Medi-Cal

DHCS MEDIL I 14-43: Information Concerning the Future Implementation of the Full-Scope Medi-Cal Coverage and Affordability and Benefit Program for Low-Income Pregnant Women and Newly Qualified Immigrants (NQIs) (7/30/14)

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DHCS issued this letter to the counties about the implementation of the new Full-scope Medi-Cal coverage and affordability benefits program for low-income women and non-qualifying immigrants, to be operational no sooner than 1/1/15.

Currently, Medi-Cal limits full-scope benefits to pregnant women under 60% FPL and pregnancy-only Medi-Cal to those between 60%-208% FPL.  Recent legislation established an affordability wrap between Medi-Cal and QHPs purchased through Covered California where pregnant women and non-qualifying (5 year bar) immigrants in a Covered California plan could have out-of-pocket expenses (including copays, premiums and deductibles) paid for by Medi-Cal.

Once these programs are fully implemented, pregnant women under 138% FPL will qualify for full-scope Medi-Cal.  Pregnant women between 138-213% FPL who are enrolled in a Covered California QHP will have the option to enroll in the wrap.  NQIs who would have been eligible for Medi-Cal due to MAGI expansion rules would enroll in a QHP with automatic enrollment in the wrap.

The letter also discusses the implementation process to be followed leading up to January 2015.

DHCS APL 14-008: Standards for Determining Threshold Languages (7/15/14)

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DHCS issued this letter to inform managed care plans of the updated dataset for threshold languages and language concentration standards.  Included is the dataset and identified threshold languages for each county.

DHCS has revised MCP contracts to include the following language about threshold languages:

A population group of mandatory Medi-Cal beneficiaries residing in the service area who indicate their primary language as other than English, and that meet a numeric threshold of 3,000 or five-percent (5%) of the beneficiary population, whichever is lower.

DHCS MEDIL I 14-42: Denying Pending Applications from both the California Health Eligibility, Enrollment and Retention System (CalHEERS) and the Statewide Automated Welfare System (SAWS) Access Channels (7/25/14)

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This DHCS letter instructs counties to follow the procedures outlined previous in MEDILs I 14-23 and 14-30 when counties need to deny pending applications after ex parte reviews and two ten-day letters while CalHEERS functionality is pending.  SAWS will issue interim procedures on denying pending applications.

DHCS MEDIL I 14-36: Using Modified Adjusted Gross Income and Express Lane Enrollment Aid Codes for Applications in the Pending Backlog (7/8/14)

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In an effort to reduce the backlog of pending Medi-Cal applications, DHCS has issued this guidance to the counties on using MAGI and Express Lane Enrollment (ELE) aid codes as a manual workaround.

These aid codes are to be used when at least one member of the household has an active Medi-Cal or CalFresh aid code in MEDS and SAWS, and only when:

  1. At least one household member has been determined eligible or contingently eligible in CalHEERS and the entire case cannot be accepted into SAWS/MEDS because others in the household are still pending.
  2. The county file clears and determines the case as MAGI eligible, and CalHEERS responds that the case is pending due to data and/or technology issues with CalHEERS.

Counties cannot use this process to manually grant Medi-Cal eligibility for non-MAGI cases, limited/restricted scope cases, cases where no household member is on an active Medi-Cal/CalFresh aid code in MEDS/SAWS, or when the only eligible case members are TLICP children.

The state will send NOAs to beneficiaries granted eligibility through ELE aid codes based on this process.  Counties will send NOAs to those granted eligibility under MAGI aid codes.  All of these beneficiaries will receive intake packets.

 

DHCS ACWDL 14-28: Elimination of the Deprivation Requirement for Medi -Cal Linkage for the Modified Adjusted Gross Income Parent/Caretaker Group and the Aid to Families with Dependent Children-Medically Needy Program (7/7/14)

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DHCS released this letter to clarify that the previous deprivation of requirement was eliminated as of January 1, 2014, as part of the implementation of the Affordable Care Act.  Prior to January 1st, family linkage to 1931(b) or AFDC-MN programs was established when a child was deprived through absence, death, incapacity or unemployment/underemployment of at least one parent in the child’s family.  With the ACA, Parent/Caretaker and AFDC-MN eligibility is established when the parent/caretaker lives with the child for whom s/he provides care.

The letter also discusses the effects of this rule change on pregnant women, stepparents, and Sneede v. Kizer cases.  DHCS provides 8 examples on determining program linkage.