This one is pretty self-explanatory.  Click here to review the circumstances in which Medi-Cal beneficiaries are entitled to continuity of care, what continuity of care entails, and the processes for providing services through continuity of care.

Prior to 2014, Medi-Cal beneficiaries enrolled in a Medi-Cal Managed Care Plan (MCP) received services within the scope of their primary care provider’s (PCP’s) practice through their PCP and received specialty mental health services for serious mental illness through the county Mental Health Plan (MHP). Effective January 1, 2014, Medi-Cal Managed Care Plans are responsible for providing certain mental health services through the plan’s provider network to beneficiaries with mild to moderate impairment of mental, emotional, or behavioral functioning resulting from a mental health disorder even when those services are outside the PCP’s scope of practice.  The letter, available here, delineates the MCP’s responsibilities for referring to, and coordinating with MHPs for the delivery of mental health services.

Reminds counties that Medically Needy Medi-CAl cases with Title II income must have the Share of Cost adjusted effective 1/1/14.  Instructions for how to apply the COLA to these cases are included.  Importantly, note that the COLA is NOT to be applied to A&D FPL, FPL-Blind, Medicare Savings Programs, 200 Percent Women and Infants, children’s FPL programs – these cases should NOT have the COLA applied until the 2014 FPL rates are published.  Also, the COLA should not be applied to MAGI Medi-Cal cases as they have no redeterminations before April 2014. Read the full letter here.

While LSNC does not represent state or county inmates, the letter also provides information about Medi-Cal eligibility for parolees and babies born to inmates. The letter specifies that inmates who had eligibility through Medi-Cal Inmate Eligibility Program (MCIEP), who are entitled to an SB87 review of their eligibility when they are paroled.  Parolees who were on the Low Income Health Program (LIHP) as inmates and were transitioned to Medi-Cal keep their eligibility until redetermination.  Babies born to inmates on MCIEP are also deemed Medi-Cal eligible for one year.  View the full letter here.

Informs Medi-Cal Managed Care Plans (MCPs)operating in Geographic Managed Care or Two Plan counties (not County Organization Health Systems, like Partnership) that they must ensure continuity of care for Medi-Cal beneficiaries transitioning from Fee For Service. MCPs must provide beneficiaries with the completion of certain covered services that the beneficiary was receiving from a non-contracted provider for up to 12 months when the beneficiary has an acute condition, serious chronic condition, is pregnant, has a terminal illness, is a newborn, or has a planned surgery.  The letter directs plans that all Medical Exemption Requests are to be treated as requests for continuity of care.  The full letter is available here.

This letter (available here) reminds Medi-Cal Managed Care Plans to communicate to its provider networks and subcontractors the requirement that transgender services (including psychotherapy, continuous hormone therapy, laboratory testing to monitor hormone therapy and gender reassignment surgery that is not cosmetic in nature) be made available to Medi-Cal beneficiaries. Criteria for medical necessity is based on the most current WPATH “Standards of Care for Health of Transsexual, Transgender, and Gender Nonconforming People.”