Medi-Cal Overview

County of Orange

New Landscape in January 2014

Provides for an expansion of Medicaid (known as Medi-Cal in

California) to previously ineligible adults (childless, non-disabled, non-

elderly) effective January 1, 2014. In addition, income levels and

asset limits change.

Requires states to create Health Care Exchanges to enable

individuals and families to purchase coverage, which will be

subsidized for persons between 138% and 400% of the Federal

Poverty Level.

Note: Coverage for both the Medi-Cal expansion and the Health Care

Exchange insurance plans are based on a household’s

Modified Adjusted Gross Income (MAGI).

Medi-Cal Expansion Overview

MAGI Medi-Cal Groups:

• Children (infants to 19 yrs) – age and income determines

whether the case is with or without premiums

(up to 250% FPL)

• Parents/Caretaker Relatives (up to 138% FPL)

• Adults (19-64 yrs.) – (138% FPL)

• Pregnant Women (138% FPL for full scope/ 139-200%

FPL for pregnancy services)

Medi-Cal Expansion Overview

MAGI Eligibility Standards:

• Income determined using modified adjusted gross income

rules

• No asset test

• No deprivation or disability required linkage factors

• Use of electronic data matches to verify information

Medi-Cal Expansion Overview Non-MAGI Medi-Cal Groups:

• Aged (65+ yrs.), Blind or Disabled (ABD) individuals

• Long-Term Care (LTC) individuals

• Medicare eligible (Part A/B) for Medicare Savings

Programs (QMB/SLMB/QI-1)

• Individuals eligible to SSI, CalWORKs, Foster Care, or

Adoption Assistance programs

• Individuals/Families eligible as Medically Needy (AFDC-

MN) with a dependent or deprived child

COVERAGE FOR IMMIGRANTS

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IMMIGRANT POPULATIONS ELIGIBLE TO FULL-SCOPE MEDI-CAL

(Qualified Immigrants):

• Lawful Permanent Residents (LPRs)

• Permanent Residence Under Color of Law (PRUCOL)

• Asylees

• Refugees

• Cuban and Haitian Entrants

• Certain Battered Spouses and Children

• Victims of Trafficking

• Individuals Granted Conditional Entry

• Individuals Granted Witholding of Deportation/Removal

• Individuals Paroled into the U.S. for at Least One Year

COVERAGE FOR IMMIGRANTS

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ELIGIBLE NON-CITIZENS UNDER 5 YEARS:

• Current Federal regulations establish a “5 year bar” for lawfully

present immigrants in order to be eligible for Federal Medicaid

• In California, qualified immigrants who have not satisfied the “5

year bar” are eligible to receive state-only full-scope

Medi-Cal

• The state has decided to continue with the same methodology with

the implementation of ACA, i.e., no separate aid codes for this

group

PENDING FUTURE GUIDANCE

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Wrap Around Program:

• Being established by the Department of Health Care Services (DHCS)

and Covered California for qualified immigrants who are childless

adults (21 years of age and older), under the “5 year bar," earning up

to 138% of the FPL.

• Program will allow these adults to enroll in coverage in Covered

California with APTC applied towards their premium. DHCS will provide

payments to reduce the premium and out-of-pocket expenses to zero.

• The program is expected to be implemented no earlier than

April 2014.

COVERAGE FOR IMMIGRANTS

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• The following qualified immigrants are eligible for full-scope Medi-Cal

benefits:

Individuals up to 21 years of age

Pregnant women with income up to 60% of the Federal Poverty

Level (FPL)

Children in families with income up to 250% of the FPL

Parents, seniors, and persons with disabilities

• Qualified immigrants who are pregnant with income above 60% and

up to 213% of the FPL are eligible for pregnancy-only Medi-Cal.

Depending on income, pregnant individuals may also be eligible

to full-scope Medi-Cal benefits with a Share-of-Cost (SOC) and/or

an Advanced Premium Tax Credit (APTC) through the Exchange,

in addition to pregnancy related services.

COVERAGE FOR IMMIGRANTS

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UNDOCUMENTED IMMIGRANTS:

• Undocumented immigrants include non-citizens without a

permanent immigration status.

• Undocumented immigrants who meet all other program

requirements for Medi-Cal will be eligible to receive

restricted/limited scope benefits.

