Health Coverage

Title: Health Coverage

OBJECTIVES:

Participants will be able to: 1. Describe health coverage programs and services in Los Angeles County for pregnant women and their newborns. 2. Explain varying eligibility criteria and application procedures for the different health coverage programs. 3. Demonstrate how to advocate for families when there are problems accessing healthcare insurance.

AGENDA:

TIME PRESENTATION FACILITATORS/ SPEAKERS

8:00-8:30 am BREAKFAST AND REGISTRATION

8:30-8:35 am Introductions, Overview of Training Objectives Terrie Anciano, BS

8:35-8:45 am Pre-Test Liz Ramirez

8:45-9:00 am The Affordable Care Act Liz Ramirez

9:00-9:15 am Introduction to Medi-Cal Liz Ramirez

9:15-9:45 am Medi-Cal Programs Liz Ramirez

• Presumptive Eligibility • 213% FPL Program • 138% FPL Program • Minor Consent • Income Disregard

9:45-10:00 am Medi-Cal Managed Care Liz Ramirez

• Who Must Join • Medical Exemptions Request

• Getting Assistance

10:00-10:15 am BREAK

10:15-10:25 am Deemed Eligible Newborn Liz Ramirez

• Newborn Referral Form

10:25-10:35 am Dental Coverage Liz Ramirez 10:35-10:55 am Medi-Cal Access Program (MCAP) Liz Ramirez

10:55-11:15 am Covered California Liz Ramirez

11:15-11:30 am LA County Child Delivery Plan Liz Ramirez

11:30-11:45 am Post-test Liz Ramirez

Wrap Up/Evaluations

11:45 am LUNCH/REGISTRATION FOR AFTERNOON SESSION Terrie Anciano, BS

Title: Health Coverage

OBJECTIVES:

AGENDA:

TIME PRESENTATION FACILITATORS/ SPEAKERS

12:00-12:30 pm BREAKFAST AND REGISTRATION

12:30-12:35 pm Introductions, Overview of Training Objectives Terrie Anciano, BS

12:35-12:45 pm Pre-Test Liz Ramirez

12:45-1:00 pm The Affordable Care Act Liz Ramirez

1:00-1:15 pm Introduction to Medi-Cal Liz Ramirez

1:15-1:45 pm Medi-Cal Programs Liz Ramirez

• Presumptive Eligibility • 213% FPL Program • 138% FPL Program • Minor Consent • Income Disregard

1:45-2:00 pm Medi-Cal Managed Care Liz Ramirez

• Who Must Join • Medical Exemptions Request

• Getting Assistance

2:00-2:15 pm BREAK

2:15-2:25 pm Deemed Eligible Newborn Liz Ramirez

• Newborn Referral Form

2:25-2:35 pm Dental Coverage Liz Ramirez

2:35-2:55 pm Medi-Cal Access Program (MCAP) Liz Ramirez

2:55-3:15 pm Covered California Liz Ramirez

3:15- 3:30 pm LA County Child Delivery Plan Liz Ramirez

3:30 -3:45 pm Post-test Liz Ramirez

Wrap Up/Evaluations

3:45 pm LUNCH/REGISTRATION FOR AFTERNOON SESSION Terrie Anciano, BS

Health Coverage SPEAKER BIO

Liz Ramirez is the Director of Training and Education for Maternal and Child Health Access. Ms. Ramirez provides training and education for agencies and low-income people on access to health care. She also provides a “Core” course for agency, school, clinic and social service staff entitled, “We’ve Got You Covered” which explains dozens of health services and programs that help to ensure at least some health care for everyone in Los Angeles County.

Prior to joining Maternal and Child Health Access Ms. Ramirez worked as a Health Care Advocate for Los Angeles Unified School District. She developed an outreach and enrollment program within the second largest school district in the United States.

She has been committed to issues with health care access for over 18 years.

