DHCS issued a letter with directions on how the county should deal with refunds of TLICP premiums or waivers due to beneficiary request or retroactive eligibility for non-premium aid codes. When a beneficiary requests prospective discontinuance in writing, counties must request the refund or waiver on the beneficiary’s behalf even if the beneficiary claims not to have paid the premium. When retroactive eligibility for free Medi-Cal is determined, the county must submit a request to Maximus (the administrative vendor) for refund/reimbursement. Note that a beneficiary may continue to receive premium due invoices after discontinuance due to the billing cycle. DHCS ACWDL 14-43 (1/5/15)
Summaries of select CalWORKs, CalFresh, Health and Housing Regulations
Prior felony drug conviction no longer precludes CalFresh and CalWORKs eligibility
It took nearly two decades for California to lift the statutory prohibition preventing individuals with prior drug felony convictions from qualifying for CalFresh or CalWORKs benefits. But the recent enactment of AB 1468 (2014) did just that. Effective April 1, 2015, no person can be excluded from an assistance unit or otherwise be denied CalFresh or CalWORKs benefits because of a prior felony drug conviction. Two important All County Letters have been issued addressing this change: All County Letter No. 14-100 sets out in detail the rule changes, key implementation dates, applicable forms, as well as what is expected of local county welfare offices to facilitate eligibility and receipt of benefits for individuals previously excluded. There is also the related All County Letter No. 14-92 explaining specific changes made to the CalFresh application form to conform to AB 1468. ACL 14-100 (December 19, 2014); ACL 14-92 (December 22, 2014).
Plans must ensure continuity of care for Medi-Cal beneficiaries transitioning into managed care
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).
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).