Former foster youth (FFY) up to the age of 26 may be eligible for Medi-Cal under the Affordable Care Act, though CalHEERS has only recently implemented the proper software.  DHCS issued a letter to clarify how to fix the situation for FFY who enrolled in a qualified health plan (QHP) through Covered California.

DHCS was to reach out to FFYs enrolled in a QHP about their potential eligibility for Medi-Cal, informing them that counties would evaluate for Medi-Cal.  If the county verifies an FFY status, no further verification is required.  FFYs can either elect to be enrolled into Medi-Cal coverage (under aid code 4M) until age 26, or they can enroll in unsubsidized Covered CA coverage.  The county will assist FFY with disenrolling from a QHP after enrolling the individual into Medi-Cal.  DHCS ACWDL 15-37 (11/30/15).

DHCS issued guidance to the counties on how to treat certain disaster assistance payments for MAGI and Non-MAGI Medi-Cal programs.  Existing rules remain applicable for non-MAGI cases (see ACWDL 92-08, MEPM Article 9M, 22 CCR §§ 50481, 50535.5).  In MAGI Medi-Cal cases, most disaster assistance in federally recognized disasters are exempt as income depending on the source of payment:

• Payments from charitable organizations are considered gifts and are excluded from the tax household’s gross income.
• Payments from insurance are exempt as income in federally declared disaster areas, while insurance payments in non-federally declared disaster areas may count depending on whether they are taxable.
• Payments from federal or state government sources that are based on need are exempt, as are payments in qualified disasters from federal, state, or local government.

When a Medi-Cal beneficiary is temporarily living out of county due to displacement from disaster, the county must help that beneficiary with the Office of the Ombudsman.  DHCS ACWDL 15-36 (11/9/15).

As of August 1, 2015, the full-scope income limit for pregnant women increased from 60% FPL to 138% FPL, to be automatically applied through both CalHEERS and SAWS applications.

For new applicants, eligible pregnant women up to 138% FPL will be enrolled into full-scope Medi-Cal coverage through managed care.  Those between 139% FPL and 213% FPL will be eligible for pregnancy-related services through Medi-Ca.  Aid codes will be based on the applicant’s income and citizenship/immigration status.

Current (as of 8/1/15) pregnancy-only beneficiaries between 60% and 138% FPL received notices about the change on 9/14/15 and were given the option to remain in fee-for-service or switch to managed care.

DHCS ACWDL 15-35 (11/12/15).