How to treat disaster-related payments for Medi-Cal eligibility

DHCS issued guidance to the counties on how to treat certain disaster assistance payments for MAGI and Non-MAGI Medi-Cal programs.  Existing rules remain applicable for non-MAGI cases (see ACWDL 92-08, MEPM Article 9M, 22 CCR §§ 50481, 50535.5).  In MAGI Medi-Cal cases, most disaster assistance in federally recognized disasters are exempt as income depending on the source of payment:

  • Payments from charitable organizations are considered gifts and are excluded from the tax household’s gross income.
  • Payments from insurance are exempt as income in federally declared disaster areas, while insurance payments in non-federally declared disaster areas may count depending on whether they are taxable.
  • Payments from federal or state government sources that are based on need are exempt, as are payments in qualified disasters from federal, state, or local government.

When a Medi-Cal beneficiary is temporarily living out of county due to displacement from disaster, the county must help that beneficiary with the Office of the Ombudsman.  DHCS ACWDL 15-36 (11/9/15).

Full-scope Medi-Cal expanded options for pregnant women

As of August 1, 2015, the full-scope income limit for pregnant women increased from 60% FPL to 138% FPL, to be automatically applied through both CalHEERS and SAWS applications.

For new applicants, eligible pregnant women up to 138% FPL will be enrolled into full-scope Medi-Cal coverage through managed care.  Those between 139% FPL and 213% FPL will be eligible for pregnancy-related services through Medi-Ca.  Aid codes will be based on the applicant’s income and citizenship/immigration status.

Current (as of 8/1/15) pregnancy-only beneficiaries between 60% and 138% FPL received notices about the change on 9/14/15 and were given the option to remain in fee-for-service or switch to managed care.

DHCS ACWDL 15-35 (11/12/15).

New child support online application

The California Department of Child Support Services (DCSS) is releasing a new on-line application that is scheduled for implementation in December, 2015. The application, called Virtual Interactive Online Application for Child Support Services (VIOLA), will be the single application process available on DCSS’ website.

VIOLA will be free to use, interfaces with the state child support computer system, can automatically create a new case and allows uploading of up to 30 documents.

LCSA Letter 15-15 (11/23/15).

Residency for CalFresh

CDSS has issued guidance on determining residency for purposes of CalFresh eligibility. CDSS states that counties cannot have a durational residency requirement, cannot require a fixed mailing address, and cannot require intent to permanently reside in the county as conditions of CalFresh eligibility.   Temporary absence from a county when there is an intent to return should not affect CalFresh eligibility or require an inter-county transfer.

“Whereabouts unknown” is not a permissible reason to terminate CalFresh benefits. If mail is returned as undeliverable, counties should send a request for information form to the last known address, if that form is not returned within 10 days, the county can terminate benefits.

Semi-annual reporting households are only required to report address changes when submitting a semi-annual report or at annual recertification. Change reporting households must report address changes within 10 days.

An overissuance cannot be established solely because a client accesses benefits in another county or state or is temporarily located in another county or state.  ACL 15-91 (11/3/15).

End of CalFresh change reporting

Currently, migrant and seasonal worker households, homeless household and households in which all adults are elderly or disabled are subject to change reporting, that is reporting all changes in household income or composition within 10 days. SB 79 Sections 54 and 55 require the elimination of change reporting and converting all households to semi-annual reporting by January 2017.

CDSS has issused instructions about transitioning these households to semi-annual reporting. CDSS states that counties that use the CalWIN computer system will convert on June 1, 2016 and counties that use the C-IV and LEADER computer systems will convert on July 1, 2016. CDSS will sent information notices to all effected households six months and three months before the change. In addition, CDSS directed counties to find good cause for late submission of a semi-annual report for twelve months after the change to semi-annual reporting occurs if the report is submitted in the first month after it is due.  ACL 15-90 (10/30/15).

Medi-Cal households to receive 1095-B letter

Starting this week, DHCS is sending Medi-Cal beneficiaries information about the 1095-B that households will need to show minimum essential coverage for the year at tax filing.  The 1095-B forms themselves will be mailed out no later than January 31, 2016.  The letter includes English and Spanish language versions of the DHCS letter and a call center script.  DHCS MEDIL I 15-36 (10/30/15).