Medi-Cal
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2017 Statewide APPR for Nursing Facility Services
DHCS has updated the Statewide Average Private Pay Rate (APPR) figure to $8515. This figure is used to determine any relevant periods of ineligibility due to disqualifying property transfers in 2017. DHCS ACWDL 17-14 (May 11, 2017).
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Guidance on Continuity of Care for MER Denials
DHCS issued a new letter to non-COHS health plans reminding MCPs to treat denied medical exemption requests (MERs) as an automatic request for continuity of care with an existing FFS or nonparticipating health plan provider. MCPs must make…
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Changes to Managed Care Appeal and Grievance Processes
DHCS has issued updates and clarifications for Managed Care Plans (MCPs) and Dental Managed Care Plans (DMCs) regarding new federal guidelines around the grievance and appeals process. These rules take effect July 1, 2017. Attachment A summarizes the…
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Changes to State-Funded Breast and Cervical Cancer Treatment Program
The State-funded Breast and Cervical Cancer Treatment Program (BCCTP) supplements the Federal program by providing eligibility for women regardless of immigration status or age and for men with breast cancer of any age or immigration status. The state…
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Changes to Medi-Cal’s Special Needs Trusts Rules
The passage of the 21st Century Cures Act has expanded the category of individuals authorized to establish a special needs trust to include the disabled trust beneficiary. Previously, SNTs were only established by a disabled beneficiary’s parent, grandparent,…
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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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Position Statements in CDSS hearings
CDSS has issued instructions implementing AB 2346 about position statements. Previously, public and private agencies other than the Department of Health Care Services were required to make paper copies of their position statements available to claimants at least…
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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…