Presented by, Liz Ramirez, Director of Training and Education [email protected] Donald Nollar, Training Specialist Extraordinaire [email protected] What is Medi-Cal? Medicaid Medi-Cal

Federal $$$ California State $$$ = Medi-Cal 1. I Live & Intend to Reside HERE! or 2. I Live & Work HERE! Medi-Cal House

Elderly (65 and over) or Pregnant People Disabled

Children Adults Under age 65

Each room has its own rules... Two Kinds of Medi-Cal MAGI MEDI-CAL NON-MAGI MEDI-CAL For people ages 0 through 64 For people age 65 and over Cannot have Medicare or People younger than 65 who have Medicare MAGI CRITERIA FOR ELIGIBILITY

Immigration Status

*Assets Don’t Count in MAGI!! What does Immigration status determine?

IF YOU ARE 65+ (OR HAVE MEDICARE AND MEDI-CAL) Assets Count! What can I have?

1 Principal Residence 1 Car $2000 for one person $3000 for a couple Cash or other liquid assets Who Get’s What?

Medi-Cal Immigration Basics Full Scope Medi-Cal

United States Citizens Legal Permanent Residents (Green Card holders) Qualified Immigrants Undocumented Children and Young Adults ages 0-26 Deferred Action for Childhood Arrivals (DACA) Permanently Residing in the U.S. Under Color Of Law (PRUCOL) Qualified Immigrants Medi-Cal uses this term to define immigrants who are eligible for full scope benefits. Some of the statuses include:

✓ Legal Permanent Residents (LPR) ❖NO 5 YEAR BAR IN CALIFORNIA ✓ Asylees ✓ Refugees ✓ Cuban & Haitian Entrants ✓ Certain battered spouses and victims of trafficking (U & T visa holder) ✓ Individuals paroled into the U.S. for at least 1 year Who Gets Restricted Medi-Cal?

Undocumented residents of California Non-Immigrant Visa Holders age 26 and over What does Restricted Medi-Cal cover?

Emergencies (what is an emergency?) Pregnancy Dialysis Long Term Care Medicaid = Medi-Cal

Medi-Cal is funded by both Federal and State money:

Federal $$$ + California State $$$ = Medi-Cal

Many immigrants qualify for state funded Medi-Cal... Public Charge

Is Medi-Cal really a Public Charge?? What is Public Charge?

Some immigrants have a Public Charge test when they get their LPR “green card” status. The “public charge” test is designed to identify people who may depend on the government as their main source of support. If the government determines that a person is likely to become a “public charge,” it can deny a person admission to the U.S. or lawful permanent residence (or “green card” status).

There is no Public Charge test for For complete details please visit Naturalization/Citizenship www.protectingimmigrantfamilies.org

On March 9th, the Supreme Court dropped appeals that allowed the Trump Administrations punitive Public Charge policies to go into effect. The less severe 1999 Public Charge rules are now back in effect!

Trump Rules (now blocked): 1999 Rules (now in effect): The public charged test looked at The public charge test only looks at non-cash assistance programs cash assistance, and government- funded long-term institutional care. Federally Funded Medi-Cal and Food Assistance programs could be Federally funded Medi-Cal and Food considered Public Charge benefits Assistance are NOT considered Public Charge benefits.

For complete details please visit: www.protectingimmigrantfamilies.org Hooray! PROTECTIONS DURING A PUBLIC HEALTH CRISIS No Negative Actions!

During the Public Health Crisis MC should not terminate your case unless you :

1. Move out of state 2. Request your MC be cancelled 3. Are deceased

See MEDIL 20-14 https://www.dhcs.ca.gov/services/medical/eligibility/letters/Documents/I20-14.pdf I don't have Medi-Cal, or, My insurance doesn't cover COVID services. What can I do?

California offers COVID-19 diagnostic testing, testing-related services, and treatment services, including hospitalization and all medically necessary care, at no cost to the individual, for up to 12 months or the end of the public health emergency, whichever comes first INTRODUCING...... The COVID-19 Uninsured Group Program!!

