DHCS issued a letter to all Medi-Cal managed care plans regarding podiatric and chiropractic services in light of California Rural Health Clinics v. Douglas. If these services are provided at a Federally Qualified Health Center or Rural Health Center, plans shall cover them but may restrict reimbursement to contracted providers. APL 15-003 (1/26/15).
DHCS issued guidance to counties regarding how to treat fluctuating or self-employment income and how to use projected annual income in MAGI determinations in CalHEERS. The letter notes that IRS rules for net income from self-employment activities are different from non-MAGI rules; IRS deductions are broader than those allowed for non-MAGI programs.
For projected annual income, counties can take an average to determine monthly income. If income fluctuates monthly, the single streamlined application uses projected annual income. If the individual’s current monthly income is lower than the projected annual income, counties should use the current monthly income. CalHEERS is expected to be fixed in March 2015 to address this situation. DHCS ACWDL 15-06 (1/21/15).
DHCS issued additional guidance to counties for those cases transitioning to Medi-Cal due to the Covered California annual redetermination process. A prior letter referred to a batch data file sorted rejected cases into categories of “eligible,” “conditionally eligible,” or “pending eligible.” This file has 1720 cases, 879 of which were provided temporary coverage and 841 rejected for a second time.
The 841 rejected cases are to be evaluated manually by the counties and consortia for eligibility. The 879 temporary coverage cases were granted Express Lane aid codes and Medi-Cal coverage until the cases can be evaluated. DHCS ACWDL 15-05 (1/20/15).
DHCS issued new income and poverty caps under the Medicare Catastrophic Coverage Act. As of 1/1/15, the community spouse resource allowance is now $119,220; the increased spousal income allowance/minimum monthly maintenance needs allowance is $2981/month. DHCS ACWDL 15-04 (1/20/15).
DHCS issued a letter directing counties to stop terminating cases for specific aged, blind and disabled cases where the beneficiary did not return the Request for Tax Household Information form associated with MAGI rules. Counties will also be reinstating those ABD beneficiaries who were terminated for not returning the RFTHI. In these cases, the county must restore eligibility back to the date of discontinuance, then proceed to complete a 2014 redetermination based on ABD status before going onto a MAGI determination. DHCS ACWDL 15-03 (1/20/15).
DHCS is directing managed care plans to treat Medical Exemption Requests as automatic requests for continuity of care for those Medi-Cal beneficiaries transitioning into managed care. MCPs must treat every exemption listed in data reports as an automatic continuity of care request. MCPs must attempt to contact beneficiaries via letter and two calls, and must begin processing requests within five days.
DHCS All-Plan Letter 15-001 (1/14/15).
DHCS recently clarified the process for using out-of-pocket expenses from personal care services to meet current or future share of cost amounts. Previously, IHSS needed to assess and approve the need for personal care services, and the out-of-pocket costs of approved hours were used as an income deduction. Since these services are now provided as a Medi-Cal benefit, out-of-pocket costs can now be used to meet share of cost and not income deductions.
These out-of-pocket personal care services must be prescribed by a healthcare professional. The services need not be assessed by IHSS or provided by an IHSS provider, and they may exceed the maximum assessed IHSS hours as long as the need for hours has been documented.
The letter provides answers to frequently asked questions about using these out-of-pocket expenses toward the Medi-Cal share of cost. DHCS ACWDL 15-02 (1/12/15).
Upon request, or upon notice that a person requires accommodation due to a disability, counties must assist CalWORKs applicants and recipients to obtain required benefit eligibility evidence if the applicant’s or recipient’s good faith efforts to obtain the evidence have failed. CDSS has directed counties to revise 17 notices of action that deny, discontinue or decrease benefits due to failure to provide required verification to specify that the client did not ask the county for help getting the required proof of evidence of eligibility. CDSS also directs the counties to rescind any negative actions on CalWORKs cases wherein the applicant or recipient asked the county for help, but did not receive help. ACL 14-88 (11/20/14)
Resolving what must have been a heated dispute between various counties when processing inter-county transfers of IHSS cases, CDSS has verified that, notwithstanding the fact the form is not listed among required forms in the Manual of Policies and Procedures, the Health Care Certification Form (SOC 873) is indeed required to be provided in hard copy format by the transferring county during an inter-county transfer. ACL 14-86 (12/9/14)
DHCS issued a letter to guide counties on how to handle Covered California cases transitioning to Medi-Cal after Covered California’s annual redetermination process, which will always run at the same time each year. When Covered California determines that a beneficiary may now be income-eligible for Medi-Cal, it will forward the information to the counties for final determination.
Those found eligible, conditionally eligible, or pending eligible are sent to the county for appropriate verification. Eligible cases were granted temporary full-scope Medi-Cal eligibility as of January 1, 2015, and assigned to the same health plan where possible.
DHCS’s letter included talking points on the transition process and sample notices/letters to consumers. DHCS ACWDL 15-01 (1/7/15).