County of Responsibility for Incarcerated Medi-Cal Beneficiaries

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DHCS issued clarification to the counties about how to deal with Medi-Cal Inmate Eligibility Program (MCIEP) applications for beneficiaries who reside in one county (County of Residency) but are incarcerated in a different county (County of Incarceration) in order to ensure proper billing to inmate claims to the correct county.  As of July 1, 2016, an inmate’s full scope and restricted scope inmate coverage can coexist in the MEDS system, along with the proper county of responsibility.

Under MCIEP, the county of incarceration is responsible for paying the non-federal portion of fee-for-service services provided to eligible inmates.  The county of incarceration is responsible for completing the eligibility determination for MCIEP.  Where the county receiving the MCIEP program is not the county of incarceration, the application will be forwarded to the county of responsibility.

DHCS MEDIL I 16-23 (December 23, 2016).

DHCS MEDIL I 16-23E (January 12, 2017).

Questions and Answers about Expanded Subsidized Employment

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CDSS has issued questions and answers about Expanded Subsidized Employment (ESE) for CalWORKs recipients.  Highlights of these questions and answers include

  • ESE funds cannot be used for dental services, glasses or tattoo removal, but non-prescription glasses and tattoo removal can be ancillary supportive services.
  • ESE funds cannot be used for the 25% match for federal work study placements, but can be used for CalWORKs work study placements.
  • ESE can be used for workers’ compensation costs and backgrounds checks but not for physicals or uniforms.
  • Counties can place a recipient in a second ESE placement if the first ESE placement does not use all six months of ESE eligibility, but counties must determine on a case-by-case basis if that placement is appropriate.
  • Youth can participate in ESE either as their welfare-to-work participation or as exempt volunteers, but Non-Minor Dependents are not eligible for ESE.

(ACL 17-03, January 25, 2017.)

Restoration of Acupuncture Services as a Medi-Cal Benefit

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As of July 1, 2016, the State has reinstated outpatient acupuncture services as a Medi-Cal managed care benefit.  Acupuncture will be covered as needed to prevent, modify, or alleviate the perception of severe, persistent chronic pain resulting from a generally recognized medical condition.  Services are limited to two sessions per month, though additional sessions may granted through medical necessity and prior authorization.

DHCS APL 16-015 (December 1, 2016).

Medi-Cal Coverage of Tobacco Prevention, Cessation Services

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DHCS issued an All Plan Letter providing instructions on what tobacco prevention and cessation services should be covered by managed care plans.  DHCS points to the US Preventive Services Task Force in setting coverage requirements for both pregnant and non-pregnant beneficiaries, including:

  1. Assessments of tobacco use for all adolescent and adult beneficiaries
  2. FDA-approved medications for non-pregnant adults, at least one of which must be available without prior authorization requirements
  3. Counseling services for tobacco user beneficiaries of any age
  4. Tailored counseling services for pregnant tobacco users
  5. Prevention of tobacco use for children and adolescents
  6. Training of managed care-contracted providers
  7. Systems to identify tobacco users for assessment and reporting purposes
  8. Systems to track utilization of tobacco cessation treatment

APL 16-014 (November 30, 2016).

CalFresh eligibility for people in SSI suspense status

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CDSS has issued instructions to counties implementing the decision and judgment in Riojas v. Vilsack and Lightbourne, 2016 WL 3566941.  Riojas held that people in SSI suspense status are eligible for CalFresh.

CDSS instructed counties that, effective immediately, people who are not receiving a SSI payment are eligible for CalFresh as long as all other CalFresh eligibility criteria are met. Within two months counties must identify applications that were filed after August 30, 2016 that were denied solely because the applicant was in SSI suspense status and issue retroactive benefits to those people.  Counties must also identify household members excluded solely because of their SSI suspense status on or after August 30, 2016, and, if otherwise eligible, issue retroactive benefits to those persons.

A change in SSI from active status to suspense status is not a mandatory mid-period report. However, if this change is reported, the county must add the household member effective the first day of the next month.  If SSI status changes to active status and that change is known to the county, then the county must increase or decrease benefits effective the first day of the next month, or as soon as 10-day notice can be given.  (ACL 17-09, January 27, 2017.)