![]() Part II, Resumption of Normal Medi-Cal Eligibility Operations, includes information on federal eligibility flexibilities that will be utilized during the unwinding of the continuous coverage requirements to help support county efforts with the Medi-Cal redetermination process and federally approved eligibility coverage retention strategies. ![]() Part I, Unwinding Medi-Cal Program Flexibilities, includes information about eligibility flexibilities received during the public health emergency, flexibilities that were or will be made permanent, and flexibilities that will expire at the end of the public health emergency. If members receive a Covered California enrollment notice, they must confirm their plan and pay the first monthly premium to remain covered. If someone is no longer eligible for Medi-Cal, but they are eligible for financial help through Covered California, DHCS and Covered California will work together to automatically enroll them in a health plan to make sure they don’t lose their health coverage. ![]() California estimates that between two and three million people will be determined ineligible for Medi-Cal over the next year. Millions of Medi-Cal members will remain eligible for Medi-Cal, but some individuals and families will no longer be eligible. DHCS also released a continuous coverage toolkit to aid the campaign and support the work of the DHCS Coverage Ambassadors who are helping to raise awareness among Medi-Cal members in their community about the redetermination process. DHCS launched a statewide public information, education, and outreach campaign, called “Keep Your Coverage”, to raise awareness about the upcoming return of the Medi-Cal eligibility renewals to help Medi-Cal members keep their current Medi-Cal coverage, get free or low-cost coverage from Covered California or other government programs, or transition to employer-sponsored health coverage that may be available to them.ĭHCS created a Keep Medi-Cal Coverage webpage where Medi-Cal members can find out how to update their contact information and sign up to receive important updates. It also means that the annual renewal process for Medi-Cal members will resume on April 1, 2023, and continue for the next 14 months.Ĭalifornia is working to help Medi-Cal members navigate this process. On December 29, 2022, the federal government, in the Consolidated Appropriations Act of 2023, delinked the Medi-Cal continuous coverage requirement from the PHE and set March 31, 2023, as its end date.Īs a result, California will start its “unwinding” process at that time (see the DHCS Medi-Cal COVID-19 Public Health Emergency and Continuous Coverage Operational Unwinding Plan). This became known as the “ continuous coverage requirement.” This assured that low-income families, older adults, working adults, children, and people with disabilities would have access to health care throughout the pandemic. In March 2020, at the beginning of the federal PHE, the federal government required states to continue to cover every person who became eligible for Medi-Cal, even if their income or other circumstances changed. View the DMHC COVID-19 fact sheet for more information and resources for health plan enrollees. Health plan enrollees can be charged cost-sharing only if these services are provided out of network after November 11, 2023. The federal PHE ends on May 11, 2023, and state laws extend these requirements for six months through November 11, 2023.Īfter November 11, 2023, enrollees can continue to access COVID-19 tests, vaccines and treatment with no prior authorization or cost sharing when they access these services through their health plan’s network. Continued Access to COVID-19 Tests, Vaccines and Treatment with No Cost-SharingĬalifornia state laws add six months to the federal PHE requirements on health plans to continue covering COVID-19 tests, vaccines and treatment from any licensed provider (in- or out-of-network) with no prior authorization or enrollee cost sharing. Enrollee cost-sharing includes co-pays, co-insurance, deductibles or other enrollee out-of-pocket costs not including health plan premiums. ![]() Health plans regulated by the California Department of Managed Health Care (DMHC) must cover COVID-19 tests, vaccines and treatment with no health plan prior authorization or enrollee cost-sharing. Health Plan Enrollees Have the Right to COVID-19 Tests, Vaccines and Treatment with No Cost-Sharing ![]()
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