Earlier this week, DHCS released instructions on resetting redetermination dates for those Medi-Cal beneficiaries who retain eligibility due to a change in circumstances.  The letter can be found here.

Where the county is responsible for Medi-Cal case management. beneficiaries shall be granted a new 12 month period of eligibility if they retain eligibility after a change of circumstances redetermination.  This is applicable only when the change is to an eligibility data element, such as income or household composition.  If the beneficiary is protected by a consumer protection program (e.g., CEC, TMC, etc…), the redetermination date will not reset.  Change of circumstances applies to changes reported in other public benefit programs as well.

DHCS is providing guidance to ensure continuing eligibility for children during 2014 annual redeterminations as pre-ACA coverage transitions to ACA MAGI coverage.   The full letter is available here.

Children currently enrolled in pre-ACA Medi-Cal coverage that would no longer be eligible under MAGI rules at their 2014 redetermination must remain on Medi-Cal (including any premiums or cost sharing) until their 2015 redetermination date (2101(f) protection).  This applies to children receiving Medi-Cal on or before 12/31/13 and losing eligibility at their 2014 MAGI redetermination.  They will be shifted to a new ACA children aid code.

The letter provides the applicable aid codes, scenarios, and exceptions to 2101(f) protection.

 

This week, the Department of Health Care Services has issued guidance to counties about verifying income for pending Medi-Cal cases.  Those cases currently pending in SAWS are first to be rerun through the federal data hub when available.  If the information available in the hub is not reasonably compatible with the income reported in the application, counties are to do an ex parte review for that information.  If the county cannot verify income through ex parte review, the county is to mail a three ten-day requests for verification before denying the application; this is a temporary change from the normal two requests in order to deal with the backlog of pending applications.

For more information, the full letter is available here.

DHCS issued guidance on how Medi-Cal NOAs are being generated by CalHEERS and SAWS beginning 4/15/14.  The full letter is available here.  Two sets of NOAs will be released:

1. A “one-time batch” of NOAs from pre-enrollment and pre-CalHEERS/SAWS interface (applications filed 10/1/13 to 1/20/14) and post-interface (1/21/14-3/10/14)
2. Ongoing as part of regular processing of NOAs dating from 3/11/14 onwards

The letter identifies some issues that may cause confusion among Medi-Cal beneficiaries:

1. Both CalHEERS and SAWS may issue separate NOAs regarding MAGI and Non-MAGI Medi-Cal, respectively.  SAWS will reflect the correct eligibility category.
2. CalHEERS NOAs may have the wrong coverage effective date, using the date of eligibility determination instead of the correct effective date of eligibility.
3. CalHEERS is generating NOAs for each month of eligibility or conditional eligibility in certain circumstances.