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How to treat disaster-related payments for Medi-Cal eligibility
DHCS issued guidance to the counties on how to treat certain disaster assistance payments for MAGI and Non-MAGI Medi-Cal programs. Existing rules remain applicable for non-MAGI cases (see ACWDL 92-08, MEPM Article 9M, 22 CCR §§ 50481, 50535.5). …
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Full-scope Medi-Cal expanded options for pregnant women
As of August 1, 2015, the full-scope income limit for pregnant women increased from 60% FPL to 138% FPL, to be automatically applied through both CalHEERS and SAWS applications. For new applicants, eligible pregnant women up to 138%…
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Medi-Cal households to receive 1095-B letter
Starting this week, DHCS is sending Medi-Cal beneficiaries information about the 1095-B that households will need to show minimum essential coverage for the year at tax filing. The 1095-B forms themselves will be mailed out no later than…
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Counties may continue accepting older Medi-Cal applications
According to state law, counties are supposed to stop accepting older, non-single streamlined applications for Medi-Cal after January 1, 2016. However, DHCS is requiring counties to continue to accept these older applications (including the SAWS 2 PLUS) and…
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Notices for 1095-B at Initial Medi-Cal Application
Counties must offer a 1095-B beneficiary notice to all households at application for insurance affordability programs including Medi-Cal. The Notice will provide information about the Form 1095-B and remind all applicants to report all changes that may affect…
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Counties must review Share of Cost cases for MAGI eligibility
The State issued an urgent reminder to counties to review caseloads for share of cost cases (or potential share of cost cases denied due to assets) for MAGI eligibility. These cases should be appropriately determined back to January…
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Medi-Cal Benefits for Students Attending College Out of County
When a student attends college in a different county, the family needs to inform the county of this change. The county will update only the student’s address in SAWS and MEDS. This change will trigger change in health…
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Medi-Cal Discontinuance Notices for Overincome, Ineligible Beneficiaries
DHCS is clarifying NOA issuing requirements for Medi-Cal discontinuances when the beneficiary is over income for MAGI, not eligible for consumer protection programs, and has no potential non-MAGI eligibility. Counties must issue a timely and adequate manual discontinuance…
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Medi-Cal Managed Care Coverage of BHT Services through Regional Centers
Medi-Cal managed care plans are responsible for providing medically necessary Behavioral Health Treatment (BHT). This includes coordinating with Regional Center and BHT providers as applicable. Plans are required to execute an MOU with local regional centers by December…
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Medi-Cal Plan Coverage of Abortion Services
DHCS issued a letter to Medi-Cal managed care plans reminding the plans about their responsibility to provide timely access to abortion services as a physician service. While prior authorization may be required for non-emergency inpatient hospitalization, plans must…