DHCS issued a letter on November 26, 2014, reminding counties that the appointment of authorized representatives now lasts until a change is made. This change could be the applicant/beneficiary modifying/cancelling the authorization, the appointment of a new representative, the representative withdrawing, or a change in the law. Previously, the appointment period lasted for a year. DHCS MEDIL I 14-57.
DHCS is providing counties initial guidance on dealing with MAGI Medi-Cal cases where all individuals on the case need to be denied or terminated from the program. The letter outlines five steps:
- Counties will identify pending and active cases that should be denied or terminated where all members on the case are MAGI Medi-Cal within three priority areas: duplicate applications, failure to complete redetermination, and failure to complete determination.
- SAWS will receive the county lists and send them to CalHEERS.
- SAWS or MEDS will take negative action through a backend data fix.
- SAWS will generate and send NOAs.
- CalHEERS will take negative action using a backend data fix.
The letter includes a list of negative actions (Attachment A) and an overview of the different systems (Atttachment B). DHCS MEDIL I 14-56
This letter notifies counties of the DHCS-required process for reducing the pending backlog of Medi-Cal cases. DHCS will cull through lists for a preliminary determination of eligibility, which counties will then evaluate by December 1. DHCS will then start granting preliminary eligibility coverage included on these lists. DHCS MEDIL I 14-55, 14-55 E
DHCS issued guidelines about which materials must be offered to households at the time of application and at the time of renewal. The set of documents depends on applicant type: New Household, Medicare Savings Program, Non-MAGI, Renewal. The letter provides the lists of documents. DHCS MEDIL I 14-54.
Several new forms and notices for Stage 1 child care, revised to comply with current regulations and to be more easily understood by recipients, were sent to the counties on November 13, 2014. ACL 14-85.
CDSS has made available a new online video, available in English, Spanish, Armenian and Chinese, that demonstrates how providers are to document overtime and travel time that will be compensable beginning January 1, 2015. The video explains the compensation and reimbursement changes related to SB 855 and SB 873 and explains proper use of several new related forms, including the revised time sheet and the new travel claim form. ACIN I-65-14.
Beginning July 1, 2014, counties must determine whether or not a CalWORKs recipient has met his or her hourly participation obligations by using a weekly average per month rather than a weekly minimum number of hours. Workers should (1) add up the total number of participation hours in all CalWORKs activities for the month, (2) divide by 4.33 and (3) round to the nearest whole number. Counties should no longer use weekly minimums, thus allowing recipients more flexibility in a given month to reach the required participation hours total. ACL 14-80.
The Department issued this letter informing counties that the updated application for the Medicare Savings Programs has been translated in the 12 threshold languages.
This letter informs counties about the Every Woman Counts program. The letter includes a brochure and flyer about the program, and it encourages counties to provide this information to those ineligible for other programs.
DHCS issued this letter focusing on annual redeterminations for MAGI Medi-Cal and Covered California mixed coverage household. Since different annual redetermination periods and processes are involved, there will be two different annual redetermination dates for mixed coverage household members based on program: any time during the year for Medi-Cal, and before January 1 for Covered California.
Medi-Cal annual redeterminations are set for 12 months after the initial application date or most recent redetermination. Covered California redeterminations start processing in early October (for 2014) via CalHEERS. Covered California beneficiaries will be defaulted into their current plans if they don’t make an affirmative change, but they will have the option to switch plans during open enrollment.
When a mixed household population has the same annual redetermination date for Medi-Cal and Covered California, the Medi-Cal redetermination process will initiate the annual redetermination process. That means the county will go through the ex parte process and request of verifications to confirm Medi-Cal eligibility.
When a mixed household population has different redetermination dates for Medi-Cal and Covered California cases, the redetermination for one will be processed as a change of circumstances for the other, unless the county receives beneficiary information that does not change the information currently on file.
Counties are responsible for Medi-Cal eligibility determinations and ongoing case management of Medi-Cal cases with regards to cases that may have contact with the Exchange. The counties are required to assist with renewals for mixed households where changes are reported for Covered California that may impact Medi-Cal eligibility.