Medi-Cal
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Changes to Medi-Cal estate recovery
Effective January 1, 2017, SB 833 changes rules regarding Medi-Cal estate recovery. DHCS will be limited to recovering for nursing facility services, home and community-based services, and related hospital and prescription drug services when beneficiaries receive nursing facility…
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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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Adult Immunizations as a Medi-Cal Pharmacy Benefit
DHCS has issued a letter to Medi-Cal managed care plans to instruct plans to include adult immunizations on plan formularies. A pharmacist may administer immunizations according to plan protocols as long as the pharmacist completes an immunization training,…
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Medi-Cal scope of benefits for various Employment Authorization codes
DHCS has issued an informational letter to summarize the categories of employment authorization codes and the scope of Medi-Cal benefits qualified individuals can expect. The EAD category code indicates an individual’s immigration status, and this MEDIL includes a…
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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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Medi-Cal Coverage for Services under End of Life Option Act
DHCS issued an All Plan Letter to guide managed care plans about the administration of the End of Life Option Act benefit. This benefit allows terminally ill beneficiaries over the age of 18 with the capacity to make…