Medi-Cal
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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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Implementation of Medi-Cal Asset Verification Program Pilot
DHCS is piloting a new Asset Verification Program in order to detect unreported assets for Aged, Blind, and Disabled Medi-Cal participants who are not receiving SSI/SSP. Asset verification can be performed at any time a change of circumstances…
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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 Eligibility and the 2017 SSA COLA and Medicare Premiums
DHCS has issued guidance and provided resources on dealing with the 2017 SSA Cost of Living Adjustment (COLA) and the new Medicare premiums. In 2017, the COLA is 3%. Meanwhile, Part B premiums will be either $109 (current…
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County of Responsibility for Incarcerated Medi-Cal Beneficiaries
DHCS issued clarification to the counties about how to deal with Medi-Cal Inmate Eligibility Program (MCIEP) applications for beneficiaries who reside in one county (County of Residency) but are incarcerated in a different county (County of Incarceration) in…
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Increase in Medi-Cal Spousal Impoverishment Caps
DHCS has updated the maximum income and property caps under the Medicare Catastrophic Coverage Act as of January 1, 2017. The community spouse resource allowance (CSRA) will be $120,900, while the spousal income allocation (or minimum monthly maintenance…
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Restoration of Acupuncture Services as a Medi-Cal Benefit
As of July 1, 2016, the State has reinstated outpatient acupuncture services as a Medi-Cal managed care benefit. Acupuncture will be covered as needed to prevent, modify, or alleviate the perception of severe, persistent chronic pain resulting from…
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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…
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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…