DHCS issued a letter directing counties to stop terminating cases for specific aged, blind and disabled cases where the beneficiary did not return the Request for Tax Household Information form associated with MAGI rules. Counties will also be reinstating those ABD beneficiaries who were terminated for not returning the RFTHI. In these cases, the county must restore eligibility back to the date of discontinuance, then proceed to complete a 2014 redetermination based on ABD status before going onto a MAGI determination. DHCS ACWDL 15-03 (1/20/15).
Summaries of select CalWORKs, CalFresh, Health and Housing Regulations
Medi-Cal
Non-COHS Medi-Cal managed care plans must treat medical exemption requests and denials as continuity of care requests
DHCS is directing managed care plans to treat Medical Exemption Requests as automatic requests for continuity of care for those Medi-Cal beneficiaries transitioning into managed care. MCPs must treat every exemption listed in data reports as an automatic continuity of care request. MCPs must attempt to contact beneficiaries via letter and two calls, and must begin processing requests within five days. DHCS All-Plan Letter 15-001 (1/14/15).
Clarification for using personal care services to meet Medi-Cal share of cost
DHCS recently clarified the process for using out-of-pocket expenses from personal care services to meet current or future share of cost amounts. Previously, IHSS needed to assess and approve the need for personal care services, and the out-of-pocket costs of approved hours were used as an income deduction. Since these services are now provided as a Medi-Cal benefit, out-of-pocket costs can now be used to meet share of cost and not income deductions.
These out-of-pocket personal care services must be prescribed by a healthcare professional. The services need not be assessed by IHSS or provided by an IHSS provider, and they may exceed the maximum assessed IHSS hours as long as the need for hours has been documented.
The letter provides answers to frequently asked questions about using these out-of-pocket expenses toward the Medi-Cal share of cost. DHCS ACWDL 15-02 (1/12/15).
Guidance on transitioning Covered California cases to Medi-Cal
DHCS issued a letter to guide counties on how to handle Covered California cases transitioning to Medi-Cal after Covered California’s annual redetermination process, which will always run at the same time each year. When Covered California determines that a beneficiary may now be income-eligible for Medi-Cal, it will forward the information to the counties for final determination.
Those found eligible, conditionally eligible, or pending eligible are sent to the county for appropriate verification. Eligible cases were granted temporary full-scope Medi-Cal eligibility as of January 1, 2015, and assigned to the same health plan where possible.
DHCS’s letter included talking points on the transition process and sample notices/letters to consumers. DHCS ACWDL 15-01 (1/7/15).
Directions for issuing refunds for premiums from Optional Targeted Low Income Children Program
DHCS issued a letter with directions on how the county should deal with refunds of TLICP premiums or waivers due to beneficiary request or retroactive eligibility for non-premium aid codes. When a beneficiary requests prospective discontinuance in writing, counties must request the refund or waiver on the beneficiary’s behalf even if the beneficiary claims not to have paid the premium. When retroactive eligibility for free Medi-Cal is determined, the county must submit a request to Maximus (the administrative vendor) for refund/reimbursement. Note that a beneficiary may continue to receive premium due invoices after discontinuance due to the billing cycle. DHCS ACWDL 14-43 (1/5/15)
Plans must ensure continuity of care for Medi-Cal beneficiaries transitioning into managed care
DHCS issued an All-Plan Letter providing requirements for continuity of care for Medi-Cal beneficiaries that are transitioning into managed care plans from fee-for-service Medi-Cal. The requirements allow for the option to continue treatment for up to 12 months with an out-of-network Medi-Cal provider for Medi-Cal services. The letter also covers issues relating to outpatient mental health services, transition from Covered California to Medi-Cal, transition of Seniors and Persons with Disabilities, and coverage of behavioral health treatment for children with autism. DHCS APL 14-021 (12/29/14).