The California Department of Health Care Services (DHCS) will begin to unwind special Medi-Cal enrollment and eligibility protections with the cessation of the Covid-19 pandemic Public Health Emergency (PHE) regulations. The PHE will expire on July 15, 2022. Medi-Cal will return to normal operations regarding the redetermination of beneficiaries for eligibility. However, many of the program flexibilities and enhancements adopted during the Covid pandemic will remain in place.
The following information regarding changes to the Medi-Cal program comes from the Department of Health Care Services “Medi-Cal Covid-19 Public Health Emergency Operation Unwinding Plan, May 17, 2022.”
Medi-Cal Continuous Coverage To End
Under the continuous coverage requirements of the PHE rules, Medi-Cal must maintain enrollment of all beneficiaries through the end of the PHE. While the PHE is set to expire July 15, 2022, coverage for Medi-Cal beneficiaries who may not meet the conditions for eligibility will be covered through the end of July. DHCS is hoping the federal Department of Health and Human Services will extend the continuous coverage requirement for another 60 days beyond the end of July.
Regardless of whether the extension is granted, with the end of PHE, county Medi-Cal offices will need to conduct full redetermination for all beneficiaries who would have otherwise been subject to redetermination during the PHE. Medi-Cal has approximately 14 months to complete all of the redeterminations that were put on hold because of the PHE. If Medi-Cal beneficiaries have been providing regular updates to your household status (income, household members, address, etc.), Medi-Cal may use those updates to redetermine your eligibility for the particular program you are enrolled into. DHCS has also developed a plan to make a smooth transition to normal operations and reduce unnecessary Medi-Cal terminations.
Medi-Cal will maintain the beneficiary’s current renewal month and conduct a full redetermination at that time. This avoids a crush of case redeterminations as the PHE expires. For example, beneficiaries who are set to have their eligibility redetermined in January 2023, will receive a Medi-Cal renewal packet in November 2022. If by January 1, 2023, there is no response from the Medi-Cal beneficiary to the renewal packet, a notice of action regarding termination will be sent, no later than January 21, 2023. Medi-Cal, in this case scenario, would terminate at the end of January 2023.
Once the PHE expires, for a short period of time, changes to the beneficiary’s status that might terminate Medi-Cal (such as new job with increased income) will have the termination paused until the beneficiary’s annual redetermination date. For example, if the PHE expires in October 2022 and the beneficiary’s renewal month is February 2023. In November the beneficiary reports an increased income amount over the Medi-Cal eligibility limit. The change will not be processed until the beneficiary’s full redetermination date in February 2023.
Of course, even during the PHE, a Medi-Cal beneficiary could request a redetermination of their eligibility when their income increased. County Medi-Cal offices have processed Medi-Cal terminations when the necessary income verifications were supplied. This allowed Medi-Cal beneficiaries to then enroll in a Covered California health plan with the subsidies.
Medicare Enrollment and Medi-Cal Public Health Emergency
DHCS noted that some Medi-Cal beneficiaries eligible for Medicare when they turned 65, did not enroll in Medicare because their Medi-Cal wasn’t terminated during the PHE. This may create problems for individuals who may lose Medi-Cal during the redetermination period and have not enrolled in Medicare. Technically, the Medicare eligible should have a Special Enrollment Period to enroll into Medicare and then be determined eligible for Medi-Cal Savings Program at the loss of full Medi-Cal coverage. However, the Special Enrollment Period, along with the Open Enrollment Period, are date sensitive and there may be a delay before Original Medicare Parts A and B become effective.
The end result is the possibility of a gap in coverage, or a period when the individual is not covered by either Medi-Cal or Medicare. DHCS stated that they, “…will keep the population that would have had their initial enrollment period but for the PHE protections enrolled in Medi-Cal to December 2022, and redetermine them at that time. By doing so, it will allow these individuals an opportunity to apply for Medicare during the open enrollment and not risk losing their health coverage.” Additionally, the Centers for Medicare and Medicaid Services (CMS) has proposed a new rule to allow individuals with the termination of Medi-Cal to enroll into Medicare outside of the traditional enrollment periods.
Loss of Coverage and Income
Currently, there are 14.5 million Californians in some sort of Medi-Cal health care program. This represents a 16 percent increase since March 2020, largely attributed to continuous coverage requirements of the PHE. Based on Medi-Cal outreach mailings that had a 12 percent return rate, undeliverable, DHCS estimates that upwards of 2 million people could lose their Medi-Cal coverage due to loss of contact. Consequently, if you, or someone you know, have not updated your contact information, and want to continue Medi-Cal benefits, it is important to contact your local county Social Services Medi-Cal office and update your contact information.
To help accelerate the redetermination process, DHCS, when possible, will use electronic verification of income. This electronic income verification will be similar to Covered California. When the current income is reasonably compatible with federal information sources, the income will be approved. The electronic verification will reduce the paperwork load on the applicant to prove their income for a MAGI Medi-Cal eligibility determination.
Covered California and DHCS are working together to automatically enroll individuals who have lost Medi-Cal eligibility into a private health plan with the subsidies. The automated transition from Medi-Cal to Covered California should be implemented by July 2022. Of course, the health plan will only become effective if the member pays their first month’s premium, if one is due at time of enrollment.
Several Medi-Cal Program Enhancements Will Remain
Telehealth. The ability for patients to consult with a health care provider on the phone or web application was a necessary and popular addition to many Medi-Cal health plans. DHCS is working to maintain the telehealth services within the framework increasing health care access while not diminishing physical access to providers.
Covid testing, treatment, and vaccine coverage. Medi-Cal will continue cover Covid-19 testing and vaccines without cost-sharing for most Medi-Cal beneficiaries.
Certain providers will be able to continue to prescribe benefits such as non-emergency medical transportation, home health services, durable medical equipment, physical and speech therapies and prosthetics.
The reimbursement rates for some health care services and equipment will be maintained at 100 percent of the Medicare rate. Some of the items include clinical laboratory services, Covid-19 vaccine administration, oxygen and respiratory durable medical equipment.
Specific drug and rehabilitative services that were expanded will stay in place after the PHE. Some of the programs expanded individual counseling, substance abuse counseling, crisis intervention, treatment and discharge planning.
The HIV/AIDS Waiver will continue. This means some of the face-to-face assessments and care management activities can be completed through telephonic or live virtual conferencing, allowing for digital signatures.
There were numerous changes to how the DHCS managed Medi-Cal health care programs, services, eligibility, enrollment, and providers as granted by federal rules, waivers, and Executive Orders during the Public Health Emergency. DHCS is planning for a resumption of normal operations over the next 14 months. Some enhancements to the Medi-Cal systems will stay in place and others will be phased out. For a complete overview of the changes and plans for the resumption of normal operations, please refer to the Medi-Cal Covid-19 PHE Unwinding Plan.
California Department of Health Care Services for unwinding the special eligibility and enrollment protections under the Public Health Emergency of Covid-19 and resuming normal operations.