jtan
-
Medi-Cal Denial Notices for Retroactive MAGI Eligibility Determinations
Counties are required to send Notices of Action when an individual is denied MAGI Medi-Cal as a result of being over MAGI income limits (138% FPL) during any of the three retroactive months prior to the application month. …
-
2018 Statewide Average Private Pay Rate for Nursing Home Services
DHCS announced that the 2018 Statewide APPR for nursing home services is $8841. Use the new APPR to determine any periods of ineligibility due to transfer of property for less than fair market value. DHCS ACWDL 18-08 (May…
-
Clarification of Accessing Non-Emergency Medical Transportation (NEMT)
Recently, DHCS issued a letter educating counties about non-emergency medical transportation (NEMT). NEMT services are covered through Medi-Cal when a beneficiary cannot safely use other means of public or private transportation due to medical contraindication. These beneficiaries can…
-
New Notices for 250% Working Disabled Program
DHCS has issued new guidance directing counties to issue discontinuance and denial notices for applicants for the 250% Working Disabled Program. Prior to discontinuing a case, the county must evaluate individuals for all other programs, including MAGI Medi-Cal…
-
Medi-Cal Managed Care Network Adequacy Requirements
Beginning July 1, 2018, all Medi-Cal managed care plans (MCPs) will be required to submit annual network certifications in addition to continuing requirements for reporting significant changes to their networks. MCPs must confirm that their networks will meet…
-
2018 Thresholds for Insurance Affordability Programs
DHCS has updated its charts for thresholds for Medi-Cal, MCAP, and APTC eligibility to reflect 2018 Federal Poverty Levels. Updated thresholds for Non-MAGI Medi-Cal will not be effective until April. DHCS ACWDL 18-03 (January 30, 2018).
-
Providing Voluntary Inpatient Detox Services through Medi-Cal Fee for Service
Voluntary inpatient detoxification (VID) services are a Medi-Cal benefit carved out of managed care and covered through Medi-Cal fee for service. To be eligible, inpatient detoxification must be the primary reason for voluntary admission. DHCS’s All Plan Letter…
-
Clarification of Medi-Cal ICT Process after SB 1339
SB 1339 codified the Medi-Cal Intercounty Transfer (ICT) process, effective June 1, 2017. Medi-Cal beneficiaries must notify either the county they are leaving (sending county) or the county to which they are moving (receiving county) of a change…
-
Denials and Terminations of Caretaker Adult MAGI Medi-Cal Cases when Child Lacks Coverage
Under current State and Federal regulations, a parent or caretaker relative with a dependent child under 19 living in the home does not qualify for MAGI Medi-Cal if the child does not have minimum essential coverage (MEC). Applicants…
-
2018 Update to Spousal Impoverishment Cap
Effective January 1, 2018, the community spouse resource allocation (CSRA) under the Medicare Catastrophic Coverage Act has been increased to $123,600. The minimum monthly maintenance needs allowance (MMMNA) has also been increased to $3090 per month. DHCS ACWDL…