Under the ACA, 19 to 64 year olds who are neither disabled nor blind can be eligible for Medi-Cal if if their modified adjusted gross income (MAGI) is below a certain amount. There are several MAGI aid codes, many of which indicate eligibility for full-scope Medi-Cal with federal financial participation (FFP). For such individuals who have not yet been determined to be disabled by CDSS or the Social Security Administration, they may still receive IHSS if they (1) meet the criteria for disability under MPP Section 30-780.2(b), and (2) have an assessed need for IHSS. ACL 14-67.
Summaries of select CalWORKs, CalFresh, Health and Housing Regulations
Medi-Cal
County instructions on entering reported income
DHCS has provided instructions on how the county should enter income information when applicants enter both or neither current monthly income or projected annual income. Currently, CalHEERS and SAWS are not programmed with appropriate changes for projected annual income. The letter includes information on how to deal with certain situations. DHCS MEDIL I 15-07 (3/9/15).
Reference charts for Medi-Cal eligibility based on 2015 FPLs
DHCS has updated its Medi-Cal eligibility ceiling charts. The effective dates for these amounts vary by program; these dates are listed in the letter. Attached to the letter are FPL calculation charts for monthly and annual income amounts, as well as a breakdown of the eligibility ceiling categories. DHCS ACWDL 15-11 (3/11/15).
DHCS provides an overview of backlog batch processes
In this letter, DHCS walks through the various efforts the state has made to expedite processing and eligibility for applicants waiting for eligibility determinations throughout the ACA era. Of the described batches, the state is still processing the following batches:
- Processing applications for short term negative actions due to the absence of such functionality in CalHEERS;
- Transition to Medi-Cal cases from Covered California annual redetermination period; and
- Accelerated enrollment for cases that have not been processed within 45 days since the second open enrollment period.
The letter includes a graph describing each batch process and relevant state instruction letters. DHCS MEDIL I 15-05 (3/5/15).
Upcoming Changes to CalHEERS online Single Stream Application
As of March 2, 2015, the online CalHEERS application portal has been changed to be more consumer friendly and in line with the paper application. This DHCS letter explains that changes were made to simplify language and improve applicant understanding by putting some information front and center and making links available in easier places. The changes include:
- Asking questions about whether applicant qualifies for subsidies up front;
- Links to information about the Deemed Infant Program, the Former Foster Youth program, and programs for pregnant women;
- Updating the household information section to clarify what documentation is required;
- Preventing the entry of contradictory tax information; and
- Offering the opportunity to register online to vote.
Paper applications are being reviewed and will be printed when approved. DHCS MEDIL I 15-04 (3/4/15).
Change in Third Party Administrator for CMSP Benefits
As of April 1, 2015, CMSP medical and dental benefits will be authorized by Advanced Medical Management, taking over for Anthem Blue Cross. On March 3, 2015, beneficiaries were mailed notices regarding this transition. CMSP ACL 15-02 (3/3/15).
AEVS responses and the Medi-Cal Provider Operations Manual will be updated to reflect this change as of April 1, 2015. DHCS MEDIL I 15-06 (3/6/15).