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.
The CMSP Governing Board issued this letter to update its current policy regarding Covered California eligibility to reflect Open Enrollment dates of November 15, 2014, to February 15, 2015.
The policy is largely unchanged. If a CMSP application is received during the period between the first day of Covered California open enrollment and 15 days before the end of open enrollment, that application is considered “subject to the Covered California open enrollment period.” As such, CMSP applicants who are not eligible for Medi-Cal must provide evidence of application for and first month’s premium payment of Covered California participation. Those applicants not subject to the open enrollment period (here, starting 2/1/15) must provide evidence of termination from Covered California for lack of monthly premium payment and lack of eligibility for a special enrollment period.
Instructions regarding the new State Utility Assistance Subsidy (SUAS) program. Lists how to cover recipients during the transfer period from LIHEAP Heat and Eat to SUAS. The SUAS payment ($20.01) is only to be provided to those households who will actually receive additional CalFresh benefits or become eligible for CalFresh as a result of receiving the payment. [Download]
Instructions on the AB 855 and SB 873 limit on the number of authorized hours providers in the IHSS and and Waiver Personal Care Services (WPCS) programs are permitted to work in a workweek. The letter provides information and instructions for implementing new policies that require that IHSS/WPCS providers receive compensation for travel time and wait time under certain circumstances. Included are new and revised forms and notices to be used by counties in implementing the new policies. [Download]
Instructions on the prohibition of using Advance Pay money to pay Individual Providers who have not completed the IHSS provider enrollment process and have not enrolled as IHSS providers, and a review of the time sheet rules. The Advance Pay option allows eligible IHSS recipients (described in the letter) to get a direct monthly IHSS payment , in order to pay providers at the time services are rendered. When in Advance Pay the provider’s time sheets must be sent it at the end of each authorized service month. If the recipient fails to submit the provider’s time sheets, within 90 days from the date of payment, the county shall have the right to change the recipient’s payment delivery method from payment in advance to payment in arrears. [Download]
DHCS issued this letter to remind counties to extend eligibility for Hospital Presumptive Eligibility individuals who have applied for Medi-Cal beyond the two months allotted under HPE. HPE beneficiaries who submit a timely application should not lose coverage. Counties need to send the appropriate transaction to MEDS in order to prevent MEDS from automatically terminating the HPE beneficiary; CalHEERS should automatically submit the appropriate transaction to MEDS.
DHCS issued this letter to the counties regarding interim policies and procedures for Non-MAGI and Mixed Medi-Cal cases. Counties are to conduct ex parte reviews by consulting electronic records and information in other open cases (e.g., CalFresh, CalWORKS). Potential MAGI beneficiaries must be evaluated for MAGI. Non-MAGI beneficiaries will need a property evaluation. Where no MAGI eligibility exists, counties will make a SAWS determination on the case.
Where no member of the household is in LTC, county will send a Medi-Cal Annual Redetermination (MC 210 RV) with a 60 day return period and relevant beneficiary outreach. With the information, the county will make a MAGI determination (send a RFTHI if potentially eligible) or determine what missing information needs verification (e.g., property supplement). When a family member is in LTC and ex parte determination is not possible, counties should send out the MC 210 Rv along with an MC 262.
For Mixed Medi-Cal household without LTC members, the county will do an ex parte review. MAGI members are sent through CalHEERS for eligibility, while non-MAGI members will go through SAWS. MAGI members are designated ineligible for the Non-MAGI MFBU, while non-MAGI members are designated as “non-applying” household members of the tax filing unit for MAGI determinations. Where there’s an LTC member in a mixed Medi-Cal household, the household receives a pre-populated MAGI redetermination form and an MC 604 IPS.
The letter also contains a list of “Mega-Mandatory” aid codes that take priority over MAGI codes for non-MAGI eligibility determinations. These groups follow the pre-ACA rules.
DHCS issued this letter to the counties about how to proceed with a Safe at Home confidential PO Box address. MEDS must only display the designated P.O. Box with a four digit Safe at Home identifier. While all the addresses are in Sacramento, counties must maintain the residence county and county of responsibility in the County where participants are living. The letter outlines the protections and steps to be taken to update information about a Safe at Home participant.