Medi-Cal
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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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Medi-Cal benefits through the Trafficking and Crime Victims Assistance Program
DHCS has issued guidance on Medi-Cal benefits for TCVAP beneficiaries. The letter reviews eligibility for TCVAP and documentation requirements for Medi-Cal eligibility purposes. DHCS ACWDL 15-25 (7/22/15).
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Notice requirements for Medi-Cal applicants/beneficiaries who fail to respond or provide additional information
In light of the recent preliminary injunction in Korean Community Center of the East Bay v. DHCS, DHCS has instructed counties as of June 23, 2015, to stop discontinuing for failure to respond until appropriate and adequate NOAs…
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Medi-Cal income thresholds for Blind FPL programs
DHCS clarified income levels for the Blind FPL Medi-Cal programs starting 4/1/15: – Individuals: $1211 – Couples: $1751 where both are blind; $1666 where one individual is blind and the other is aged or disabled. DHCS ACWDL 15-24…
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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…
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Medi-Cal managed care coverage of wheelchairs
DHCS issued an All Plan Letter clarifying how Medi-Cal plans should determine medical need for wheelchairs and applicable seating and positioning components. The criteria for medical necessity must include a medical evaluation of the beneficiary and review of…
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Residency for Out-of-State Students for Medi-Cal Purposes
DHCS recently issued guidance around Medi-Cal residency requirements for students either from out-of-state who attend California schools or California residents who attend out-of-state schools. If otherwise eligible, those students who come to California to attend school may apply…
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Medi-Cal plans must offer certified nurse midwife services
Medi-Cal managed care plans are required to provide access for certified nurse midwife services to Medi-Cal beneficiaries. Beneficiaries may seek out CNM services from outside the plan when the plan is unable to provide such services within network. …
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New Medi-Cal guidelines for Hepatitis C treatments
This week, DHCS issued new guidance to Medi-Cal managed care plans about new treatment guidelines for recent FDA-approved treatments for Hepatitis C. The updated policy, effective July 1, 2015, looked at recent medical evidence and practice guidelines to…