Available in clinics and hospitals Immigration status does not matter There are no income limits

Eligibility can go retroactive to April 8, 2020. https://www.dhcs.ca.gov/services/medi-cal/eligibility/Pages/COVID-19-Presumptive-Eligibility-Program.aspx COVID-19 Medi-Nurse Line DHCS COVID-19 Response DHCS is working with our program partners and state and federal officials to ensure Medi-Cal beneficiaries have access to medically necessary COVID-19 testing and care. The resources included contain detailed information about our actions during the COVID-19 emergency. Restricted Medi-Cal Covers COVID-19 Testing and Treatment Managed Care & Medi-Cal Do I have to pick a plan? NO YES

• Youth in Foster Care • Everyone else • Former Foster Youth • Restricted Medi-Cal • Native Americans • Private Ins/Medi-Cal

Medi-Cal with a plan “HMO” Fee-For-Service “Regular MC” LOS ANGELES COUNTY’S TWO PLAN MODEL

LA CARE HEALTH NET Local Initiative Commercial Plan Admin: (213) 694-1250 Admin: (800) 291-6911 Member Services (888) 452-2273 Member Services http://www.lacare.org/find-doctor-or-hospital (800) 675-6110 (including contracted plans below)

Blue Shield Of California Health Net Anthem Blue Cross Promise Health Plan, Member Services Member Services formerly Care First (800) 675-6110 (888) 285-7801 Member Services (800) 605-2556 Molina Healthcare LA Care Member Services Kaiser Permanente Member Services (800) 526-8196 (888)452-2273 Member Services (800) 464-4000 But, what happens if you need a doctor out of network? Or in a different medical group (IPA)?

Health Plan “Carve Outs”

Substance Abuse Disorder Dental Mental Health

Use These

Not This Health Plan “Carve Outs”

Substance Abuse o Provided through the Department of Public Health Substance Abuse Prevention and Control (SAPC) (888) 742-7900 http://publichealth.lacounty.gov/sapc/ Health Plan “Carve Outs”

Dental Care - also called Denti-Cal

In LA County you have 2 options:

1. Keep your Denti-Cal as Fee For Service o Find a MC dentist: www.denti-cal.ca.gov or 2. Assign it to a dental plan o Access, Health Net, and Liberty

It’s your choice! Health Plan “Carve Outs”

Mental Health o Some mental health services are provided through your Medi-Cal health plan o Other services are provided through the Department of Mental Health (DMH)

LMHP Access: 1-800-854-7771

50% of California’s pregnant people get Medi-Cal!

Child Delivery Plan

Don’t forget about the Medi-Cal Access Program (MCAP)! Medi-Cal Presumptive Eligibility (PE)

ELIGIBILITY ✓ All pregnant people who declare they are income eligible (213% of poverty) and state residents are presumed to be eligible for Medi-Cal for their pregnancy

WHERE TO APPLY ✓ At the clinic or doctor’s office where receiving prenatal care MEDI-CAL PRESUMPTIVE ELIGIBILITY (PE) CARD Pregnant People with PE need to apply for Medi-Cal for continuation of coverage!

DPSS Offices https://dpss.lacounty.gov/ Community Based Organizations Online CHOIContractorListEngSp.pdf (lacounty.gov) https://www.yourbenefits.laclrs.org/ybn/Index.html

HOSPITAL OR CLINIC OR 0-138% FPL 139-213% 214-322% FPL 214% FPL and up US Citizen and Full Scope Pregnancy** MCAP (AIM) Covered Qualified Medi-Cal Medi-Cal Comprehensive California Immigrants No Managed Care Coverage (Also available to women over 139%) Undocumented Pregnancy** Pregnancy** MCAP (AIM) Not eligible Medi-Cal Medi-Cal Comprehensive No Managed Care No Managed Care Coverage

**Pregnancy MC covers EVERYTHING that is medically necessary!!!!! YAY!! Medi-Cal Income Disregard for Pregnant Youth Under Age 21

Pregnant person must be:

