Info on the process to allow reimbursement to a recipient for overpaid Medi-Cal Share of Cost (SOC) as the result of missing the State’s payment of medically recognized expenses (also known as Buy-Out) at the beginning of the month through no fault of the recipient.

The In-Home Supportive Services Plus Waiver (IPW) had an impact on the IHSS and Medi-Cal (MC) SOC processing. While IHSS allows “obligations” to count towards the SOC, Medi-Cal requires payments. IHSS recipients with a Medi-Cal SOC are now subject to the same SOC spend-down processing as all other Medi-Cal beneficiaries. To deal with this issue, people in the Personal Care Services Program (PCSP) or IPW, who get IHSS, will have a comparison of their Medi-Cal and IHSS SOCs, and must meet the lesser of the two SOCs. The State will “Buy-Out” the difference between the two SOCs.

Procedurally, the state runs a Buy-Out processing about 1 week prior to the end of the month. After this file is processed, DHCS will not accept any retroactive or subsequent Buy-Out payments.

Due to the timing of the MEDS Monthly Renewal File process, new IHSS recipients will rarely be included in the Buy-Out during their first month of eligibility. These recipients are responsible for their entire Medi-Cal SOC for the first month of IHSS eligibility. The letter also addresses problems when recipients are not in the MEDs file or found eligible retroactively (must meet MC SOC, but may be eligible for reimbursement.)

The letter also transmit a new form, the X-27 SPEC, to reimburse recipients who through no fault of their own have paid out-of-pocket SOC expenses in excess of their obligation after the SOC comparison. For those of you not already lost, there is a description of how Conlan retro MC coverage and handling SOC for couples. [Download]