Affordable Care Act
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Limitations on Medi-Cal Presumptive Eligibility Enrollment
Based on CMS guidance, DHCS has implemented limitations on Presumptive Enrollment (PE) periods. PE portals will screen new applicants for any PE enrollment in the prior 12 months. Former foster youth, parents and caretaker relatives, and expansion group…
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Medi-Cal continuity of care guidelines for transitions into managed care
DHCS has issued guidelines for continuity of care requirements for Medi-Cal beneficiaries transitioning into managed care. The guidelines list timeliness and eligibility requirements for plans, beneficiaries and providers. The guidelines also include specific guidelines for transitions relating to…
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New income guidelines for Pregnancy full-scope Medi-Cal expansion
As of August 1, 2015, CalHEERS is programmed for the expansion of full-scope Medi-Cal for pregnant women up to 138% FPL. These beneficiaries will be placed in aid code M7 and required to enroll in a managed care…
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Rescinding Medi-Cal discontinuances with timely information
DHCS issued a letter reminding counties to process promptly information received after a discontinuance notice is sent but before the date of discontinuance or during the 90-day cure period. Counties must restore Medi-Cal benefits even with an incomplete…
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Spanish translations of Medi-Cal notice language for failure to respond, cure period
DHCS issued a letter with the required Spanish-language Notice of Action language for failure to respond to requests for information at application or redetermination. The letter also includes language counties should use to explain the 90-day cure period. …
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CalHEERS glitch affects MAGI Medi-Cal individuals without SSNs
DHCS issued a letter to address a known CalHEERS system defect where individuals without a social security number go through the system and return with pending eligibility from CalHEERS. The defect occurs when an individual is processed for…
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CalHEERS issues with Medi-Cal scope of services for immigrants
DHCS issued clarification about the CalHEERS issues regarding scope of services for certain immigrants. The new release of CalHEERS uses two data fields for scope of services. If both fields (Citizen and Eligible Immigrant) are marked “no” or…
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Medi-Cal applicants pending Accelerated Enrollment
DHCS has issued clarification in cases where individuals are pending AE and the County doesn’t deny the application. Counties are reminded that they must ensure that the individuals excluded from the 45-day AE process due to pending negative…
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New CalHEERS Functionality for Medi-Cal
The State is implementing a new CalHEERS release. In this letter, DHCS provides an overview of new major functionalities of this release. Counties will now be able to initiate negative actions (denials/discontinuances). Additionally, CalHEERS is supposed to reduce…
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Priorities for Processing Medi-Cal Application Batches
DHCS has set priorities for counties to process Medi-Cal batch applications. Counties are to resolve batch transactions that DHCS has not batched in weekly 45-day accelerated enrollment (AE) batch runs. Then, counties need to review Rivera Notice of…