Expansion of Medi Cal Benefits to Undocumented Patients AAHAM WESTERN REGION EDUCATIONAL PROGRAM September 19, 2019 Stephenson, Acquisto & Colman 303 North Glenoaks Blvd. Suite 700 Burbank, CA 91502 Office: (818) 559 - 4477 Fax: (818) 559 - 5484 SACFirm.com

Healthcare as a National Agenda Item “…we already pay for the healthcare of undocumented immigrants. It's called the emergency room. People show up in the emergency room and they get care, as they should.  Julian Castro

Cost for Expansion of Undocumented Eligibility $98 million first year Impacts 138,000 young adults

Undocumented-MediCal Eligibility Expansion-Senate Bill 104 New Law Expands Medi Cal coverage to now include Residents through-age 25 Regardless of immigration status Previously- 2016 under 19 and income level qualified. Income requirements must still be met

CCS Caution If 22 and younger- CCS eligible CCS eligible conditions are a carve out from Medi Cal Managed Care. Must submit to CCS or lose $$$ In Orange County and other counties, CCS eligibility and adjudication handled by county now and not state.

CCS Eligibility Birth to 21 years of age​ Residence​ Income ​ Medical eligibility​

Analysis Legally Present v. Undocumented Benefits available for both to certain degrees Alternative eligibility

Legally Present Options: Medi-Cal Income requirements California state residency Covered California-purchase plan with subsidies Medi-Cal- legal presence and income validation.

What does it mean to be “Legally Present” Lawful Permanent Residence Permanent Residence under Color of Law ( PRUCOL)

Residency Under California law, a person who stays in the state for other than a temporary or transitory purpose is a resident, vacations or brief transactions, such as signing a contract or giving a speech, constitute temporary or transitory purposes that do not confer residency

Not Legally Present Impact on Covered California Mixed status families DACA

Covered California Must be lawfully present in California If not- Medi-Cal -25 and under and income verification Pregnancy ER Commercial plan outside Covered California

Families with Mixed Status Covered California requires all family members to be listed on the plan. Legally present Income qualification If mixed status- no Covered California subsidy

DACA Deferred Action for Childhood Arrivals-DACA Not considered legally present. Cannot purchase plan with Covered California subsidy Medi Cal if 25 or under or pregnant-Income qualification

Additional Opportunities for Eligibility Prucol-Full Qualified Alien-Full HPE –Hosital Presumptive Eligibility Program Full temporary

PRUCOL Permanently Residing Under Color of Law Will be considered as permanent residents if they meet specific criteria. Criteria listed in “Citizenship, Alienage, and Immigration Status” form.

Exhibit 1 Criteria listed in “Citizenship, Alienage, and Immigration Status” form.

Qualified Alien Qualified Non Citizen entering US prior to August 1996 Qualified immigrant completed 5 year waiting period Exempt from 5 year waiting period- refugees, trafficking victims, veteran families, Asylees(political asylum).

Exemption From 5 Year Waiting Period Battered spouses Children of battered spouses Human trafficking victims Refugees Spouses and children of US military personnel Green card holders Immigrants entering US from Cuba or Haiti

Hospital Presumptive Eligibility Program On January 1, 2014, the Hospital Presumptive Eligibility Program (HPE) was implemented.  The HPE Program provides qualified individuals immediate access to temporary, no-cost Medi-Cal while applying for permanent Medi-Cal coverage or other health coverage.

Hospital Presumptive Eligibility Program To qualify for HPE, individuals must meet the rules below. Have income below the monthly limit for household size. Be a California resident. Not already have Medi-Cal. If not pregnant, have not received PE Enrollment benefits from any Medi-Cal PE Program up to the maximum limitation allowed within the past 12 months of applying. If pregnant, have not had a PE Enrollment during the current pregnancy of applying.

Hospital Presumptive Eligibility Program And, be eligible in one of the following HPE groups below: Children under 19 years old Parents and Caretaker Relatives Pregnant Women (benefits are limited to ambulatory prenatal services.) Former Foster Youth between ages 18 to 26 years old, who were in foster care in any state on their 18th birthday or older. (No income limit) Adults between ages 19-64, not pregnant, not in Medicare, and not eligible for any group stated above.

Hospital Presumptive Eligibility Program To apply for HPE benefits, an individual must visit a hospital that is a qualified HPE Provider. The HPE Provider submits the individual’s information via the HPE Medi-Cal Application online portal and eligibility is determined in real-time.

Hospital Presumptive Eligibility Program The HPE enrollment period begins on the date the individual is determined eligible for HPE, which is the day the HPE Medi-Cal Application is submitted via the online portal.   To obtain coverage prior to the HPE start date, individuals must apply for full scope Medi-Cal and mark the box that indicates the individual has medical expenses in the last three months and needs help to pay.

Undocumented-over 25 Limited services available Emergency Services Pregnancy services Dialysis Nursing Home Status

Whole Child Model Senate Bill (SB) 586 authorizes the Department of Health Care Services (DHCS) to establish the Whole Child Model (WCM) program in designated County Organized Health System (COHS) or Regional Health Authority counties to incorporate California Children’s Services (CCS) program covered services for Medi-Cal eligible CCS children and youth into a Medi-Cal managed care plan (MCP) contract.  DHCS has developed a “Whole Child Model” to be implemented in 21 specified counties, no sooner than July 2018.  The results are improved care coordination for primary, specialty, and behavioral health services for CCS and non-CCS conditions.  The benefits are consistent with CCS program standards and provided by CCS paneled providers, specialty care centers, and pediatric acute care hospitals.  WCM approach meets the six goals for CCS Redesign:​

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