DHCS has instructed counties that they must accept updated beneficiary contact information from managed care plans. If the beneficiary approves of the plan doing this, the county must update within 2 days. If the beneficiary has not approved, the county must contact the beneficiary to get an update within 5 days. DHCS ACWDL 15-19 (4/16/15).
Counties should also accept this information from Health Care Options immediately, with consent from the enrollee. DHCS ACWDL 15-20 (4/27/15).
The Chief ALJ has determined that hearing decisions that order retroactive termination of Medi-Cal eligibility were issued in error and should be returned to CDSS for correction. Should beneficiaries disagree with the corrected order, due process rights still exist. DHCS MEDIL I 15-12 (4/7/15).
DHCS issued guidance about notice requirements for Medi-Cal applicants whose applications have not been processed within 45 days per the Rivera decision. These beneficiaries have a right to file an appeal and request a hearing when the Medi-Cal determination has not been made within 45 days of application.
To comply with these requirements, DHCS has implemented in two phases a Rivera notice that foregoes the 90 day deadline to file for a hearing (applicable only for Rivera notices). Notices are available only in English and Spanish; samples are available with the letter.
DHCS MEDIL I 15-11 (4/7/15)
Anthem Blue Cross’s January data breach may have affected 120,000 beneficiaries of the CMSP and Path2Health programs. These beneficiaries were sent notices at their last known address, but counties are to post information in county offices. CMSP ACL 15-04 (4/7/15).
Beginning in 2014, CDSS implemented AB 74, which changed the sequence of activities for CalWORKs Welfare to Work (WTW) participants provided in Welf. & Inst. Code Section 11320.1 in order to better serve individuals who face significant barriers to employment in light of the WTW 24-month clock. AB 74 permits participants to bypass the job search (job market test) when the participant is identified as having potential barriers to employment, such as mental health, substance abuse or domestic abuse, which warrant further assessment during the appraisal process. AB 74 also provides for a standardized appraisal tool to identify such individuals. That tool, the Online CalWORKs Appraisal Tool (OCAT), is to be implemented in Spring 2015. When significant barriers are identified during appraisal, the participant should be evaluated for a WTW exemption and referred for barrier evaluation and related services when appropriate. ACL 15-09.
DHCS has updated the statewide average private pay rate (APPR) for 2015 to $8092. This is used to determine periods of ineligibility due to transfers of nonexempt personal property for less than FMV. DHCS ACWDL 15-17 (3/26/15).