneficiaries

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DHCS is clarifying NOA issuing requirements for Medi-Cal discontinuances when the beneficiary is over income for MAGI, not eligible for consumer protection programs, and has no potential non-MAGI eligibility.  Counties must issue a timely and adequate manual discontinuance notice when an individual loses eligibility for one of the above mentioned reasons, whether or not the individual is eligible for Covered California coverage.  Sample NOAs are included with the letter.  DHCS ACWDL 15-33 (10/9/15)

Spanish versions of the notices are available with DHCS MEDIL I 15-33 (10/16/15).

Medi-Cal Managed Care Coverage of BHT Services through Regional Centers

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Medi-Cal managed care plans are responsible for providing medically necessary Behavioral Health Treatment (BHT).  This includes coordinating with Regional Center and BHT providers as applicable.  Plans are required to execute an MOU with local regional centers by December 31, 2015 (a sample MOU is included with the letter).  DHCS will review to make sure plans are making a good faith effort.  DHCS APL 15-022 (10/2/15).

Medi-Cal Plan Coverage of Abortion Services

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DHCS issued a letter to Medi-Cal managed care plans reminding the plans about their responsibility to provide timely access to abortion services as a physician service.  While prior authorization may be required for non-emergency inpatient hospitalization, plans must ensure that prior authorization is not required for outpatient abortion services.  No physician is required to perform abortion services, but plans must inform beneficiaries that providers may refuse to provide such services.  Additionally, plans may not deny or interfere with a woman’s right to choose or get an abortion when necessary for the life or health of the woman.  DHCS APL 15-020 (9/30/15).

Changes in Processing Medi-Cal Cases for Former Foster Youth

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Recently, DHCS has issued some new guidance regarding Medi-Cal for Former Foster Youth (FFY).

First, if a former foster youth becomes eligible for Medi-Cal through Hospital Presumptive Eligibility (HPE), aid code 4E, counties are to process the beneficiary for full-scope Medi-Cal aid code 4M within 30 days.  If workers are unable to verify FFY status, they must assess for other programs and send a notice accordingly.  DHCS MEDIL I 15-28 (9/25/15)

Second, DHCS has provided new SAWS notices for FFY.  The notices provide language for approvals, conditional approvals, automatic renewals, continuations of coverage, and changes to coverage after age 26.  Beneficiaries should also receive appropriate denial notices as needed.  These revised notices need to be issued no later than October 30, 2015.  DHCS ACWDL 15-32 (10/7/15)

Change to Eligibility Period for Presumptive Eligibility (PE) Medi-Cal

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As of December 31, 2014, PE coverage begins on the date of the eligibility determination and ends at the end of the following month if no Medi-Cal application is submitted for full determination.  Previously, presumptive eligibility went back to the first day of the month for a 60-day enrollment period.  There is no change to the end date of eligibility.  DHCS MEDIL I 15-31 (9/24/15)

Making Changes to Beneficiary Information with a Health Plan

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Managed care plans are to contact county office liaisons to provide updated contact information for Medi-Cal beneficiaries.  If the plan has received the beneficiary’s approval, the counties must incorporate these changes immediately.  If the plan does not have the beneficiary’s approval, a county worker must verify the changes before making them.  DHCS ACWDL 15-30 (9/22/15).