As of this month, January 2022, Medi-Cal has several important changes that will affect how older beneficiaries receive their Medi-Cal benefits. These changes are a result of legislation passed in 2021 and California’s 5-year initiative, California Advancing and Innovating Medi-Cal (CalAIM). See our partner’s, Justice in Aging’s comprehensive fact sheet on the changes for full details. Below are a few highlights as summarized in the fact sheet.
Medi-Cal Prescription Drugs
As of January 1, 2022, the Medi-Cal prescription drug benefit has been carved out of managed care plans and into fee-for service. This means managed care plans are no longer responsible for providing or approving prescription drug coverage or related medical supplies for Medi-Cal beneficiaries. This change is statewide in all counties. Those on Medicare and Medicare-Cal will continue to access most of their prescription drugs through Part D plans as Medicare is the primary payor for most drug coverage. Dual eligibles may experience a transition if they use medication not covered under Medicare Part D, like over-the-counter medications and medications for weight loss or gain. The California Department of Health Care Services (DHCS) is providing beneficiary protections to minimize disruption to prescription drugs during this transition. See DHSC’s FAQ on the transition to Medi-Cal Rx for more information.
There are some exceptions to this change: Medi-Cal prescription drugs will not be carved out of Cal MediConnect plans, Program for All Inclusive Care for the Elderly (PACE), Senior Care Action Network (SCAN), and Major Risk Medical Insurance Program (MRMIP).
Expanded Medi-Cal Coverage for Undocumented Older Adults
Beginning May 1, 2022, Medi-Cal full-scope benefits will be provided to all individuals age 50 or older statewide, regardless of immigration status, who meet Medi-Cal financial eligibility requirements. Previously, individuals without legal status only had access to restricted scope Medi-Cal, even if they met other Medi-Cal criteria such as income and assets. With this new change, anyone age 50 or older is eligible for full Medi-Cal benefits including primary, specialty, behavioral health, long-term care, In-Home Supportive Services, and other home and community-based supports, transportation, vision (eyeglasses) and hearing aid coverage. Individuals age 50 or older on restricted scope Medi-Cal will automatically be transitioned into full-scope Medi-Cal on May 1, 2022. Eligible beneficiaries do not need to take any affirmative steps to receive full-scope Medi-Cal. Individuals who are not currently enrolled in restricted scope Medi-Cal will need to apply and be evaluated for eligibility.
Asset Test Elimination in Medi-Cal and Medicare Savings Programs
On July 1, 2022, the Medi-Cal asset test will significantly increase for the Aged & Disabled, medically needy with a share of cost, and long-term care Medi-Cal programs from $2,000 to $130,000 for an individual and $65,000 for each additional family member. The asset limits will also increase to $130,000 for Medicare Savings Programs (MSPs) including the Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), Qualified Income (QI), and Qualified Disabled Working Individual (QDWI) programs. The MSPs help low-income Medicare enrollees pay for Medicare out-of-pocket expenses including premiums and cost-sharing.
The asset test will be fully eliminated for these Medi-Cal programs effective July 1, 2024.
Once effective, DHCS will send outreach notices to individuals who were denied Medi-Cal or who were terminated from Medi-Cal coverage for being over the asset limit during the 90-day period preceding the effective date.
Note: this asset test elimination in Medi-Cal will not change the asset limit in SSI. The SSI program is a federal program administered by the Social Security Administration. So while individuals who have SSI could qualify for Medi-Cal if they have resources higher than $2,000, they would lose eligibility for SSI if they have higher resources for any month their resources go above the SSI limit. We are working with our partners on advocating for modernizing the SSI program as the income and asset levels are beyond outdated.
Cal MediConnect Plans Ending
Cal MediConnect health plans in the seven CCI counties (Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo and Santa Clara) will sunset on December 31, 2022. Cal MediConnect members will automatically transition into Dual Special Needs Plans (D-SNPs) operated by the Medi-Cal plans operating in these counties. Cal MediConnect plans integrate both Medicare and Medi-Cal benefits into one health plan. D-SNPs are Medicare Advantage (MA) plans that contract with Medi-Cal plans to coordinate care and Medi-Cal benefits, so members will be enrolled in two plans – one for their Medicare and one for their Medi-Cal.
Resources for Help with These Changes
- CCI Ombudsman. The CCI Ombuds is available to provide assistance and advice on upcoming changes in CCI counties including how to access care, beneficiary care protections, and appeal and grievance rights. You should contact the Ombudsman if a beneficiary is having difficulty disenrolling or changing their plan, if the beneficiary has been denied coverage or is experiencing a disruption in care, or if you have general questions about these changes. The Ombudsman program is available by calling (855) 501-3077 (TTY: 855- 847-7914), Monday through Friday, 9am-5pm. To find the local program acting as the ombudsman in your county, visit the CalDuals website.
- HICAP. Beneficiaries should contact their local Health Insurance Counseling & Advocacy Program (HICAP) to receive free individualized choice enrollment counseling for Medicare Advantage and Part D prescription drug plans. HICAP counselors can help beneficiaries review their choices and make an informed decision. HICAP can be reached at (800) 434-0222.
- Health Consumer Alliance. The Health Consumer Alliance (HCA) offers free assistance over the phone or in-person to help people statewide who are struggling to get or maintain health coverage and resolve problems with their health plans. HCA can be reached at call 1-888-804-3536.
Read Justice in Aging’s full fact sheet for more details.