Medi-Cal
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Medi-Cal Eligibility Exceptions due to Public Health Crisis or Disaster
DHCS has issued guidance about the timeliness exceptions for processing applications and redeterminations in counties affected by a state or federally declared major public health crisis or natural disaster. Applicants in affected areas requested expedited medical services shall…
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Recent Changes to Medi-Cal Notice of Action Requirements
Revised NOA for 250% Working Disabled Program Approval DHCS has revised NOAs for Working Disabled Program approvals to clarify that couples do not need to pay separate premiums as a couple. DHCS has also revised its EFT premium payment…
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Updated Specialty Thresholds for Medi-Cal Programs in 2018-2019
Effective July 1, 2018, through June 30, 2019, the FMBA amount for a family member living with the community spouse of an institutionalized spouse is $2,058 (compared to last year’s $2,030). DHCS ACWDL 18-13 (July 3, 2018); DHCS…
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Processing Medi-Cal cases with no potential MAGI eligibility
DHCS has issue guidance on not running CalHEERS business rules for certain household with no potential MAGI Medi-Cal eligibility. These include Mega-Mandatory beneficiaries in programs required by federal law or categorical programs (e.g., foster care, Pickle, SSI/SSP) and…
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Medi-Cal for Unaccompanied Refugee Minors (URMs)
DHCS issued a letter with information and guidance to counties regarding cases for Unaccompanied Refugee Minors (URMs) URMs who are otherwise eligible get no share of cost full scope Medi-Cal benefits, and are to be treated like foster…
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Non-MAGI Denial and Termination Notices for Non-Linkage
The State has revised Notices for individuals who are not eligible for Non-MAGI Medi-Cal due to lack of linkage. Counties will manually issue these NOAs until SAWS is updated. Counties are to send denial notices to applicants who…
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Medi-Cal Denial Notices for Retroactive MAGI Eligibility Determinations
Counties are required to send Notices of Action when an individual is denied MAGI Medi-Cal as a result of being over MAGI income limits (138% FPL) during any of the three retroactive months prior to the application month. …
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Presumptive transfer of specialty mental health services for children, youth, and non-minor dependents in foster care
The California Department of Social Services (CDSS) has issued instructions regarding the implementation of AB 1299 regarding presumptive transfer of specialty mental health services (SMHS) for children, youth, and non-minor dependents in foster care. In the event that…
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2018 Statewide Average Private Pay Rate for Nursing Home Services
DHCS announced that the 2018 Statewide APPR for nursing home services is $8841. Use the new APPR to determine any periods of ineligibility due to transfer of property for less than fair market value. DHCS ACWDL 18-08 (May…
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Clarification of Accessing Non-Emergency Medical Transportation (NEMT)
Recently, DHCS issued a letter educating counties about non-emergency medical transportation (NEMT). NEMT services are covered through Medi-Cal when a beneficiary cannot safely use other means of public or private transportation due to medical contraindication. These beneficiaries can…