CHA News Article

Medi-Cal Coverage for all Children Expands to Full-Scope May 1

Effective May 1, the California Department of Health Care Services (DHCS) will expand full-scope Medi-Cal coverage to qualified children under 19 years of age — regardless of immigration status — if they are otherwise eligible, pursuant to SB 75 (Chapter 18, Statutes of 2015). These children currently have restricted-scope Medi-Cal. When their Medi-Cal coverage expands to full scope, they will be covered for both non-emergency and emergency medical services, dental care, vision benefits, mental health and substance use disorder services.

DHCS has addressed in the attached SB 75 Eligibility and Enrollment Plan the process by which children will receive full scope Medi-Cal under SB 75 once the eligibility and enrollment systems are in place. This plan provides an overview of the application process for the new enrollee population (children not currently enrolled in restricted Medi-Cal); the transition process for the existing restricted Medi-Cal population, including how and when the transition population is identified, when they will receive notices, when and how their aid code will change; and the managed care health plan enrollment process for both new enrollee and transition populations. Most children must enroll into a Medi-Cal Managed Care Plan within 60 days of receiving full-scope Medi-Cal. Children who have a share of cost or other health coverage at the time of the transition will still have full-scope Medi-Cal coverage and will remain in fee-for-service.

DHCS’ goal is to complete the implementation of all system changes no sooner than May 16. DHCS has finalized the design of system changes in the California Healthcare Enrollment, Eligibility and Retention System (CalHEERS) to create new functionalities that determine full scope Medi-Cal eligibility for individuals under the age of 19 who do not have satisfactory immigration status. Although CalHEERS system changes are scheduled for May 16 implementation, the eligibility effective date (when the system changes and transition plan are implemented) will be May 1.

Medi-Cal is based on full-month eligibility, so if an individual is eligible for one day of a given month, they are eligible for the entire month. DHCS notes that if the system implementation date is delayed, then the eligibility effective date will change also. For example, if system implementation is delayed into the month of June, the eligibility effective date would shift from May 1 to June 1.

For more information about the expansion, visit the DHCS website at http://dhcs.ca.gov/sb75.

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