DHCS MEDIL I 14-43: Information Concerning the Future Implementation of the Full-Scope Medi-Cal Coverage and Affordability and Benefit Program for Low-Income Pregnant Women and Newly Qualified Immigrants (NQIs) (7/30/14)

DHCS issued this letter to the counties about the implementation of the new Full-scope Medi-Cal coverage and affordability benefits program for low-income women and non-qualifying immigrants, to be operational no sooner than 1/1/15.

Currently, Medi-Cal limits full-scope benefits to pregnant women under 60% FPL and pregnancy-only Medi-Cal to those between 60%-208% FPL.  Recent legislation established an affordability wrap between Medi-Cal and QHPs purchased through Covered California where pregnant women and non-qualifying (5 year bar) immigrants in a Covered California plan could have out-of-pocket expenses (including copays, premiums and deductibles) paid for by Medi-Cal.

Once these programs are fully implemented, pregnant women under 138% FPL will qualify for full-scope Medi-Cal.  Pregnant women between 138-213% FPL who are enrolled in a Covered California QHP will have the option to enroll in the wrap.  NQIs who would have been eligible for Medi-Cal due to MAGI expansion rules would enroll in a QHP with automatic enrollment in the wrap.

The letter also discusses the implementation process to be followed leading up to January 2015.