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Changes in Processing Medi-Cal Cases for Former Foster Youth
Recently, DHCS has issued some new guidance regarding Medi-Cal for Former Foster Youth (FFY). First, if a former foster youth becomes eligible for Medi-Cal through Hospital Presumptive Eligibility (HPE), aid code 4E, counties are to process the beneficiary…
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Change to Eligibility Period for Presumptive Eligibility (PE) Medi-Cal
As of December 31, 2014, PE coverage begins on the date of the eligibility determination and ends at the end of the following month if no Medi-Cal application is submitted for full determination. Previously, presumptive eligibility went back…
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Making Changes to Beneficiary Information with a Health Plan
Managed care plans are to contact county office liaisons to provide updated contact information for Medi-Cal beneficiaries. If the plan has received the beneficiary’s approval, the counties must incorporate these changes immediately. If the plan does not have…
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Medi-Cal backlog cases no longer batched for Accelerated Enrollment
DHCS has explained that the application batching process that allowed the state to mitigate some of the 2014 application backlog through Accelerated Enrollment (AE) has ended. DHCS is still required to send Rivera Notices of Inaction when an…
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Fixing Medi-Cal Aid Codes for Former Foster Youth
DHCS issued instructions to the counties to facilitate the appropriate Medi-Cal coverage of former foster youth through aid code 4M. Former foster youth are entitled to receive Medi-Cal through the age of 26. The current CalHEERS programming uses…
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Limitations on Medi-Cal Presumptive Eligibility Enrollment
Based on CMS guidance, DHCS has implemented limitations on Presumptive Enrollment (PE) periods. PE portals will screen new applicants for any PE enrollment in the prior 12 months. Former foster youth, parents and caretaker relatives, and expansion group…
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Medi-Cal continuity of care guidelines for transitions into managed care
DHCS has issued guidelines for continuity of care requirements for Medi-Cal beneficiaries transitioning into managed care. The guidelines list timeliness and eligibility requirements for plans, beneficiaries and providers. The guidelines also include specific guidelines for transitions relating to…
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New income guidelines for Pregnancy full-scope Medi-Cal expansion
As of August 1, 2015, CalHEERS is programmed for the expansion of full-scope Medi-Cal for pregnant women up to 138% FPL. These beneficiaries will be placed in aid code M7 and required to enroll in a managed care…
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Rescinding Medi-Cal discontinuances with timely information
DHCS issued a letter reminding counties to process promptly information received after a discontinuance notice is sent but before the date of discontinuance or during the 90-day cure period. Counties must restore Medi-Cal benefits even with an incomplete…
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Spanish translations of Medi-Cal notice language for failure to respond, cure period
DHCS issued a letter with the required Spanish-language Notice of Action language for failure to respond to requests for information at application or redetermination. The letter also includes language counties should use to explain the 90-day cure period. …