• Under Age 21 • Living with parents or • Claimed as a tax dependent by parents

The parents’ income is not counted! Medi-Cal Postpartum Care Extension

As of August 1, 2020, eligibility for Medi-Cal or the Medi-Cal Access Program (MCAP) can be extended an additional ten months for people diagnosed with a maternal mental health condition, such as anxiety, depression, or bipolar disease. Affects people with Pregnancy Medi-Cal o (213% program and the undocumented) Prior to August 1, 2020, Medi-Cal and MCAP continued coverage to the end of a “postpartum period”, which lasts until the end of the month in which the 60th day after the end of a pregnancy occurs MCAP will not charge premiums for the additional ten months of coverage. This new eligibility category is discussed at the Provisional Postpartum Care Extension page for providers and the All County Welfare Directors Letter 20-14. Download the Enrollment Form MC 61 THE BABY IS BORN. NOW WHAT? Guess what? I’m “Deemed Eligible”!!! MEDI-CAL FOR THE NEWBORN

1. CALL DPSS: 2. CHDP GATEWAY At the provider office at first visit CALL CENTER (866) 613-3777 Or the postpartum, if no Medi-Cal yet. Issues: Los Angeles County ✓ Deemed infants do not always Infant Registration Line (833) 735-9359 get full year via the CHDP Gateway. ✓ Tell them the name, DOB and gender of the ✓ Limit on CHDP Gateway (2 in 12 baby. month period) ✓ No documents are needed for Medi-Cal ✓ Hospital PE counts as 1 only! ✓ DPSS should issue BIC card and add baby to case. 3. NEWBORN REFERRAL (MC 330) Fill out and send/email it to the County using the Advocate Liaison List MC 330 Newborn Referral Form

MC 330 Newborn Referral, English (ca.gov)

Advocate Liaison List http://www.mchaccess.org/pdfs/training- materials/Copy%20of%20BWS%20Advocate %20Liaison%20Listing- %20June%202020%20(002).pdf Medi-Cal Access Program (MCAP) Insurance for Pregnant Women over the MC income limit Full Coverage including Dental Uses Medi-Cal Health Plans and Providers If income drops during pregnancy you switch to free Medi-Cal Apply using Covered CA website Premiums can be waived during the COVID-19 Public Health Crisis, they must call 1-800-433-2611 Family MAGI Monthly Family Total Cost of Payments 12 Monthly Size Income (1.5% of your MAGI Monthly Income x 12 ) 2* $3,062 - $4,627 $552 - $833 $46- $70 3 $3,857 - $5,829 $695 - $1050 $58 - $88 4 $4,652 - $7,031 $838 - $1,270 $70 - $106 5 $5,447 - $8,233 $981 - $1,482 $82 - $124 6 $6,242 - $9,435 $1,124 - $1,699 $94 - $142 * A pregnant woman counts as one PLUS the number of expected child(ren). How do I register my baby for the Medi-Cal Access Infant Program?

MCAP will mail you an Infant Registration Form 30 days before the expected due date. The Infant Registration Form asks for the following information: 1.First, middle, and last name of your baby 2.Date of birth 3.Gender (sex) 4.Weight at birth 5.SSN

Complete the Infant Registration Form and send it to MCAP within 30 days after the delivery. Fax this information to 1-888-889-9238, or send this information to MCAP at the address printed on the form. If you do not receive the Infant registration Form, call 1-800-433-2611.

The place you can buy health insurance with subsidies! With income over 139% of the FPL = Premium Assistance/Tax Credits/Subsidies 139% to 250% of the FPL = Cost Sharing Reductions, lower deductibles and co-pays (Enhanced Silver Plans) It is the ONLY place (if eligible) you can receive Premium Assistance or Cost Sharing Reductions OPEN ENROLLMENT OPEN UNTIL MAY 15TH 2021 New American Rescue Plan Special Enrollment Period: April 12- Dec. 31, 2021 Regular Special Enrollment Periods: Loss of eligibility for MC Loss of work or private insurance coverage Gaining citizenship or LPR status Marriage, birth or adoption of a child Move into or out of a service area Discharged from the military Domestic Violence Affected by wildfires or income loss due to COVID-19 YOUR COST SHARING PERCENTAGE

PLAN INSURANCE PAYS CONSUMER SAMPLE CATEGORY ON AVERAGE/ PAYS ON PREMIUM YEAR AVERAGE/ 45 YRS. 37,000/YR YEAR 2019 | 2020 APTC $129|$137

BRONZE 60% 40% $189|$186

SILVER 70% 30% $279|$281

GOLD 80% 20% $296|$295

PLATINUM 90% 10% $354|$358 Pregnant folks who are enrolled in Covered CA have options!

