Medi-Cal: Beyond the Basics

Report
Medi-Cal—Hot Topics and
Updates on Current Issues
Randy Boyle, Staff Attorney
Legal Aid Association of California
2007 Spring Teleconference Training
February 8, 2007
Recent Medi-Cal Changes
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Cap on Denti-Cal services for adults
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$1800/year, with some exceptions
An approved TAR does not guarantee
payment
Dental services for people in LTC exempt
See Denti-Cal Provider Bulletin 11/05
Denti-Cal services for pregnant women
(started 1/1/06)
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Denti-Cal coverage for all pregnant women,
regardless of immigration status
See Denti-Cal Provider Bulletin 12/05
Income Level Changes for 2007
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Spousal resource allowance =
$101,640
Spousal monthly maintenance need
= $2541/month
FPL income limit changes do not
take effect until April
Recent Medi-Cal Changes
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Deficit Reduction Act of 2006
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Citizens must present proof of citizenship
No changes for immigrants
People on SSI and Medicare are exempt
from requirement
State has not yet implemented this
requirement, though it became effective
July 1 nationally
Watch for counties incorrectly asking for
this information from those seniors who
should be exempt
Medi-Cal Health Debt & Billing
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Share of cost (SOC)
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Different than “cost sharing”
Need not be paid, but must be incurred before
Medi-Cal coverage can begin for that month. Welf. &
Inst. Code §§ 14054, 14005.9(a), Cal. Code of Regs.
Title 22
§ 50090.
Can satisfy SOC with old bills and bills of dependents.
Old bills must be unpaid and still owed in the month
they are used for the SOC. Hunt v. Kizer
Clients may want to save bills for months in which
they will need to meet a SOC.
Generally, the bill must be dated within 90 days.
Moving Clients to Medi-Cal Disability
Programs without a Share of Cost
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Aged & Disabled FPL Program
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Currently up to $1047 for an individual, $1502
for a couple (maximum for an individual will go
up to $1080 on 4/1/07)
Applicants in board and care homes may use
the $315 personal care services deduction
IHSS expenses are not exempt. However,
IHSS caregiver wages paid to a spouse are
exempt income.
“Health insurance premium” is deducted from
countable income. Cal. Code of Regs. Title 22
§ 50555.2
Moving Clients to Medi-Cal with No
Share of Cost
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250% Working Disabled Program
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Beneficiary must be working, but that
work need only be $20 per month.
Substantial Gainful Activity rules do not
apply
Beneficiary must obtain envelopes for
sending in payments
Premiums are based on income. Premium
amount appears in MEDS in the SOC field.
Program is underutilized—mailings going
out to people with SOC or receiving IHSS.
(ACWDL 06-27, Oct. 12, 2006)
Medi-Cal Breast and Cervical Cancer
Treatment Program (BCCTP)
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Up to 200% of FPL
Diagnosed with breast or cervical cancer
Lack insurance or have insufficient insurance
Two programs
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Full Scope Medi-Cal: Citizens, qualified
immigrants. Lasts as long as treatment is
needed.
Time-limited Medi-Cal: Undocumented or men.
Breast cancer: 18 months; Cervical Cancer: 24
months
Providers who participate in the program
can qualify patient with presumptive
eligibility through an Internet application.
Questions?
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Randy Boyle
National Health Law Program
(310) 204-6010, ext. 108
[email protected]
Medi-Cal Fact Sheets available at:
www.healthconsumer.org

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