DHCS issued an All-Plan Letter providing requirements for continuity of care for Medi-Cal beneficiaries that are transitioning into managed care plans from fee-for-service Medi-Cal. The requirements allow for the option to continue treatment for up to 12 months with an out-of-network Medi-Cal provider for Medi-Cal services. The letter also covers issues relating to outpatient mental health services, transition from Covered California to Medi-Cal, transition of Seniors and Persons with Disabilities, and coverage of behavioral health treatment for children with autism. DHCS APL 14-021 (12/29/14).
Summaries of select CalWORKs, CalFresh, Health and Housing Regulations
The State will provide Accelerated Enrollment to Medi-Cal applicants when eligibility has not been determined within 45 days
DHCS issued a letter explaining a new state policy to grant accelerated enrollment (AE) to Medi-Cal applicants who have not had an eligibility determination within the statutory 45-day timeline. During Covered California’s 2015 open enrollment period, DHCS will implement a new batch process to provide AE for those in the backlog. The batch process will occur weekly and will target those who have made applications starting November 15, 2014, and going through February 15, 2015. These applicants will be given fee-for-service Medi-Cal through aid code 8E until a final eligibility determination is made. DHCS MEDIL I 14-61 (12/31/14).
New Job Aid issued to explain 90-day cure period
DHCS issued a MEDIL providing the counties a job aid to outline the requirements for the 90-day cure period for the Medi-Cal renewal process. The cure period begins from the date of a NOA for discontinuance. The job aid states that this process applies for both MAGI and Non-MAGI beneficiaries and will treat as timely any required information received within the 90-day cure period. MEDIL 1 14-60 (12/10/14).
Change in treatment of work expenses for disability-linked Medi-Cal beneficiaries
DHCS has issued instruction to the counties regarding the retroactive exclusion of impairment-related and blind work expenses for all disability-linked Medi-Cal cases going back to 12/1/90. Counties are to make these changes when a case comes to its attention and review systems and cases to reestablish eligibility for those who were discontinued or denied for this reason.
Until DHCS develops appropriate worksheets, counties are directed to use SSI/SSP definition and methodologies to determine eligibility. The exclusion for IRWE is applied before the one-half earned income deduction, while the BWE exclusion applies after the half earned income deduction. These exclusions both apply before the determination of SGA level. Attached to the letter are examples of deductible expenses and detailed explanations of the income exclusion applications. DHCS ACWDL 14-42 (12/10/14).
USDA publishes final guidance on Title VI prohibition against discrimination of persons with limited English proficiency
The Office of Civil Rights within the USDA has issued detailed final guidance, including its responses to submitted comments, clarifying the obligations of entities receiving federal financial assistance from USDA (e,g,, the California Department of Social Services, which administers the SNAP/CalFresh program). If you work on language access issues affecting the CalFresh population, this is a must-read, to better understand USDA’s expectations of state agencies “in meeting their existing obligations to provide meaningful access for LEP persons.” 79 Federal Register 70771- 70784.
Process changing for warnings about excessive EBT replacement requests
In response to recent FNS changes in the federal SNAP rules targeting illegal trafficking, the CalFresh program is changing its process for warnings to recipients who make repeated requests for replacement EBT cards. Effective 2015, County Welfare Departments will issue warning letters to any EBT cardholder after the fourth card replacement within any rolling 12-month period. Upon the fifth request, if trafficking is suspected, the County will be required to refer the case to the Special Investigation Unit (SIU).
That said, this ACL recognizes that frequent requests for EBT card replacement may be indicative of non-fraudulent situations, e.g., the recipient’s need for a disability-related reasonable accommodation, simply (although frequently) misplaced cards, or the recipient’s inability to properly use the card. The County is expected to explore these alternate reasons for the repeated requests before making an SIU referral. ACL-14-90.