DHCS has instructed counties that they must accept updated beneficiary contact information from managed care plans. If the beneficiary approves of the plan doing this, the county must update within 2 days. If the beneficiary has not approved, the county must contact the beneficiary to get an update within 5 days. DHCS ACWDL 15-19 (4/16/15).
Counties should also accept this information from Health Care Options immediately, with consent from the enrollee. DHCS ACWDL 15-20 (4/27/15).
The Chief ALJ has determined that hearing decisions that order retroactive termination of Medi-Cal eligibility were issued in error and should be returned to CDSS for correction. Should beneficiaries disagree with the corrected order, due process rights still exist. DHCS MEDIL I 15-12 (4/7/15).
DHCS issued guidance about notice requirements for Medi-Cal applicants whose applications have not been processed within 45 days per the Rivera decision. These beneficiaries have a right to file an appeal and request a hearing when the Medi-Cal determination has not been made within 45 days of application.
To comply with these requirements, DHCS has implemented in two phases a Rivera notice that foregoes the 90 day deadline to file for a hearing (applicable only for Rivera notices). Notices are available only in English and Spanish; samples are available with the letter.
DHCS MEDIL I 15-11 (4/7/15)
DHCS has updated the statewide average private pay rate (APPR) for 2015 to $8092. This is used to determine periods of ineligibility due to transfers of nonexempt personal property for less than FMV. DHCS ACWDL 15-17 (3/26/15).
DHCS has issued guidance and resources materials on the remote identity proofing process for CalHEERS. The letter contains a guide compiling a number of job aids about the RIDP process, as well as two reference sheets to address additional questions.
Currently, there are three methods for identity proofing in CalHEERS:
DHCS MEDIL I 15-10 (3/24/15).
DHCS has instructed counties to evaluate all RMA beneficiaries for eligibility for MAGI and Covered California back to January 1, 2014. New RMA applicants will be screened for Medi-Cal up to 138%, 8 months of RMA from 138% to 200%, and Covered California above 200%.
For current RMA beneficiaries whose 8 month time limit has not expired, counties must restore eligibility back to 1/1/14 for those who would have been eligible for MAGI Medi-Cal; those who are not eligible for MAGI or for other Medi-Cal linkage will be assessed for Covered California APTCs once their eight month eligibility period has run. Reviews should be ex parte to the fullest extent possible, with requests for information used only if counties can not get the information through available sources.
For RMA/RCA cases closed after 1/1/14, counties must redetermine them for MAGI or Covered California eligibility.
RCA beneficiaries must stay in the RCA aid code for the full eight months until further notice. DHCS ACWDL 15-16 (3/20/15).