Medi-Cal

Notice requirements for Medi-Cal applicants/beneficiaries who fail to respond or provide additional information

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In light of the recent preliminary injunction in Korean Community Center of the East Bay v. DHCS, DHCS has instructed counties as of June 23, 2015, to stop discontinuing for failure to respond until appropriate and adequate NOAs can be issued with the specific information requested.  DHCS MEDIL I 15-18 (7/29/15).

The state has issued more specific instructions for denials at application (DHCS ACWDL 15-26) and discontinuances at redetermination (DHCS ACWDL 15-27).  The letters provide required language for these situations.  Additionally, the state reminds counties on how to handle verbal requests for discontinuing benefits. (7/31/15).

Priorities for Processing Medi-Cal Application Batches

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DHCS has set priorities for counties to process Medi-Cal batch applications.  Counties are to resolve batch transactions that DHCS has not batched in weekly 45-day accelerated enrollment (AE) batch runs.  Then, counties need to review Rivera Notice of Inaction individuals.  Next, counties would process applications within the required 45 day timeframe.  Finally, counties should process full eligibility determinations for those batched in aid code 8E.

DHCS MEDIL I 15-15 (7/13/15).

Medi-Cal managed care coverage of wheelchairs

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DHCS issued an All Plan Letter clarifying how Medi-Cal plans should determine medical need for wheelchairs and applicable seating and positioning components.  The criteria for medical necessity must include a medical evaluation of the beneficiary and review of the equipment to ensure that the beneficiary has appropriate mobility in or out of the home.

Medi-Cal covers medically necessary equipment when it is appropriate for use in or out of the patient’s home, regardless of whether the needed equipment will be used inside or outside of the home.  DHCS APL 15-018 (7/9/15).

Residency for Out-of-State Students for Medi-Cal Purposes

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DHCS recently issued guidance around Medi-Cal residency requirements for students either from out-of-state who attend California schools or California residents who attend out-of-state schools.  If otherwise eligible, those students who come to California to attend school may apply for Medi-Cal (all other eligibility rules apply).  Similarly, Medi-Cal beneficiaries who leave California to attend school can continue their Medi-Cal eligibility assuming they are still otherwise eligible.  These beneficiaries may also apply for Medicaid in the state in which they attend school.

Parents/caretakers and households would also retain Medi-Cal eligibility if the only child or one child attends school out of state.  Medi-Cal will only cover emergency services as long as the provider agrees to accept Medi-Cal.  DHCS ACWDL 15-23 (7/9/15).