DHCS ACWDL 14-32: Medi-Cal Annual Redetermination Process for MAGI Beneficiaries (9/19/14)

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DHCS has issued this letter to guide SAWS and counties on implemented annual redeterminations for 2015 for MAGI Medi-Cal beneficiaries.

First, counties are to review any ex parte information available to the county about the beneficiary or beneficiary’s immediate family members, including cases that are either open or closed within the last 90 days.  If the ex parte review is sufficient to confirm eligibility, a redetermination form is not required.  This information is entered into SAWS and sent to CalHEERS for a MAGI eligibility determination.  For pre-ACA beneficiaries, counties will attempt to obtain RFTHI information ex parte.  If CalHEERS confirms MAGI eligibility, SAWS will receive the result back with a NOA confirming eligibility.

If a beneficiary is found ineligible through ex parte review, the county will send a pre-populated redetermination form (MC 0216) from SAWS and given at least 60 days to complete and return it.  Beneficiaries may complete this through many methods.  Counties are to contact the beneficiary if they have not yet received the form.  If the beneficiary fails to provide the requested information, county will issue a discontinuance NOA with a 90-day cure period.

When information from MC 0216 is received and entered into SAWS, CalHEERS will determine Medi-Cal eligibility.  MAGI eligible will be sent a NOA for a new 12-month eligibility period.  Those who are not MAGI eligible will go through the process described here.  Where there isn’t enough information, counties will work with beneficiaries to gather the necessary information.

DHCS MMCD APL 14-011: Interim Policy for the Provision of Behavioral Health Treatment Coverage for Children Diagnosed with Autism Spectrum Disorder (9/15/14)

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Following the release of federal guidance on the matter, DHCS issued interim policy guidance on the provision of BHT services to Medi-Cal beneficiaries 0-21 diagnosed with Autism spectrum disorder.  Under Federal law, states are required to provide coverage to EPDST eligible individuals for any covered service determined to be medically necessary to correct or ameliorate any physical or behavioral conditions.  DHCS intends to include BHT services, including Applied Behavioral Analysis (ABA), as a covered benefit for individuals under 21 with ASD.

The letter defines BHT and provides 12 months of continuity of care for those with ASD getting services outside a Regional Center.  Medi-Cal beneficiaries who spent out of pocket for BHT services from licensed providers between 7/7/14 and 9/14/14 are eligible for reimbursement under Conlan.  The letter also sets out eligibility criteria for BHT services, covered services, limitations, treatment plans and exclusions

Finally, the letter includes a beneficiary notice from DHCS as well as guidance from CMS dated 7/7/14.

DHCS ACWDL 14-31: 2014 Alternate Renewal Policy Letter (9/11/14)

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DHCS issued this letter about implementing Medi-Cal annual redeterminations in 2014, a process meant to convert some beneficiaries from pre-ACA Medi-Cal to MAGI Medi-Cal.

At the 2014 annual redetermination, counties will try to convert beneficiaries to MAGI by sending a RFTHI form at least 60 days prior to the redetermination date.  If a beneficiary reports certain changes (e.g., size of household, categorical eligibility), counties will complete the annual redetermination process per previous guidance.  If there are no such cases, the county will just renew without a CalHEERS transaction.  Counties must also review Share of Cost cases for MAGI Medi-Cal.  Those ineligible will be granted APTC eligibility per Covered California requirements for special enrollment periods.

For MAGI populations, RFTHI information must be provided but not necessarily in paper form.  The information will be entered into SAWS for the next renewal.  If a beneficiary fails to respond to the RFTHI, counties must try to contact the beneficiary to get this information.  If after these attempts the beneficiary still does not respond, and if the information is not available ex parte, then the county shall send a timely NOA to discontinue benefits.  There is a 90 day cure period.

ACL 14-55: Termination Of State Funding For Supplemental Security Income Advocacy Programs (SSIAP) For Cash Assistance For Immigrants (CAPI) (9/10/14)

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Announcing the demise of state funding reimbursement for SSI advocacy for CAPI folks to transition to SSI.  The funding was set to expire years ago, and was repeatedly extended, and intended to cover immigrants of age 65 or older, who entered the U.S. before August 22, 1996, and allege a disability.  [Download]

ACL 14-61: CalWORKs: Family Stabilization (FS) Program Guidance, Notices, And Request Form (9/2/14)

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Additional guidance on the Family Stabilization (FS) program, a new
request form, and notices.   A county may provide FS program participants with services, including housing assistance, for so long as they meet the CWD’s criteria for the FS program as set forth in the CWD’s FS plan.  Clients may request FS services at any point in their 24 month WTW clock, via the new FSP 1 form.   [Download]

ACL 14-62: Commercially Sexually Exploited Children (CSEC) Program 99/3/14)

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This letter passes on information regarding SB 855, which clarified that commercially sexually exploited children (CSEC) whose parents or guardians failed or were unable to protect them may fall within the description of 300(b) and be adjudged as dependents of the juvenile court. The Legislature also established a state-funded county CSEC Program to be administered by CDSS that counties may opt into.  The DSS is spending 1.75 million (not a typo!) to provide training of county workers and out of home caregivers, which will cover awareness and identification of children who are commercially sexually exploited, or who are at risk of being commercially sexually exploited.  An additional $750,000 is also provided for the training of foster youth to help them recognize and avoid commercial sexual exploitation, for those counties that elect to participate in the CSEC Program. $2.5 million for FY 2014-15 will be allocated to participating counties for protocol development and capacity building for services to commercially sexually exploited children.  [Download]