medi-cal
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ACWDL 05-32: Section 1115 Demonstration Application Template – Evacuees of Hurricane Katrina (10/5/05)
Reminds counties that, pursuant to the Lynch v. Rank lawsuit, every potentially eligible Pickle person must receive a Pickle Medi-Cal notice for three consecutive years. The letter also announces that individuals listed during years previous to the most…
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ACWDL 05-28: Medi-Cal Changes Due to a Property Change in the SSI program (8/29/05)
Effective April 1, 2005, all Medi-Cal programs that use SSI property rules (Pickle, Disabled Adult Child, Disabled Widow(er), and 250% Working Disabled) are to adopt the following changes: · The definitions of “Household goods” and “personal effects” have…
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ACWDL 05-24: Processing Qualified Medicare Beneficiary Cases When Eligibility Has been Erroneously Discontinued (8/5/05)
Directs counties how to reinstate eligibility for Qualified Medicare Beneficiary Program (QMB) cases that are erroneously discontinued through no fault of the beneficiary. Eligibility can be reinstated for months when the beneficiary should have been receiving benefits. Medi-Cal…
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Independent Medical Reviews – Experimental and Investigational Therapies – 28 C.C.R. § 1300.70.4
This regulation, effective July 2005, describes the requirements for a plan’s notice to its enrollee when denying coverage on the basis of the treatments’ experimental or investigational status, when it is appropriate to request an IMR for this…
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Block Transfer Filings, 28 C.C.R. § 1300.67.1.3
This regulation, which became effective in August of 2005, establishes standards for redirecting enrollees to one or more contracting providers when their health plan terminates or does not renew the contract with their provider group or hospital. The…
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Independent Medical Review System, 28 C.C.R. §1300.74.30
This regulation, which became effective in September 2005, provides a mechanism for health plan enrollees to challenge their plans’ denials of coverage. The regulation details how applications for Independent Medical Review should be submitted and what supporting materials…
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Medi-Cal Emergency Regulation R-32-00E – Estate Recovery (March 23, 2005).
Have a low-income client who is an heir on the receiving end of the estate of a deceased Medi-Cal beneficiary, but the estate is subject to repayment for the deceased person’s Medi-Cal costs? That client, my friend, may…
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DHS ACL 04-31 – Questions and Answers on SB 87 Medi-Cal Redetermination Process for Discontinued SSI/SSP Beneficiaries as Ordered in Craig v. Bonta (October 22, 2004)
Clarifies the policy directives in ACL 03-24. Clarifies that if the SSA discontinuance reason is “no longer disabled” the beneficiary can still allege a disability but it must be a disability different from the disability under which the…
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DHS ACL 04-28 – New Camera-Ready Notices of Action and Transitional Medi-Cal Flyer (August 30, 2004)
Provides counties with copies of English and Spanish Notices of Action (NOAs) that were revised to reflect the requirements from Midyear Status Reporting, SB 87, and Sneede v. Kizer net nonexempt income determination. The Transitional Medi-Cal (TMC) flyer…
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DHS ACL 04-26 – Pregnancy Exemption for the Midyear Status Report (July 8, 2004)
Informs counties that all pregnant women are exempt from the MSR requirement (see ACL 03-41). To qualify for the exemption, pregnant women must report their pregnancy to the county eligibility worker. DHS plans to revise the MSR form…