Updates the income standards and resource limits for Medi-Cal’s tuberculosis program, now at $1291 in income per month and $2000 in resources for an individual (if the applicant is married, this limit applies to all of the applicant’s separate property and half of the community property). [Download]
Summaries of select CalWORKs, CalFresh, Health and Housing Regulations
ACWDL 05-42: Increase in Substantial Gainful Activity Amount (12/19/05)
Makes note of the $30 Substantial Gainful Activity increase to $860 per month (effective January 1, 2006) and clarifies that, even where severe medical conditions exist, an applicant will not be considered disabled if he or she has average monthly earnings at or above the SGA level. [Download]
ACWDL 05-32: Section 1115 Demonstration Application Template – Evacuees of Hurricane Katrina (10/5/05)
Reminds counties that, pursuant to the Lynch v. Rank lawsuit, every potentially eligible Pickle person must receive a Pickle Medi-Cal notice for three consecutive years. The letter also announces that individuals listed during years previous to the most recent three will be dropped from the Pickle Tickler report and a year’s worth of ineligibles will be purged each year. Lynch also requires that each person on the Pickle Tickler listing who has an active Medi-Cal case or who brings the Tickler notice into the county welfare department to apply under the Pickle Amendment shall have an eligibility determination completed.[Download]
ACWDL 05-28: Medi-Cal Changes Due to a Property Change in the SSI program (8/29/05)
Effective April 1, 2005, all Medi-Cal programs that use SSI property rules (Pickle, Disabled Adult Child, Disabled Widow(er), and 250% Working Disabled) are to adopt the following changes:
· The definitions of “Household goods” and “personal effects” have been broadened and, regardless of their dollar value, no longer count as resources.
· The $500 limit for items of unusual value has been eliminated. [Download]
ACWDL 05-24: Processing Qualified Medicare Beneficiary Cases When Eligibility Has been Erroneously Discontinued (8/5/05)
Directs counties how to reinstate eligibility for Qualified Medicare Beneficiary Program (QMB) cases that are erroneously discontinued through no fault of the beneficiary. Eligibility can be reinstated for months when the beneficiary should have been receiving benefits. Medi-Cal must retroactively pay for all past-due Medicare premiums. [Download]
Independent Medical Reviews – Experimental and Investigational Therapies – 28 C.C.R. § 1300.70.4
This regulation, effective July 2005, describes the requirements for a plan’s notice to its enrollee when denying coverage on the basis of the treatments’ experimental or investigational status, when it is appropriate to request an IMR for this reason, and the procedure for requesting an IMR. Notably, enrollees applying for IMR under this regulation are not required to participate in the health plan’s grievance system first. [Download]