Medi-Cal Discontinuance Notices for Overincome, Ineligible Beneficiaries

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DHCS is clarifying NOA issuing requirements for Medi-Cal discontinuances when the beneficiary is over income for MAGI, not eligible for consumer protection programs, and has no potential non-MAGI eligibility.  Counties must issue a timely and adequate manual discontinuance notice when an individual loses eligibility for one of the above mentioned reasons, whether or not the individual is eligible for Covered California coverage.  Sample NOAs are included with the letter.  DHCS ACWDL 15-33 (10/9/15)

Spanish versions of the notices are available with DHCS MEDIL I 15-33 (10/16/15).

Medi-Cal Managed Care Coverage of BHT Services through Regional Centers

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Medi-Cal managed care plans are responsible for providing medically necessary Behavioral Health Treatment (BHT).  This includes coordinating with Regional Center and BHT providers as applicable.  Plans are required to execute an MOU with local regional centers by December 31, 2015 (a sample MOU is included with the letter).  DHCS will review to make sure plans are making a good faith effort.  DHCS APL 15-022 (10/2/15).

CalFresh fleeing felon and probation violation rules

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CDSS has issued new rules about when persons can be disqualified from CalFresh for being a fleeing felon violating a condition of probation and parole. These rules comply with new federal regulations issued at 80 Fed. Reg. 54410. To be considered a fleeing felon and ineligible for CalFresh, a person must have a warrant issued for their arrest that is under the National Crime Information Center (NCIC) code for escape, flight to avoid prosecution or flight-escape. Only warrants with one of those three NCIC codes are a reason to deny or terminate CalFresh benefits.

To be considered violating a condition of probation or parole and be ineligible for CalFresh, there must be a judicial determination that the individual violated a condition of probation or parole. Issuance of a warrant for a violation of probation or parole by itself is not a reason to deny or terminate CalFresh benefits.

In addition, local law enforcement must be actively seeking the individual to enforce a condition of probation or parole. To determine whether law enforcement is actively seeking an individual, the county must contact local law enforcement and ask whether they intend to enforce violation of probation or parole within 30 days. If the answer is no, then the individual is not considered a probation or parole violator. If the answer is yes, the case is held for 30 days to find out if local law enforcement takes action to enforce the probation or parole violation. If no action is taken in 30 days, the individual is not consider a probation or parole violator.

The new rules are effective December 1, 2015. ACL 15-82 (10/14/15).

Medi-Cal Plan Coverage of Abortion Services

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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).

Changes in Processing Medi-Cal Cases for Former Foster Youth

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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

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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).