Affordable Care Act
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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).
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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…
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Medi-Cal Pregnancy Services Available Regardless of Gender Identity
DHCS issued an All County Letter to update counties about eligibility for pregnancy services. Based on Section 1557 of the Affordable Care Act, SAWS will change its language for Medi-Cal NOAs about coverage of pregnancy services. The programming…
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SAWS Soft Pause Removal
Currently, the Soft Pause feature of SAWS protects consumers from losing MAGI-based Medi-Cal eligibility when personal circumstances change. The soft pause allows the county to run eligibility determinations for other programs while keeping the beneficiary on a MAGI…
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Extension of Presumptive Eligibility Period for Pregnant Women
DHCS has reminded counties that women on Presumptive Eligibility for Pregnant Women should have their PE period extended when they submit the required application. Currently, PE benefits last for up to two months beginning on the day of…
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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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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…