Updates to Medi-Cal Aged and Disabled, Medicare Savings Program Thresholds

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DHCS has updated the thresholds for the the Medi-Cal Aged and Disabled Federal Poverty Level program.  As of April 1, 2017, the monthly income limit for an individual is $1235 ($1005 + $230 disregard); the monthly income limit for a couple is $1664 ($1354 + $310 disregard).

DHCS ACWDL 17-19 (June 23, 2017)

Effective January 1, 2017, allocations, property limits, and premium amounts have been updated:

  • The SSI Standard Allocation is $368.
  • The SSI Parental Allocation is $735 for an individual (if one ineligible parent lives with a child), or $1103 for a couple (if both ineligible parents live with a child).
  • The Medicare Part A premium is $413 for those not receiving free Part A.  A beneficiary with 30-39 quarters has a reduced premium of $227.
  • The Medicare Part B premium is $109 on average for those held harmless, while it is $134 for those who are new to Medicare or not subject to hold harmless status.  The Part B deductible is $183.
  • The property limits for Medicare Savings Programs are $7390 for an individual and $11,090 for a couple.

DHCS ACWDL 17-20 (June 30, 2017).

Updates to the Online Single-Streamlined Application

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The online application for Medi-Cal and other health insurance programs has been redesigned to group questions in a more logical fashion, using prior responses to display future questions on an as-needed basis for program eligibility determinations.

Additionally, the application has changed to conform with newer statutory and regulatory requirements.  Applicants are to be treated in a manner consistent with their gender identity.  They will be able to designate a choice without need for verification from the county.  Individuals can also be deemed pregnant regardless of gender identity.  Additionally, DHCS must collect voluntary information about sexual orientation and gender identity.  The application also removes requirements to collect Social Security numbers from non-applicants.

The updated online application adds questions about Indian Health Service access, military service, and personal injury lawsuits.  It also adds Medi-Cal notice information about non-discrimination, 10-day reporting requirements, and estate recovery to the signature page.

DHCS MEDIL I 17-08 (June 29, 2017).

Medi-Cal Non-Emergency Medical and Non-Medical Transportation

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DHCS issued an All Plan Letter to clarify what transportation services plans must provide in non-emergency situations.

Subject to prior authorization, non-emergency medical transportation (NEMT) is a covered benefit when a member needs to obtain medically necessary services and when it is prescribed in writing by a provider.  Plans are required to authorize at minimum the lowest cost type of NEMT that is adequate for the member’s medical needs with no limits as long as the medical services are medically necessary and authorized.

NEMT is required when the member cannot take ordinary public or private means due to medical and physical condition and when transportation is required for obtaining medically necessary services.  Plans must ensure door-to-door assistance for members receiving NEMT services, and plans must provide transportation for a parent or guardian is the member is minor.  The letter discusses when plans must provide NEMT ambulance services, litter van services, wheelchair van services, and NEMT by air.  NEMT requests require a Physician Certification Statement that includes functional limitations justification, dates of service and mode of transportation needed, and a certification statement.

Effective July 1, 2017, non-medical transportation (NMT) expands from EPSDT to a managed care benefit for all members to obtain medically necessary services covered by the managed care plan.  This expands to cover NMT for all Medi-Cal services, including carved out services, starting October 1, 2017.  NMT requested must be the least costly method of transportation that meets the member’s needs.  NMT services must include round trip transportation for a member to obtain covered services, as well as mileage reimbursement when the member arranges for a private vehicle to get to an appointment.  The round trip is available for covered services, picking up prescriptions, and picking up medical equipment and supplies.  The provided NMT must be in a form and manner that is accessible for the member.

NMT services must be authorized prior to use.  Coverage includes the transportation costs for the member and one attendant, subject to authorization.  The member must attest to the plan that other transportation resources have been reasonably exhausted.

Plans are still required to meet timely access standards, either contractually or through Knox-Keene licensing.  The member’s need for NEMT or NMT services do not relieve the MCPs from complying with these obligations.

DHCS APL 17-010 (June 29, 2017)

CalWORKs and CalFresh treatment of ABLE accounts

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The California Department of Social Services has issued instructions regarding treatment of ABLE accounts for purposes of CalWORKs and CalFresh.  An ABLE account allows persons with disabilities to save and invest money for disability-related expenses without losing eligibility for certain benefits programs.  ABLE accounts cannot exceed $100,000 and the maximum annual contribution is $14,000.

CalWORKs recipients can reduce their unearned income from Social Security Disability or other disability benefits buy making contributions to an ABLE account.  Money in, contributions to and any distribution up to $100,000 for qualified expenses from an ABLE account does not count toward determining eligibility for any state or local means-tested program, including CalWORKs.

ABLE accounts are excluded as both income and resources for CalFresh.

Counties are strongly encouraged to inform eligible CalWORKs and CalFresh applicants and recipients with disabilities that they can retain an ABLE account so they do not need to spend down their savings to be eligible.  (ACL 17-61, June 27, 2017.)

Changes to Inter-County Transfer process

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The California Department of Social Services has issued instructions implementing changes to the Inter-County Transfer (ICT) process required by SB 1339.  Effective June 1, 2017, CalWORKs and CalFresh recipients can report a move to either their old county or their new county.  CalWORKs recipients must report a change of residence within 10 days of the actual move.  Failure to report a move, by itself, cannot be a basis for an overpayment, overissuance or other negative action.

The county that the recipient informs of the move must initiate the ICT process within seven days.  Benefits must be transferred from the sending county to the receiving county with no redetermination or recertification of eligibility in the receiving county.  The new county cannot interview the recipient, request or require a new application, or request or request any verification.  The new county can interview the client only regarding Welfare-to-Work participation.

The sending county must provide the receiving county copies of documents necessary to verify current benefits and grant amount within seven business days, including the most recent SAR 7, SAWS 2 Plus, SAWS 1 and Welfare-to-Work plan.  Benefits and payment responsibility must be transferred to the receiving county no later than the first day of the next month following 30 days after the county is notified of the move.  If the move is from a Region1 to Region 2 county or visa versa, the receiving county adjusts the grant accordingly.

The county can provide the Child Care Request form (CCP 7) as part of the ICT process, but the recipient must apply for child care in the receiving county.

The receiving county is responsible for determination of homeless assistance eligibility and issuance of homeless assistance benefits.

The process is the same for non-assistance CalFresh cases except that CalFresh recipients are not required to report a mid-period move to a new county.  CalFresh recipients are encouraged to promptly notify the county when they move to another county to ensure continuity of benefits.

The ICT process now applies to Transitional CalFresh cases.  This change will be effective when the computer systems are programmed for it, but no later than September 1, 2017.  (ACL 17-58, June 23, 2017.)

IHSS eligibility for children in Adoption Assistance Program or Foster Care

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The California Department of Social Services (CDSS) has issued instructions about IHSS eligibility for children in Adoption Assistance Program (AAP) or Foster Care.  Children who receive AAP benefits who apply for IHSS must receive a comprehensive needs assessment.  Children who receive AAP can be eligible for IHSS.  AAP cannot be considered an alternative resource when determining the number of hours of IHSS eligibility.

Children placed in with an approved resource family or in a setting that must be approved as a resource family prior to December 31, 2019 are considered to be residing in their own home and are eligible for IHSS.  Children placed with a relative or with Non-Relative Extended Family Member are also eligible for IHSS.  Children who live in licensed community care facilities such as group homes, short-term residential therapeutic programs and transitional housing placement providers are not eligible for IHSS as long as they are in those placements because they are not residing in their own home.  (ACIN I-40-17, June 23, 2017.)