Undocumented immigrant childless adults will be included in

the MAGI Medicaid Expansion population for restricted

benefits.

Undocumented immigrant children will be eligible for

restricted-scope benefits via the coverage groups that exist for

children’s coverage

COVERAGE FOR IMMIGRANTS

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Medi-Cal for undocumented immigrants: • Not eligible for Medicare or full-scope Medi-Cal.

• If all eligibility requirements are met, undocumented immigrants

will continue to receive:

Emergency-related services.

Pregnancy-related services:

State funded Long-Term Care (LTC).

• May seek non-emergency health services at community health

centers or safety-net hospitals.

ACA Implementation Timelines Oct 2013 Nov 2013 Dec 2013 Jan 2014 Feb 2014 Mar 2014

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LIHP program sunsets

ACA Implementation Begins

Pre Enrollment Period

Covered California – Open Enrollment Period

Interim Period October 2013 to December 2013

Will require County to assess the needs of applicants and decide whether to

process an application for pre-ACA coverage (“Now”) or January 2014 coverage

(“Later”).

Now – Current Medi-Cal regulations

If the applicant is determined ineligible to Medi-Cal “now,” the client will be

evaluated for LIHP/MSI.

If the applicant is ineligible to LIHP/MSI or eligible to LIHP/MSI under the MCE

category, we will obtain additional information required to determine eligibility

for “later.”

Later – MAGI Medi-Cal, Non MAGI Medi-Cal and Covered CA health plans

If the applicant is determined ineligible to either MAGI or Non-MAGI Medi-Cal,

the client will be evaluated for subsidized health insurance through Covered

CA.

County Application Processing January 2014

When an application is received at the County…

County Staff are expected to:

• Complete file clearance and case assignment

• Evaluate eligibility for all Insurance Affordability Programs,

including:

MAGI Medi-Cal

Non- MAGI Medi-Cal

Mixed Household eligibility (e.g. APTC parent(s) with MAGI

children)

APTC

Individual Insurance (non-subsidized)

• Present, assist and enroll clients with health plan selections

Existing Application Forms Applications such as the MC 210 and the MC 321 Healthy Families/Medi-Cal Joint application will eventually sunset. These applications are being replaced by the SSApp.

• Counties must continue accepting all

existing applications until January 1, 2016. (County will not ask someone who submits one of these applications to start over and fill out an SSApp instead.)

• Additional information will need to be

collected to conduct MAGI Medi-Cal determination, especially tax household information. (A supplemental form may be developed, but this is still being determined.)

Application Forms Single Streamlined Application (SSApp)*

Will be used to apply for health insurance

affordability programs:

Medi-Cal (MAGI and non-MAGI)

Access for Infants and Mothers (AIM)

Subsidized Covered California coverage

SSApp will captures tax filer and tax dependent information, including income and

immigration status.

SSApp will not request assets information; there is no asset test for MAGI Medi-Cal

or for the Covered California subsidized coverage (APTC/CSR).

SSApp can be used to start non-MAGI application, register app and protect app date,

but additional information (i.e., asset information) must be collected.

* SSApp pending final development/approval

Application Forms SAWS 2/SAWS 2 Plus

• State revised the SAWS 2 application, and

renamed it the SAWS 2 Plus.

• Revised application now includes the request

for tax filer household information.

• The application is pending Federal approval,

but once provided, the application can be

used to apply for all programs, including MAGI

and non-MAGI Medi-Cal.

• The SAWS 2 Plus includes a page that can be

used in a standalone format to serve as the

SAWS 1.

• Target date to begin using the application is

(pending).

Application Channels/“No Wrong Door”

• In person at County Office Assisted by County eligibility staff

• Online Through Covered California website Through MyBenefitsCalWIN.org website

• By Phone Statewide phone number with warm handoff to network of

designated county service centers using Quick Sort questions Directed to county or county call center by Covered CA

• Mail Sent to Covered California

Sent to county Social Services Agency

• In person at Community Based Organization Assisted by certified enrollment assisters

Ongoing Case Maintenance

• SSA staff will be expected to support ongoing

cases for existing beneficiaries in addition to

the new MAGI Medi-Cal population, including

mixed household cases

• SSA staff will be expected to evaluate new

potential MAGI and Non-MAGI Medi-Cal

individuals when changes are reported to

Covered California on subsidized health plan

beneficiaries