1. Medi-Cal—Hot Topics and Updates on Current Issues Randy Boyle, Staff Attorney Legal Aid Association of California 2007 Spring Teleconference Training February 8, 2007

2. Recent Medi-Cal Changes  Cap on Denti-Cal services for adults $1800/year, with some exceptions An approved TAR does not guarantee payment Dental services for people in LTC exempt See Denti-Cal Provider Bulletin 11/05  Denti-Cal services for pregnant women (started 1/1/06) Denti-Cal coverage for all pregnant women, regardless of immigration status See Denti-Cal Provider Bulletin 12/05

3. Income Level Changes for 2007  Spousal resource allowance = $101,640  Spousal monthly maintenance need = $2541/month  FPL income limit changes do not take effect until April

4. Recent Medi-Cal Changes  Deficit Reduction Act of 2006 Citizens must present proof of citizenship No changes for immigrants People on SSI and Medicare are exempt from requirement State has not yet implemented this requirement, though it became effective July 1 nationally Watch for counties incorrectly asking for this information from those seniors who should be exempt

5. Medi-Cal Health Debt & Billing  Share of cost (SOC) Different than “cost sharing” Need not be paid, but must be incurred before Medi-Cal coverage can begin for that month. Welf. & Inst. Code §§ 14054, 14005.9(a), Cal. Code of Regs. Title 22 § 50090. Can satisfy SOC with old bills and bills of dependents. Old bills must be unpaid and still owed in the month they are used for the SOC. Hunt v. Kizer Clients may want to save bills for months in which they will need to meet a SOC. Generally, the bill must be dated within 90 days.

6. Moving Clients to Medi-Cal Disability Programs without a Share of Cost  Aged & Disabled FPL Program Currently up to $1047 for an individual, $1502 for a couple (maximum for an individual will go up to $1080 on 4/1/07) Applicants in board and care homes may use the $315 personal care services deduction IHSS expenses are not exempt. However, IHSS caregiver wages paid to a spouse are exempt income. “Health insurance premium” is deducted from countable income. Cal. Code of Regs. Title 22 § 50555.2

7. Moving Clients to Medi-Cal with No Share of Cost  250% Working Disabled Program Beneficiary must be working, but that work need only be $20 per month. Substantial Gainful Activity rules do not apply Beneficiary must obtain envelopes for sending in payments Premiums are based on income. Premium amount appears in MEDS in the SOC field. Program is underutilized—mailings going out to people with SOC or receiving IHSS. (ACWDL 06-27, Oct. 12, 2006)

8. Medi-Cal Breast and Cervical Cancer Treatment Program (BCCTP)  Up to 200% of FPL  Diagnosed with breast or cervical cancer  Lack insurance or have insufficient insurance  Two programs Full Scope Medi-Cal: Citizens, qualified immigrants. Lasts as long as treatment is needed. Time-limited Medi-Cal: Undocumented or men. Breast cancer: 18 months; Cervical Cancer: 24 months  Providers who participate in the program can qualify patient with presumptive eligibility through an Internet application.

9. Questions?  Randy Boyle National Health Law Program (310) 204-6010, ext. 108 boyle@healthlaw.org Medi-Cal Fact Sheets available at: www.healthconsumer.org