A few helpful notes about the expansion of full-scope Medi-Cal toundocumented children; thanks to Cathy Senderling at CWDA.
As you
prepare for this significant and high profile change, we wanted to
provide some additional information that may be helpful.
Transition
Cases. For any child currently receiving restricted scope benefits,
during the week of May 16 your SAWS will do several batch runs including
some with CalHEERS to transition them to full scope. Inquire with your
SAWS for the timing of the batch runs. Statewide approximately 123,000
children will transition.
IMPORTANT
NOTE: As with any batch process, there are going to be
circumstances under which an existing case will not automatically
transition and will require worker intervention to complete. Cases
that will fall out of the SAWS batch process for any reason, including those
cases with an overdue renewal or have not previously been run through the
CalHEERS business rules may not automatically transition. Your SAWS are working with your county on
this and will produce lists for you. We ask that your staff
prioritize getting these cases in the system successfully.
SB 75
specifies that any children receiving restricted scope benefits on the day of
implementation are entitled to full-scope benefits, therefore all beneficiaries
should transition and any follow-up case actions should occur later. Based
on this, the policy direction from DHCS has been clear that counties are to process
eligibility and retain children in coverage rather than discontinuing them
if, for example, there is a renewal due that has not been processed. The
policy direction from DHCS is to process the transition first and then deal
with the renewal after that.
CWDA will be developing talking points for counties regarding the transition, which may be available as early as Monday. Importantly, if a child who does not
successfully transition has a medical need, they may contact the county and
request coverage to processed immediately. This can be accomplished by working
the reason that the case fell out of the batch or, if necessary, processing an
online transaction to MEDS. Ensuring coverage is critical for reasons stated
below.
·
Media Attention. Although several
articles have already been published over the past week, you may expect
media inquiries through next week and especially on May 16. Inquiries may include
requests for information about any increased applications and how the change is
working.
·
Advocate Inquiries. Advocates have helped make this
program a reality. Local advocates also may inquire about increased
applications, system functionality as well
as the transition of current children with restricted scope benefits to
full scope coverage.
New
applicants. Given the media attention on this change, you may see an
uptick in applications leading up to and through
the coming weeks and into the near future, and CWDA advises considering this possibility when assigning staff resources.
There has been extensive outreach in some areas advising
parents to enroll their children now in restricted benefits so they will simply
transition to full scope when the program starts. Staff should explain to applicants approved between May 9 and May
13, the children will receive restricted scope benefits first and then will be
changed to full scope by the end of the month. The parent will receive a
notice about the change and the full scope benefits will be for the entire
month of May.
Note:
Your staff may get inquiries from consumers approved prior to May 16 and who
receive their notice for restricted benefits on or after May 16. The
parents may be confused that the full scope should have started May 16.
The explanation in the paragraph above can be used in this circumstance too.
Any new
applicant child approved May 16th forward will receive full scope
benefits for the month of May and the corresponding notice.
