The Affordable Care Act broadened the definition of an “institutionalized spouse” to include HCBS recipients and persons who have requested HCBS and generally reside at home or in the community. DHCS ACWDL 17-25 (July 19, 2018) initially extended spousal impoverishment rules from institutionalized spouses in long term care settings to applicants and recipients of other HCBS and waiver programs.  DHCS has clarified that the spousal impoverishment provisions apply to registered domestic partners.

Spousal impoverishment rules apply to the first month when a request for HCBS or IHSS has been made and the individual meets a nursing facility level care.  These rules must be applied to HCBS spouses who request IHSS and provide a verification form.  These provisions should be applied retroactively; DHCS provides examples of how to apply these rules.

The Letter walks through the process of applying spousal impoverishment rules to the HCBS spouse and community spouse.  First, the county needs to characterize property and apply any CSRA protections. Next, the county would calculate income. An eligible individual would be placed in a budget unit separate from the community spouse once the couple’s property meets the CSRA limit plus $2000.

The HCBS spouse will remain eligible (short of change in circumstance) unless and until the county denies the HCBS request.  At annual renewal, the HCBS spouse only needs to confirm continued HCBS participation. Continuous eligibility ends when the HCBS spouse or institutionalized spouse does not receive HCBS waiver services or inpatient care for a full calendar month.

If the community spouse applies for Medi-Cal, that spouse will need to spend down non-exempt countable property before the end of the month of application.  A spousal income allocation is still permitted.  However, if the community spouse requests HCBS, there is no longer a community spouse.  The letter also goes through applying these rules retroactively, including reimbursement through the Conlan process.

DHCS ACWDL 18-19 (August 21, 2018)

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)].

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).

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).