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.

This letter provides preliminary information on Hospital Presumptive Eligibility.  Effective January 1, 2014, qualified hospitals can temporarily enroll certain individuals into MAGI Medi-Cal.  Application is by one-page attestation, and qualified hospitals complete the process through online Hospital PE portal; eligibility is made in real time.

Enrollment is limited to once per 12-month period for 60 days of HPE coverage; pregnant women are permitted one HPE period per pregnancy for ambulatory prenatal services.  HPE providers are required to provide HPE individuals an insurance application prior to leaving the hospital, which must be completed no later than the end of the next month.  HPE eligible individuals will receive full-scope Medi-Cal benefits unless eligibility is based on pregnancy.

This letter provides guidance on verifying applicant citizenship/immigration eligibility through the federal data hub before sending out the MC 13 Status Form.