Affordable Care Act
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Certain IHSS/HCB caregiver wages are MAGI exempt
DHCS clarified its MAGI Income and Deductions chart to account for recent IRS clarification about live-in caregiver wages. Caregiver wages paid under certain IHSS and Home and Community Based Waivers are not counted for MAGI determinations when paid…
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Changes to CalHEERS and determination of immigration status
Recently, DHCS updated CalHEERS and how the system determines program eligibility based on immigration status. The update removed a question asking applicants whether they are an “eligible immigrant” and added a drop-down option for those who do not…
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Preserving Medi-Cal eligibility for Foster Youth who run away from placements
DHCS has issued a letter to clarify eligibility guidelines for foster care youth who leave court-ordered placements. While loss of contact with the youth may discontinue foster care payments, that youth may be in other Medi-Cal aid codes…
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Transitioning from Medi-Cal/MEC to Covered California with SEPs
DHCS is reminding county workers to assist MAGI Medi-Cal beneficiaries to get immediate health coverage when they are being discontinued from Medi-Cal and transitioning into Covered California during a special enrollment period. Workers must assess individuals for non-MAGI…
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Hospital payments for CCS beneficiaries in Medi-Cal managed care plans
DHCS issued two all-plan letters about billing for inpatient services at both designated public hospitals (DPH) and private or non-designated public hospitals for CCS-eligible conditions of managed care Medi-Cal beneficiaries. Generally, CCS services are paid through fee-for-service Medi-Cal,…
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Individual Medi-Cal determinations while household is pending
DHCS recently released information about making sure that individuals determined Medi-Cal eligibility by CalHEERS should be considered eligible even when other members of the household are pending eligibility. CalHEERS should determine the lowest potential eligibility for an individual…
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Medi-Cal Termination NOAs for Over Income and Not Otherwise Medi-Cal Eligible
DHCS issued new guidance on the requirements for issuing Notices of Action to individuals discontinued from Medi-Cal due to being over income for MAGI programs, not being eligible for Consumer Protection Programs, and not being eligible for any…
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Expanded eligibility and services under CMSP
As of May 1, 2016, the County Medical Services Program (CMSP) is changing some of its eligibility requirements and benefits. CMSP provides limited-term health coverage for indigent residents in 35 mostly rural California counties. These changes should be…
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Manual Workaround to Preserve Covered California Coverage for Pregnant Women
DHCS issued a letter to the counties about a workaround for women enrolled in a Covered California plan with premium tax credits to remain in their health plans and not transition to Medi-Cal when they report a pregnancy.…
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Clarifying the Inter-county Transfer Process
DHCS has issued this letter to update information about how to process an ICT and how that affects managed care enrollment. A beneficiary needs to report a change in county address within ten days of the change in…