1. Stay in Covered CA & keep subsidies OR 2. If income is 139- 213% FPL transfer to Medi-Cal 3. If income is 213-322% FPL transfer to MCAP 4. Covered California account needs to be updated with pregnancy information so clients can be screened for all pregnancy health programs. Having a baby opens a Special Enrollment Period! Newborns are covered under the mother’s Covered CA plan for the first 30 days. You have 60 days to add your newborn on to your Covered CA plan. Covered CA will screen your newborn for potential Medi-Cal eligibility. For more information visit: https://www.coveredca.com/marketing- blog/getting-ready-for-a-new-arrival- understandinghealth-insurance-for-your- growing-family/ Adding your baby to coverage in Covered California OK, What a Los Angeles County Health Programs LOS ANGELES COUNTY DEPARTMENT OF HEALTH SERVICES CHILD DELIVERY PLAN o Prenatal Care at LA County Comprehensive Health Centers - First 7 visits cost $60 each; remaining visits are FREE. o Delivery is at an LA County Hospital - costs $2,000 (including a c-section) - must be paid within 7 days of leaving the hospital (can be paid in installments ahead of time) o Parent must apply for Medi-Cal for newborn MY HEALTH LA

➢ At or below 138% FPL ➢ Ages 26 and up ➢ Cannot be eligible for Full Scope Medi-Cal ➢ Primary Health Care ➢ Specialty Care and Hospitalization provided by LA County DHS ➢ Mental Health ➢ Substance Abuse Treatment http://dhs.lacounty.gov/wps/portal/dhs/mhla L.A. COUNTY DEPARTMENT OF HEALTH SERVICES ABILITY TO PAY (ATP) ❑ LA County residents who do not qualify for Full Scope Medi-Cal or Medicare ❑ Clinic and outpatient hospital visits ❑ Includes Specialty Care ❑ Tests and medicines ❑ Inpatient hospital care ❑ Emergency Room visits ❑ Certain surgeries http://dhs.lacounty.gov/wps/portal/dhs/healthcoverageoptions/lacountynocost/abilitytopay County Pre-Pay Program

✓ $60 for clinic visits at Comprehensive Health Centers (CHC) and Health Centers (HC); ✓ $80 for clinic visits at county hospital clinics and Multi- service Ambulatory Care Centers (MACC); ✓ $80 for urgent care visits at all County facilities; ✓ $140 at county hospital emergency rooms; ✓ $500 at outpatient surgery clinics. ✓ $2000 Pre-Natal and Child Delivery Plan (mother must apply for Medi-Cal for newborn). Need advice? Contact us!

Liz Ramirez: [email protected] Donald Nollar: [email protected] (213) 749-4261 1111 W. Sixth Street, Suite 400 Los Angeles County’s Los Angeles, CA 90017-1800 Medi-Cal - Two Plan Model Tel 213. 749.4261 Fax 213. 745.1040 Regular Medi-Cal [email protected] “Fee for Service” www.mchaccess.org

MAXIMUS (The State’s Enrollment Contractor) Health Care Options

English 1 (800) 430-4263 Spanish 1 (800) 430-3003 Vietnamese 1 (800) 430-8008 Armenian 1 (800) 840-5032 Cambodian 1 (800) 430-5005 Cantonese 1 (800) 430-6006 Arabic 1 (800) 576-6881 Mandarin 1 (800) 576-6885 Korean 1 (800) 576-6883 Farsi 1 (800) 840-5034 Hmong 1 (800) 430-2022 Lao 1 (800) 430-4091 Russian 1 (800) 430-7007 Tagalog 1 (800) 576--8008

HEALTH NET LA CARE Commercial Plan Local Initiative Admin: (800) 291-6911 Member Services (800) 675-6110 Admin: (213) 694-1250 www.healthnet.com/portal/member/content/iwc/member/ Member Services (888) 452-2273 unprotected/health_plan/content/shp_provider_directory.action www.lacare.org/find-doctor-or-hospital (including Molina providers) (including contracted plans below)

