Medi-Cal

COVID-19 guidance on various Medi-Cal issues

Posted on by

The Department of Health Care Services (DHCS) has issued guidance on various Medi-Cal issues affected by COVID-19.

The county computer systems were successfully programmed to delay processing of annual renewals and reported changes, and delay discontinuances and negative actions as a result of annual renewals or reported changes while Executive Order N-29-20 is in effect.

Individual case workers can discontinue cases.  This should happen when people have died, people are no longer living in California, people request voluntary discontinuance of Medi-Cal and when non-MAGI Medi-Cal individuals move to a Long Term Care aid code.

The requirement to maintain continuous coverage applies to people who might otherwise have coverage terminated or reduced because of a change in circumstances, including people who age out of a Medi-Cal eligibility group, people who lose other benefits that would affect their Medi-Cal eligibility, people whose whereabouts become unknown, children in the Optional Targeted Low Income Children Program who would otherwise move to a premium aid code, people who would have a new or increased share of cost, and people who would otherwise move from full scope to restricted scope coverage.

Some cases may have been discontinued as early as February 20 for failure to provide information or respond effective April 1. Counties must prioritize requests for reimstatement from these individuals.

Individuals discontinued prior to March 17, 2020 who are in their 90 day cure period must work with the county to resolve outstanding eligibility issues before the county can restore eligibility.

The time to request a hearing regarding Medi-Cal eligibility or fee for service issues is extended by 120 days to a total of 210 days.  Persons who are receiving aid paid pending during the Executive Order period are enrolled for benefits and must remain eligible.  Counties must delay processing negative actions because of a hearing decision through the duration of the Executive Order.

Counties shall conduct telephone interviews or appointments when applicants are usually required to visit the office.  Counties shall accept written affidavits by telephonic signature.

Counties must process transactions for individuals released from incarceration by reporting the release date because it is a positive action that addresses a barrier to care.

Persons who are in Managed Care Plan hold status need to obtain services through Fee for Service.  (MEDIL I 20-08, April 10, 2020.)

COVID-19 PUA implementation and stimulus payments for undocumented persons

Posted on by

Governor Newsom has issued an Executive Order and press release regarding implementation of Pandemic Unemployment Assistance (PUA) and state stimulus payment for undocumented workers.  PUA will provide benefits for persons ineligible for regular unemployment insurance, including independent contractors, persons who are self-employed, gig workers, and persons who do not have a sufficient employment history to be eligible for regular Unemployment Insurnace, who are unemployed or partially unemployed because of COVID-19.  The PUA program will begin in California on April 28, 2020.  Benefits will be issued within 24-48 hours.

The Employment Development Department (EDD) will launch a new call center that will be open 7 days per week from 8:00 am to 8:00 pm.  EDD will also expedite access to the Work Share program to avert layoffs.

Governor Newsom also announced state funded stimulus payments for undocumented persons in California of $500 per person and a maximum $1,000 per household beginning in May. These funds will be disbersed through regional nonprofit organizations.

Governor Newsom also reiterated that COVID-19 testing, evaluation and treatment is considered emergency services under Medi-Cal, regardless of where they are received.  This means all Medi-Cal beneficiaries can receive COVID-19 treatment regardless of documentation status.     (Executive Order N-50-20 and Press Release, April 15, 2020.)

COVID-19 Medi-Cal annual redeterminations

Posted on by

The Department of Health Care Services (DHCS) instructs counties to delay processing of annual redeterminations and delay discontinuances and negative actions for Med-Cal, Medi-Cal Access Program, Medi-Cal Access Infant Access Program, and County Children’s Health Initiative Program for 90 days.

Counties should immediately stop processing annual renewals.  Counties can exceed the timeliness standards for Medi-Cal and Children’s Health Insurance Program for 90 days.

Counties must delay discontinuances and negative actions as a result of renewals and changes in circumstances to ensure beneficiaries remain eligible for Medi-Cal for 90 days.  Counties must process determinations or redeterminations which will cause individuals to gain access to health care coverage and resolve barriers to access to care such as new applications, intercounty transfers, adding a person, a decrease income or processing 90 day cure period restorations.  (MEDIL I-20-07, March 16, 2020.)

COVID-19 PrEP-AP enrollment

Posted on by

The California Department of Public Health has issued instructions regarding the Pre-Exposure Prophylaxis Assistance Program (PrEP-AP) to minimize exposure to COVID-19 and maintain coverage.  For clients with expiring eligibility or expired eligibility back to March 1, PreP-AP is extending eligibility for 90 days to June 30, 2020.

However, for clients in a Gilead Assistance Program, Gilead is not extending eligibility.  Clients enrolled with expiring eligibility should submit a re-enrollment application with income documentation to Gilead prior to their eligibility ending to avoid a lapse in coverage.

If clients are unable to obtain their medication or submit a re-enrollment application before their eligibility expires, Gilead can provide the pharmacy override on a case-by-case basis.  If Gilead does not allow a medication dispense, PrEP-AP may approve an override on a case-by-case basis.

Clients enrolled in Gilead’s Patience Assistance Program and Copayment Assistance Program can receive up to a 90-day fill of medication as long as there is eligibility throughout the 90 day time period.  Clients in Gilead’s Copayment Assistance Program can only receive a 90 day dispense if their insurance allows for a 90-day prescription fill.  Pharmacies must contact Gilead to get an override code.  This is in effect until April 30, 2020.

Clinical providers are encouraged to consider converting PrEP to virtual if their agency has the capacity.  PrEP-AP can reimburse telemedicine using the same billing code as for an in person visit. Providers are encouraged to reach out to client to inform them that in-person appointments are changing to telemedicine.

Providers are also asked to postpone services that require person-to-person interaction but will maintain access to in-person visits when needed based on the client’s symptoms such as acute HIV or a sexually transmitted infection.  Laboratory testing for people on PrEP with good adherence and no symptoms can usually be postponed for 3 months.  (Management Memorandum 20-08, March 20, 2020.)

COVID-19 ADAP enrollment

Posted on by

The California Department of Public Health has issued instructions regarding the AIDS Drug Assistance Program (ADAP) to minimize exposure to COVID-19.  For clients with expiring eligibility or expired eligibility back to March 1, ADAP is extending eligibility for 90 days to June 30, 2020.

New or lapsed clients can enroll over the phone.  New or lapsed clients will be required to provide documentation of eligibility.  Workers can email the client so the client can respond with enrollment and supporting documentation.

ADAP will now have early medication refills and has extended the dispense quantity to 90-day fills.  (Management Memorandum 20-06, March 16, 2020.)

Covered California opening enrollment

Posted on by

In response to COVID-19, effective Friday March 20, Covered California opened the health insurance exchance to any eligible uninsured individuals who need health care coverage through the end of June.  After selecting a plan, coverage will begin on the first of the following month, which means individuals losing job-based coverage will not have a gap in coverage.

Consumers who sign up through CoveredCA.com may find out that they are eligible for Medi-Cal, which they can enroll in online.  Those eligible for Medi-Cal can have coverage that is immediately effective.

The Department of Managed Care and the California Department of Insurance will provide guidance to health plans on the special-enrollment period, which will include off-exchange health plans.

All plans offered through Covered California and Medi-Cal provide telehealth options.  All medically necessary screening and testing for COVID-19 is free of charge.  (Covered California Press Release, March 20, 2020.)