DHCS has issued a letter with the MC 216 pre-populated renewal forms, which have now been translated into the threshold languages. DHCS ACWDL 15-09 (1/30/15).
Summaries of select CalWORKs, CalFresh, Health and Housing Regulations
Medi-Cal
The effect of the January 2015 COLA on Medi-Cal eligibility
DHCS has issued guidance on how to process the 2015 cost of living adjustment in SAWS. This COLA does not affect MAGI groups, and CalHEERS will wait for the 2015 FPL updates to run retroactive eligibility batches. The letter provides instructions on calculating gross income for Social Security recipients and Pickle amendment applicants. The letter also lays out SSI/SSP payment levels, 2015 resource limits, benefit rates, and Pickle disregards. DHCS ACWDL 15-08 (2/9/15).
Medi-Cal coverage of podiatric and chiropractic services provided by FQHCs and RHCs
DHCS issued a letter to all Medi-Cal managed care plans regarding podiatric and chiropractic services in light of California Rural Health Clinics v. Douglas. If these services are provided at a Federally Qualified Health Center or Rural Health Center, plans shall cover them but may restrict reimbursement to contracted providers. APL 15-003 (1/26/15).
How to count self-employment or fluctuating income for MAGI determinations
DHCS issued guidance to counties regarding how to treat fluctuating or self-employment income and how to use projected annual income in MAGI determinations in CalHEERS. The letter notes that IRS rules for net income from self-employment activities are different from non-MAGI rules; IRS deductions are broader than those allowed for non-MAGI programs.
For projected annual income, counties can take an average to determine monthly income. If income fluctuates monthly, the single streamlined application uses projected annual income. If the individual’s current monthly income is lower than the projected annual income, counties should use the current monthly income. CalHEERS is expected to be fixed in March 2015 to address this situation. DHCS ACWDL 15-06 (1/21/15).
More guidance on cases transitioning from Covered California to Medi-Cal as of 1/1/15
DHCS issued additional guidance to counties for those cases transitioning to Medi-Cal due to the Covered California annual redetermination process. A prior letter referred to a batch data file sorted rejected cases into categories of “eligible,” “conditionally eligible,” or “pending eligible.” This file has 1720 cases, 879 of which were provided temporary coverage and 841 rejected for a second time.
The 841 rejected cases are to be evaluated manually by the counties and consortia for eligibility. The 879 temporary coverage cases were granted Express Lane aid codes and Medi-Cal coverage until the cases can be evaluated. DHCS ACWDL 15-05 (1/20/15).
2015 Medi-Cal spousal impoverishment caps increased
DHCS issued new income and poverty caps under the Medicare Catastrophic Coverage Act. As of 1/1/15, the community spouse resource allowance is now $119,220; the increased spousal income allowance/minimum monthly maintenance needs allowance is $2981/month. DHCS ACWDL 15-04 (1/20/15).