DHCS issued a letter with the required Spanish-language Notice of Action language for failure to respond to requests for information at application or redetermination. The letter also includes language counties should use to explain the 90-day cure period. DHCS MEDIL I 15-21 (8/13/15).
This language should be used according the instructions from DHCS ACWDL 15-27.
DHCS issued a letter to address a known CalHEERS system defect where individuals without a social security number go through the system and return with pending eligibility from CalHEERS. The defect occurs when an individual is processed for an eligibility determination request at intake, renewal, or change of circumstances. The impacted populations are newborn infants, undocumented individuals, and those without SSNs, both existing MAGI beneficiaries and new applicants.
The letter gives instructions on how to deal with affected cases. DHCS MEDIL I 15-23 (8/13/15).
DHCS issued clarification about the CalHEERS issues regarding scope of services for certain immigrants. The new release of CalHEERS uses two data fields for scope of services. If both fields (Citizen and Eligible Immigrant) are marked “no” or left blank, CalHEERS will grant restricted scope benefits. Counties have been instructed to ensure that workers do the appropriate verifications. Counties also must assess how much of a problem has occurred and fix problems as appropriate, including providing a proper notice. DHCS MEDIL I 15-20 (8/11/15).
DHCS has issued clarification in cases where individuals are pending AE and the County doesn’t deny the application. Counties are reminded that they must ensure that the individuals excluded from the 45-day AE process due to pending negative action should be included in county exclusion lists. These applicants should still receive Rivera notices unless the denial action will be completed before the NOI would otherwise be mailed. DHCS ACWDL 15-28 (8/6/15).
The State is implementing a new CalHEERS release. In this letter, DHCS provides an overview of new major functionalities of this release. Counties will now be able to initiate negative actions (denials/discontinuances). Additionally, CalHEERS is supposed to reduce the number of MAGI Medi-Cal NOAs at application and change of circumstance. DHCS MEDIL I 15-19 (8/3/15).
DHCS has issued guidance on Medi-Cal benefits for TCVAP beneficiaries. The letter reviews eligibility for TCVAP and documentation requirements for Medi-Cal eligibility purposes. DHCS ACWDL 15-25 (7/22/15).