DHCS has updated its “Whose Income Counts” Flowchart [DHCS MEDIL I 18-12 (September 14, 2018)] and its MAGI Income and Deductions Type Chart [DHCS MEDIL I 19-03 (January 11, 2019)].
Summaries of select CalWORKs, CalFresh, Health and Housing Regulations
Medi-Cal
Medi-Cal Eligibility Exceptions due to Public Health Crisis or Disaster
DHCS has issued guidance about the timeliness exceptions for processing applications and redeterminations in counties affected by a state or federally declared major public health crisis or natural disaster.
Applicants in affected areas requested expedited medical services shall not have their applications delayed. Counties shall inform persons with immediate needs of available resources, expedite eligibility determinations, and accept self-attestation and electronic verification.
Any beneficiaries in affected areas shall have discontinuances delayed to the extent possible and be allowed additional time to provide required documents. The County shall accept a signed and dated affidavit in place of requested verification documentation. Those who were discontinued may have their benefits reinstated and given more time to provide information.
DHCS will waive premiums for state programs when a major public health crisis or natural disaster occurs. Cash payments received for repair or replacement of lost, damaged, or stolen exempt property shall be treated as exempt property for nine months from the date of receipt (can be extended for good cause).
A beneficiary’s current health plan will be the point of contact for services out of county until an official change of address occurs. Beneficiaries who are displaced may get assistance with transferring a case on a permanent or short-term basis.
DHCS ACWDL 19-01 (January 9, 2019)
Recent Changes to Medi-Cal Notice of Action Requirements
Revised NOA for 250% Working Disabled Program Approval
DHCS has revised NOAs for Working Disabled Program approvals to clarify that couples do not need to pay separate premiums as a couple. DHCS has also revised its EFT premium payment flyer for county use. DHCS ACWDL 18-18 (August 9, 2018).
NOAs for Beneficiaries Who Do Not Complete Non-MAGI Evaluation at Annual Renewal/Change in Circumstance
DHCS updated guidance to counties regarding MAGI discontinuance NOAs when the beneficiary is ineligible for MAGI, is potentially eligible for Non-MAGI, and the beneficiary does not complete the Non-MAGI evaluation when ex parte review is not successful. The discontinuance NOA must indicate both why a beneficiary is not eligible for MAGI and why the county could not complete the Non-MAGI evaluation. This guidance provide required language for such notices. DHCS ACWDL 18-24 (October 29, 2018).
Information Regarding Reporting Requirements on NOAs
DHCS is providing guidance about the requirement to include information about an applicant’s or beneficiary’s responsibility to report changes in circumstances on all MAGI and Non-MAGI NOAs that approve, change, or continue Medi-Cal eligibility. The letter includes sample NOA snippets for various situations. DHCS ACWDL 19-02 (January 9, 2019).
NOA Requirements at Annual Renewal or Change in Circumstance Resulting in Resetting Annual Renewal Date
DHCS has issued updated requirements for NOAs for continuing eligibility at annual renewal and change in circumstances. Federal regulations require counties to send NOAs when there are no changes to eligibility at annual renewal or following a change in circumstances resulting in resetting of the annual renewal date. DHCS has provided sample language for these circumstances. DHCS ACWDL 19-03 (January 9, 2019).
Updated Specialty Thresholds for Medi-Cal Programs in 2018-2019
Effective July 1, 2018, through June 30, 2019, the FMBA amount for a family member living with the community spouse of an institutionalized spouse is $2,058 (compared to last year’s $2,030). DHCS ACWDL 18-13 (July 3, 2018); DHCS ACWDL 18-13E (November 20, 2018).
As a result of the 2.8% COLA for 2019 Social Security benefits, DHCS has updated various threshold documents, including Pickle and SSI/SSP payment levels. This change does not affect MAGI eligibility. DHCS ACWDL 18-27 (December 7, 2018).
Effective January 1, 2019, the community spouse resource allowance is $126,420. The maximum spousal income allocation/minimum monthly maintenance needs allowance is $3,161. DHCS ACWDL 18-28 (January 14, 2019).
Processing Medi-Cal cases with no potential MAGI eligibility
DHCS has issue guidance on not running CalHEERS business rules for certain household with no potential MAGI Medi-Cal eligibility. These include Mega-Mandatory beneficiaries in programs required by federal law or categorical programs (e.g., foster care, Pickle, SSI/SSP) and cases where the entire household is potentially non-MAGI eligible (aged/disabled, receiving Medicare, no dependent children or pregnant persons).
Currently, if an applicant is Mega Mandatory and CalHEERS returns a MAGI eligibility result, counties must not accept the MAGI result and must retain or establish eligibility under the Mega Mandatory aid code. In some cases, the county is unable to grant Mega Mandatory eligibility without running the case through CalHEERS rules, which requires information that is unnecessary for aged or Mega Mandatory individuals. SAWS will be making changes to address these workarounds for Mega Mandatory and non-mixed MAGI/Non-MAGI households. Otherwise, counties must run the CalHEERS rules for other individuals.
DHCS ACWDL 18-16 (July 11, 2018).
Medi-Cal for Unaccompanied Refugee Minors (URMs)
DHCS issued a letter with information and guidance to counties regarding cases for Unaccompanied Refugee Minors (URMs) URMs who are otherwise eligible get no share of cost full scope Medi-Cal benefits, and are to be treated like foster care children for Medi-Cal eligibility purposes.
Three state-designated URM program service providers should submit applications to the county of residence on behalf of URMs placed with the agency. Social workers will provide verification letters as proof of eligibility for refugees. County welfare departments must not delay or deny services for failure to provide the SSN or verification of immigration status, though counties should work to verify status in order to maximize federal financial participation.
URM individuals are eligible for full scope Medi-Cal regardless of immigration status. Those who meet former foster youth (FFY) eligibility requirements are eligible to continue receiving full scope Medi-Cal under the FFY program. Counties must follow the appropriate rules on annual redetermination and inter-county transfers.
DHCS ACWDL 18-14 (July 3, 2018).