Effective 1/1/14, the community spouse resource allowance has increased from $115,920 to $117,240.  Additionally, the maximum spousal income allocation has increased from $2,898 to $2,931 per month.  Full letter available here.

DHCS issued guidance on how Medi-Cal NOAs are being generated by CalHEERS and SAWS beginning 4/15/14.  The full letter is available here.  Two sets of NOAs will be released:

  1. A “one-time batch” of NOAs from pre-enrollment and pre-CalHEERS/SAWS interface (applications filed 10/1/13 to 1/20/14) and post-interface (1/21/14-3/10/14)
  2. Ongoing as part of regular processing of NOAs dating from 3/11/14 onwards

The letter identifies some issues that may cause confusion among Medi-Cal beneficiaries:

  1. Both CalHEERS and SAWS may issue separate NOAs regarding MAGI and Non-MAGI Medi-Cal, respectively.  SAWS will reflect the correct eligibility category.
  2. CalHEERS NOAs may have the wrong coverage effective date, using the date of eligibility determination instead of the correct effective date of eligibility.
  3. CalHEERS is generating NOAs for each month of eligibility or conditional eligibility in certain circumstances.

Effective May 1, 2014, enteral nutrition products are restored as a Medi-Cal benefit.  This letter sets out the Standard of Care policy for managed care plans.

This week, DHCS issued a letter clarifying what counties should do when discontinuing Medi-Cal beneficiaries at annual or change in circumstance redeterminations.  The letter explains that beneficiaries should be reviewed for all programs, including MAGI Medi-Cal and non-MAGI Medi-Cal, before terminating them from the program and evaluating for APTCs/CSRs.  The letter is posted here with attachments.

The Department of Health Care Services issued All-County Welfare Director Letter 14-12E this week.  This letter, accessible here, corrects the A&D income limit for couples from $1,641 to $1,621 (100% FPL of $1,311 plus $310 disregard).

This letter informs counties of an increase in student income deductions for working students under 22 in an MFBU with an aged, blind or disabled individual.  This change should be applied retroactively.

Updated instructions on WPR reporting, including clarifications regarding holidays being in addition to excused absences, the updated activities definitions (including voc ed reporting), etc. “To help preserve months countable toward the vocational education federal 12-month limit when clients choose to utilize their welfare-to-work 24-month time clock, counties are reminded that if participation in other federally allowable activities meets or exceeds the hourly participation requirement, then the hours of participation in vocational education training would not count toward the 12-month limit.” [Download]

DSS issued this notice to provide counties with a revised progress report template for reporting their activities and progress related to implementation of Intensive Care Coordination , Intensive Home Based Services , and Therapeutic Foster Care for children and youth who meet Katie A. subclass criteria. [Download]

In this letter, DHCS clarifies the redetermination process for beneficiaries on the Refugee Medical Assistance (RMA) program.  Currently, RMA provides Medi-Cal benefits to refugees (including asylees, trafficking victims and special immigrants without categorical linkage) for their first eight months in the United States.  Post-ACA, RMA beneficiaries are still entitled to the full eight months but should be evaluated for MAGI Medi-Cal eligibility.

As of 3/24/14, CalHEERS is able to process change of circumstance redeterminations.  This letter directs counties to proceed with converting old potential MAGI-linked cases to MAGI cases using the instructions contained therein.  This is not to affect existing pre-ACA cases until their 2014 annual redetermination.

If a pre-ACA case submits a change of circumstance, the county will request additional tax household information and process for MAGI eligibility through CalHEERS.  If MAGI-eligible, the county will review the determination for potential negative action (e.g., ineligibility, share of cost, restricted scope of benefits) before approving for MAGI Medi-Cal.

The letter also presents a list of new Medi-Cal aid codes and their corresponding pre-MAGI codes.