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Blind FPL Medi-Cal Income Threshold/Disregards Update
Effective April 1, 2017, the Blind Federal Poverty Level income limits are as follows: For a blind individual, the monthly income threshold is $1235, the same as the Aged and Disabled FPL threshold. For a couple where both…
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Updated Guidance on Medi-Cal Failure to Respond NOAs
In response to the Korean Community Center of the East Bay settlement, DHCS has issued new guidance to clarify procedures for discontinuing Medi-Cal cases for failure to respond at annual redetermination for MAGI and Non-MAGI cases. In both…
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Medi-Cal 1095-B Forms and County Obligations
Per Federal law, DHCS is to provide all Medi-Cal beneficiaries with minimum essential coverage (MEC) a Form 1095-B on or before January 31 following the end of each tax year. This information is also reported to the IRS…
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Treatment of Same-Sex Spouses in Medi-Cal Post-Windsor and Obergefell
Post-Windsor (2013) and Obergefell (2015), counties must treat married same-sex spouses the same as married opposite-sex spouses for Medi-Cal eligibility purposes under both MAGI and Non-MAGI rules. Rules applying to spouses for spousal impoverishment, undue hardship, long term…
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Non-MAGI Medi-Cal Application Supplemental Forms
For Non-MAGI Medi-Cal determinations, DHCS has provided supplemental forms and a flow chart to help evaluate cases for proper eligibility. Non-MAGI evaluations are required when an applicant requests such a determination, when MAGI does not apply, or when…
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Medi-Cal Standards for Dental Anesthesia Services
DHCS issued a Dental All Plan Letter to provide instructions on how to process TARs for intravenous sedation and general anesthesia services for dental procedures. Providers must submit TARs or prior authorization requests for these services as of…
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Updates to Medi-Cal Aged and Disabled, Medicare Savings Program Thresholds
DHCS has updated the thresholds for the the Medi-Cal Aged and Disabled Federal Poverty Level program. As of April 1, 2017, the monthly income limit for an individual is $1235 ($1005 + $230 disregard); the monthly income limit…
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Updates to the Online Single-Streamlined Application
The online application for Medi-Cal and other health insurance programs has been redesigned to group questions in a more logical fashion, using prior responses to display future questions on an as-needed basis for program eligibility determinations. Additionally, the…
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Medi-Cal Non-Emergency Medical and Non-Medical Transportation
DHCS issued an All Plan Letter to clarify what transportation services plans must provide in non-emergency situations. Subject to prior authorization, non-emergency medical transportation (NEMT) is a covered benefit when a member needs to obtain medically necessary services…
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Integration of Medi-Cal Access Program into Managed Care
The Medi-Cal Access Program (MCAP) provides full-scope Medi-Cal services for pregnant women between 213% and 322% of the federal poverty level. Prior to October 1, 2016, MCAP-eligible pregnant women received services through managed care plans and were assigned…