Significant updates to numerous state-run health care programs are taking place. Here are some recent changes that may affect your patients and practice.
Aged, Blind, and Disabled Eligibility Expansion
On December 20, 2019, DHCS received federal approval of a CAFP-supported State Plan Amendment (SPA 19-0050) to extend Medi-Cal coverage to Aged, Blind, and Disabled individuals earning less than 138 percent of the Federal Poverty Level. The policy will be implemented effective August 1, 2020.
Medi-Cal Rx Frequently Asked Questions (FAQ)
DHCS posted a revised FAQ document, entitled “Medi-Cal Rx: Transitioning Medi-Cal Pharmacy Services from Managed Care to Fee-For-Service,” to the DHCS Medi-Cal Rx: Transition webpage in January 2020. On February 18, 2020, DHCS will host the third Medi-Cal Rx Public Forum via a webinar and in-person meeting, which will help to ensure that the broader stakeholder community is kept up to date about Medi-Cal Rx implementation activities and timelines. DHCS has posted all of the dates and times for these forums on the transition webpage, will post agendas in advance of the meetings, and will release reminder notices through various DHCS stakeholder email distribution lists. For questions or comments relating to Medi-Cal Rx, please email RxCarveOut@dhcs.ca.gov.
Nonmedical Transportation (NMT)
As of January 31, 2020, DHCS has received 292 applications from transportation companies requesting to enroll as NMT providers for FFS Medi-Cal. Of the total, DHCS approved 36 applications. A list of approved NMT providers is posted on the DHCS website, and is updated monthly as additional providers are approved. DHCS will continue to assist FFS Medi-Cal beneficiaries with NMT requests if there is no approved NMT provider in their area. Beneficiaries or their designees may email DHCS-Benefits@dhcs.ca.gov to request transportation assistance. Requests should be sent at least five business days in advance of the appointment if their provider is unable to arrange NMT or if they have exhausted all other transportation options.
Medicaid Optional Benefits Restoration
The Budget Act of 2019 restored certain CAFP-supported optional benefits, including audiology, speech therapy, podiatric, incontinence creams and washes, and optometric and optician services, effective January 1, 2020, through December 31, 2021, for all full-scope Medi-Cal beneficiaries. Providers may submit claims for restored services provided on or after January 1, 2020. A beneficiary notice regarding the restoration of these benefits will be mailed in February 2020.
Provisional Postpartum Care Extension (PPCE)
CAFP-supported SB 104 (2019) authorized DHCS to extend Medi-Cal or Medi-Cal Access Program coverage for pregnant or postpartum individuals who provide confirmation from a provider indicating that the individual has been diagnosed with a maternal mental health condition during their pregnancy, postpartum period, or 90-day cure period. PPCE is targeted for implementation on July 1, 2020.
Young Adult Expansion
On January 1, 2020, DHCS implemented the CAFP-supported expansion of full-scope Medi-Cal to all eligible individuals ages 19 through 25, regardless of immigration status. To support implementation efforts, DHCS has created a webpage that includes helpful information on the expansion, including an FAQ document, beneficiary notices, data on the transitioned population, and other related resources.
Healthy California for All Commission
The inaugural Healthy California for All Commission meeting was held on January 27, 2020. The intent of the Commission is to develop a plan for advancing progress toward achieving a health care delivery system for California that provides coverage and access through a unified financing system, including a single payer financing system. During the first meeting, the commission considered the history of health reform in California and the current state of health care. For more information about the commission, please visit the CHHSA website.