DHCS issued a letter to Medi-Cal managed care plans reminding the plans about their responsibility to provide timely access to abortion services as a physician service. While prior authorization may be required for non-emergency inpatient hospitalization, plans must ensure that prior authorization is not required for outpatient abortion services. No physician is required to perform abortion services, but plans must inform beneficiaries that providers may refuse to provide such services. Additionally, plans may not deny or interfere with a woman’s right to choose or get an abortion when necessary for the life or health of the woman. DHCS APL 15-020 (9/30/15).
Summaries of select CalWORKs, CalFresh, Health and Housing Regulations
Changes in Processing Medi-Cal Cases for Former Foster Youth
Recently, DHCS has issued some new guidance regarding Medi-Cal for Former Foster Youth (FFY).
First, if a former foster youth becomes eligible for Medi-Cal through Hospital Presumptive Eligibility (HPE), aid code 4E, counties are to process the beneficiary for full-scope Medi-Cal aid code 4M within 30 days. If workers are unable to verify FFY status, they must assess for other programs and send a notice accordingly. DHCS MEDIL I 15-28 (9/25/15)
Second, DHCS has provided new SAWS notices for FFY. The notices provide language for approvals, conditional approvals, automatic renewals, continuations of coverage, and changes to coverage after age 26. Beneficiaries should also receive appropriate denial notices as needed. These revised notices need to be issued no later than October 30, 2015. DHCS ACWDL 15-32 (10/7/15)
CalWORKs for disaster victims
CDSS has issued instructions regarding CalWORKs issues for disaster victims. The instructions reiterate several important facts of the CalWORKs rules as they relate to disasters including: 1) the county must accept statements under penalty of perjury when documents are unavailable because of a disaster, 2) disaster relief payment do not count as income for purposes of CalWORKs, 3) disaster is an exception to the once in a lifetime limit on homeless assistance benefits, 4) disaster victims should be evaluated for immediate need, 5) written statement is sufficient to establish residency and 6) disaster victims should be evaluated for good cause for non-participation in welfare-to-work.
In addition, disaster related issues can be good cause for late filing of semi-annual reports and annual redetermination. For the first month after a report is late, the county must evaluate for good cause for late filing. After the first month, the client must request a good cause evaluation for late filing. ACIN I-85-15 (10/14/15).
Change to Eligibility Period for Presumptive Eligibility (PE) Medi-Cal
As of December 31, 2014, PE coverage begins on the date of the eligibility determination and ends at the end of the following month if no Medi-Cal application is submitted for full determination. Previously, presumptive eligibility went back to the first day of the month for a 60-day enrollment period. There is no change to the end date of eligibility. DHCS MEDIL I 15-31 (9/24/15)
Making Changes to Beneficiary Information with a Health Plan
Managed care plans are to contact county office liaisons to provide updated contact information for Medi-Cal beneficiaries. If the plan has received the beneficiary’s approval, the counties must incorporate these changes immediately. If the plan does not have the beneficiary’s approval, a county worker must verify the changes before making them. DHCS ACWDL 15-30 (9/22/15).
Questions and answers regarding OCAT
CDSS has issued several questions and answers regarding the new Online CalWORKs Appraisal Tool (OCAT) (See ACL 15-43 for background about OCAT). Most importantly, the questions and answers state that an individual cannot be sanctioned for not answering particular OCAT questions. This should include questions about disability and domestic violence. An individual can be sanctioned for refusing to do the OCAT appraisal at all.
In addition, the questions and answers state that an OCAT appraisal can be done by telephone as a reasonable accommodation or when coming to the welfare department would interfere with work or class schedule. ACL 15-69 (9/17/15).