Affordable Care Act
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Equitable relief for people with Medicare and Marketplace coverage
Individuals who have Medicare Part A coverage are considered to meet minimum coverage requirements under the Affordable Care Act and are therefore ineligible to receive premium and cost-sharing assistance for Marketplace health insurance plans. Individuals who have Medicare…
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Recent DHCS Clarifications on Verifications and Paperwork
Annual Redetermination Signature Requirements DHCS is clarifying the signature requirements for the MAGI and Non-MAGI renewal forms, as well as the property supplement form. The renewal form may be signed by handwriting, electronic signature, or telephonic recorded signature. Beneficiaries may respond…
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Expanding Guidance on Medi-Cal Spousal Impoverishment Rules
The Affordable Care Act broadened the definition of an “institutionalized spouse” to include HCBS recipients and persons who have requested HCBS and generally reside at home or in the community. DHCS ACWDL 17-25 (July 19, 2018) initially extended spousal…
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Updated DHCS Charts of MAGI Medi-Cal Income and Deductions
DHCS has updated its “Whose Income Counts” Flowchart [DHCS MEDIL I 18-12 (September 14, 2018)] and its MAGI Income and Deductions Type Chart [DHCS MEDIL I 19-03 (January 11, 2019)].
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Recent Changes to Medi-Cal Notice of Action Requirements
Revised NOA for 250% Working Disabled Program Approval DHCS has revised NOAs for Working Disabled Program approvals to clarify that couples do not need to pay separate premiums as a couple. DHCS has also revised its EFT premium payment…
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Updated Specialty Thresholds for Medi-Cal Programs in 2018-2019
Effective July 1, 2018, through June 30, 2019, the FMBA amount for a family member living with the community spouse of an institutionalized spouse is $2,058 (compared to last year’s $2,030). DHCS ACWDL 18-13 (July 3, 2018); DHCS…
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Processing Medi-Cal cases with no potential MAGI eligibility
DHCS has issue guidance on not running CalHEERS business rules for certain household with no potential MAGI Medi-Cal eligibility. These include Mega-Mandatory beneficiaries in programs required by federal law or categorical programs (e.g., foster care, Pickle, SSI/SSP) and…
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Medi-Cal for Unaccompanied Refugee Minors (URMs)
DHCS issued a letter with information and guidance to counties regarding cases for Unaccompanied Refugee Minors (URMs) URMs who are otherwise eligible get no share of cost full scope Medi-Cal benefits, and are to be treated like foster…
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Non-MAGI Denial and Termination Notices for Non-Linkage
The State has revised Notices for individuals who are not eligible for Non-MAGI Medi-Cal due to lack of linkage. Counties will manually issue these NOAs until SAWS is updated. Counties are to send denial notices to applicants who…
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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. …