Affordable Care Act
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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…
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MAGI Eligibility for DDS Waiver Participants
Participants in the HCBS-DD (Developmentally Disabled) Waiver can be eligible under any of the MAGI eligibility programs, including the Targeted Low-Income Children’s Program (TLICP) without a change to their aid codes. The HCBS-DD Waiver allows Regional Center patients…
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Medi-Cal Disregard Program for Unmarried Pregnant Women under 21
Unmarried pregnant women under the age of 21 and not otherwise eligible for Medi-Cal can be eligible for full-scope or pregnancy-related Medi-Cal. Such potential beneficiaries must either be living with parents and not filing a tax return for…
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DHCS 2017 FPL Charts
DHCS has updated its annual eligibility charts to reflect the 2017 federal poverty level ceilings for Medi-Cal and other health programs. The new FPLS are effective 1/1/17 for MAGI programs, 1/1/17 for MSP applicants and recipients without Title…
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Transitioning from MAGI Medi-Cal to Medicare
As of 8/1/16, CalHEERS has been able to verify Part A entitlement through the Federal Data Hub. Medicare entitlement precludes MAGI New Adult group eligibility, though it does not preclude eligibility through the MAGI Parent/Caretaker Relative or pregnancy…
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Carry Forward Status for Transitioning from Covered California to Medi-Cal
As of 9/26/16, CalHEERS implemented a change to introduce the Carry Forward Status to reduce gaps in coverage while consumers transition between Covered California and Medi-Cal pending county eligibility determinations. The flag in CalHEERS triggers a new notice…
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MCAP Integration into Medi-Cal Fee for Service System
Between 10/1/16 and 6/30/17, CalHEERS will assign MCAP-eligible pregnant women into aid code 0G. This will allow MCAP eligibles to receive full-scope Medi-Cal services through fee for service until the end of their post-partum period. MCAP eligible pregnant…
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Hierarchy of Eligibility Determinations for Medi-Cal Programs
DHCS has issued guidance on how Medi-Cal applications should be assessed during eligibility determinations. In this hierarchy, an application (which includes reporting change of circumstance, annual redetermination, and initial screening) should be determined by progressing through the chain…
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Medi-Cal Coverage of Tobacco Prevention, Cessation Services
DHCS issued an All Plan Letter providing instructions on what tobacco prevention and cessation services should be covered by managed care plans. DHCS points to the US Preventive Services Task Force in setting coverage requirements for both pregnant…
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Access to Medi-Cal Services for Transgender Beneficiaries
DHCS updated its guidance to managed care plans regarding covered services for transgender beneficiaries. Under the state Insurance Gender Nondiscrimination Act and the federal Affordable Care Act, plans cannot discriminate in its health care benefits against individuals based…