This MEDIL clarifies for counties that individuals who are eligible under MAGI Medi-Cal can receive LTCSS under their MAGI Medi-Cal full scope aid code and also provides guidance to counties in situations where one LTC spouse is non-MAGI and one is MAGI. View the letter here.
Effective January 1, 2014, the Former Foster Care Children’s Program (FFCC) was extended to provide Medicaid coverage to individuals through age 26 who were in foster care on their 18th birthday in any state. This letter, available here, instructs counties to enroll any new applicants who meet this criteria.
This letter provides guidance to counties on: 1) processing pending CalHEERS applications for individuals with current Medi-Cal eligibility; 2) ex parte review of pending CalHEERS Medi-Cal applications using existing CalWORKS and CalFresh cases; and 3) verifying state residency and remote identity proofing procedures until the CalHEERS/SAWS interface is functional. The letter is linked here.
Enrollees in the Low Income Health Program (LIHP) prior to December 31, 2013 have been and will continue to be administratively moved to MAGI Medi-Cal by DHCS until the end of March 2014. These individuals were given a transition aid code which will remain in place until the next scheduled redetermination unless the enrollee makes a new application or reports a change in circumstance that requires a new eligibility determination. For more information on the LIHP transition to Medi-Cal, view the letter here.
This letter grants presumptive temporary MAGI Medi-Cal eligibility (aid code 8E) to individuals who applied through the California Healthcare Eligibility, Enrollment and Retention System (CalHEERS) and whose applications have been delayed due to the delay in functionality of interface between CalHEERS and the Statewide Automated Welfare Systems (SAWS). The letter also provides instructions for how to complete these applications once the interface is live. Read the entire letter here.
The letter notifies counties that the federal SGA amount will increase effective 1/1/14 and instructs counties that were unable to implement the change by 1/1/14 to retroactively redetermine Medi-Cal eligibility based on disability if a case has been denied erroneously or budgeted incorrectly. Click here to access the letter.
This one is pretty self-explanatory. Click here to review the circumstances in which Medi-Cal beneficiaries are entitled to continuity of care, what continuity of care entails, and the processes for providing services through continuity of care.
Prior to 2014, Medi-Cal beneficiaries enrolled in a Medi-Cal Managed Care Plan (MCP) received services within the scope of their primary care provider’s (PCP’s) practice through their PCP and received specialty mental health services for serious mental illness through the county Mental Health Plan (MHP). Effective January 1, 2014, Medi-Cal Managed Care Plans are responsible for providing certain mental health services through the plan’s provider network to beneficiaries with mild to moderate impairment of mental, emotional, or behavioral functioning resulting from a mental health disorder even when those services are outside the PCP’s scope of practice. The letter, available here, delineates the MCP’s responsibilities for referring to, and coordinating with MHPs for the delivery of mental health services.
Reminds counties that Medically Needy Medi-CAl cases with Title II income must have the Share of Cost adjusted effective 1/1/14. Instructions for how to apply the COLA to these cases are included. Importantly, note that the COLA is NOT to be applied to A&D FPL, FPL-Blind, Medicare Savings Programs, 200 Percent Women and Infants, children’s FPL programs – these cases should NOT have the COLA applied until the 2014 FPL rates are published. Also, the COLA should not be applied to MAGI Medi-Cal cases as they have no redeterminations before April 2014. Read the full letter here.
While LSNC does not represent state or county inmates, the letter also provides information about Medi-Cal eligibility for parolees and babies born to inmates. The letter specifies that inmates who had eligibility through Medi-Cal Inmate Eligibility Program (MCIEP), who are entitled to an SB87 review of their eligibility when they are paroled. Parolees who were on the Low Income Health Program (LIHP) as inmates and were transitioned to Medi-Cal keep their eligibility until redetermination. Babies born to inmates on MCIEP are also deemed Medi-Cal eligible for one year. View the full letter here.