Transitioning from MAGI Medi-Cal to Medicare

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As of 8/1/16, CalHEERS has been able to verify Part A entitlement through the Federal Data Hub.  Medicare entitlement precludes MAGI New Adult group eligibility, though it does not preclude eligibility through the MAGI Parent/Caretaker Relative or pregnancy coverage groups when eligible.

New Medi-Cal applicants who are eligible for Medicare will be evaluated for Non-MAGI Medi-Cal programs.  For New Adult MAGI beneficiaries who are become eligible for Medicare, the county shall evaluate for other MAGI programs.  Beneficiaries shall be placed on a Soft Pause until a Non-MAGI Medi-Cal eligibility determination can be made.

DHCS ACWDL 17-08 (February 24, 2017).

Carry Forward Status for Transitioning from Covered California to Medi-Cal

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As of 9/26/16, CalHEERS implemented a change to introduce the Carry Forward Status to reduce gaps in coverage while consumers transition between Covered California and Medi-Cal pending county eligibility determinations.  The flag in CalHEERS triggers a new notice to inform individuals of CFS.

Previously, DHCS and counties used Express Lane aid codes in a batch process pending county final eligibility determinations during the Covered California annual redetermination or change in circumstances reporting.  This, however, could result in a gap in coverage when, during the final eligibility determination, a person was found not to be eligible for Medi-Cal and was referred back to Covered California without retroactive coverage.  This process has been discontinued.

Now, CalHEERS will automatically place individuals into CFS when redetermination of eligibility results in potential MAGI Medi-Cal eligibility.  The individual will continue with Covered California coverage until the county completes a full Medi-Cal determination.  CFS will apply when a consumer reports a change that results in MAGI eligibility, when a consumer is determined MAGI eligible during the renewal period, when a consumer reports a change after the renewal is complete, and when a consumer reports a change after Covered CA eligibility has gone into effect.

During the CFS process, counties must treat cases as a new application for benefits.  Counties are required to send notices to affected beneficiaries.  Applicants transitioning from Covered CA to Medi-Cal may be eligible for the three-month retroactive Medi-Cal coverage period.

DHCS ACWDL 17-07 (February 24, 2017).

MCAP Integration into Medi-Cal Fee for Service System

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Between 10/1/16 and 6/30/17, CalHEERS will assign MCAP-eligible pregnant women into aid code 0G.  This will allow MCAP eligibles to receive full-scope Medi-Cal services through fee for service until the end of their post-partum period.

MCAP eligible pregnant women are those with MAGI incomes between 213 and 322 percent FPL.  Prior to 10/1/16, these women were enrolled in contracted health plans with no copays or deductibles.  Those still in health plans will continue receiving services that way until the end of the month of the 60th day following the end of their pregnancy.  New MCAP beneficiaries are being enrolled in FFS.

DHCS MEDIL I 17-03 (February 7, 2017).

Implementation of Medi-Cal Asset Verification Program Pilot

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DHCS is piloting a new Asset Verification Program in order to detect unreported assets for Aged, Blind, and Disabled Medi-Cal participants who are not receiving SSI/SSP.  Asset verification can be performed at any time a change of circumstances is reported or at any eligibility determination.  The Program allows DHCS to obtain account balances at financial institutions over the previous five years.

During this pilot, DHCS will search financial accounts for up to 3000 beneficiaries, based on the first day of the month.  Ten counties (including 2 LSNC Health counties) will receive AVP information, perform an ex parte review to determine discrepancies, and determine how many clients would normally receive a follow up contact due to the discrepancy.  Counties will provide DHCS an estimate of number of beneficiaries affected.

The pilot began in late January 2017.  In may 2017, DHCS will release pilot findings with implementation set to begin in fall 2017.

DHCS MEDIL I 17-05 (February 3, 2017).

Federal taxation of IHSS wages

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The California Department of Social Services (CDSS) has announced that it will allow IHSS providers to self-certify that they live in the same home as the IHSS recipient for purposes of federal income taxes.

Internal Revenue Service Notice 2014-7 states that wages for an IHSS provider who lives in the same home as the recipient are not considered gross income for purposes of federal income taxes.  CDSS will allow self-certification that the IHSS provider lives with the recipient by submitting the SOC 2298 form.  Providers will only need to submit the form once.  If the living situation changes, the provider will need to submit the SOC 2299 form.

Wages will continue to be included as federally taxable income until the SOC 2298 form is submitted and processed.  CDSS Provider Bulletin, Live-In Provider Self Certification Information.

CAPI payment standard increase

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Effective January 1, 2017, the Cash Assistance Program for Immigrants (CAPI) payment standard increased by 2.76%.  This increase also caused increases in the presumed maximum value of in-kind support and maintenance, the allowance for ineligible children in deeming situations, the sponsor’s allocation in alien deeming situations and the allowance for parents in parent-to-child deeming situations.

For couples where one spouse receives SSI and the other receives CAPI, budgeting will be done prospectively to prevent the couple from receiving more than the appropriate couples payment standard because of the increase in CAPI benefits.

CDSS included a chart of the new CAPI payment standards.  (ACIN I-81-16, December 19, 2016.)