Blue Shield of CA Promise Health Plan, Health Net Anthem Blue Cross Formerly Care First Member Services Member Services Member Services (800) 675-6110 (888) 285-7801 (800) 605-2556

Molina Medical Center LA CARE Kaiser Member Services Member Services Member Services (800) 526-8196 (888)452-2273 (800) 464-4000 Guidelines for Changing Health Plan Membership or Providers (Providers are able to contract with multiple plans) 1. To change Primary Care Providers (PCP) while staying with the same plan, call the specific plan’s member services number. 2. To change from one LA Care subcontracting plan to another LA Care subcontracting plan, call LA Care’s member services department (for example, moving from Care First to LA Care). 3. To change from one Health Net subcontracting plan to another Health Net plan, call Health Net’s member services department (for example, moving from Molina Medical to Health Net). 4. To change from a Health Net subcontractor to a LA Care subcontractor, contact Health Care Options. 5. To change from a LA Care subcontractor to a Health Net subcontractor, contact Health Care Options. 6. For voluntary health plan members to move from a health plan to regular fee-for-service Medi-Cal, contact Health Care Options. 7. To request an Expedited disenrollment from an LA Care plan to join a Health Net plan or to disenroll from a Health Net plan to join an LA Care plan, contact Health Care Options. ©2003 Maternal and Child Health Access/May be reprinted with permission (213) 749-4261 January 2019 2019 Health Insurance and Health Services 400% COVERED COVERED CALIFORNIA CALIFORNIA

Subsidies available up to Subsidies available 400% FPL up to 400% FPL 322% MEDI-CAL ACCESS 300% PROGRAM KAISER (MCAP) PERMANENTE LA COUNTY DHS Formerly known as AIM CHILD HEALTH PLAN ABILITY TO PAY Undocumented Immigrant Primary / Specialty / Children 0-19 Hospitalizations 267% - 300% of FPL 266% CHILDREN’S Sliding Scale - HEALTH & All Ages DISABILITY Undocumented PREVENTION children over the 250% MEDI-CAL (CHDP) Medi-Cal income 0-19 WORKING limit are eligible for DISABLED Kaiser Permanente Child Health Plan up to 213% 300% of FPL PREGNANCY MEDI-CAL LIMIT 200% MEDI-CAL MEDI-CAL LIMIT LA COUNTY LIMIT FOR ALL BREAST AND DHS PRE PAY CHILDREN CERVICAL AND CHILD CANCER UNDER AGE 19 DELIVERY PLAN PROGRAM 138% EVERY No income limits WOMAN COUNTS My LA COUNTY DHS Cancer Detection HEALTH LA Program ABILITY TO PAY Primary Health MEDI-CAL & Primary / Care LIMIT FAMILY PACT Specialty / 100 At Community ADULTS 19 MEDI-CAL AGED Hospitalizations Clinics BLIND OR and older Undocumented No Cost - DISABLED Immigrant Adults All Ages Max $1271 single Over Age 19 Max $1720 couple 0

MEDI -CAL HEALTH PLAN CARVE OUTS

 Substance Abuse Disorder  Dental  Mental Health

When accessing health plan carve outs, Medi-Cal beneficiaries ALWAYS use their BIC card. Even when a member is enrolled in a Medi-Cal HMO they should use the BIC card for Substance Abuse Disorder, Dental and Mental Health disorder services. There is an exception for dental care explained below.

PLEASE NOTE DENTAL EXCEPTION: Beneficiaries in Los Angeles and Sacramento counties have the option to assign their dental to a health plan – Access, Health Net or Liberty. In those cases they would use their specific dental cards.

Dental Care – Two options in LA County Mental Health Services Substance Abuse Disorder  Some services provided  Provided by Dept of Public Health 1. Keep your Denti-Cal through your Medi-Cal HMO Substance Abuse Prevention & Fee-For-Service OR

Control (SAPC) 2. Assign it to a dental plan  Other services provided (Access, Health Net or through the Department of  (888) 742-7900 Liberty) Mental Health (DMH)  http://publichealth.lacounty.gov/sapc 3. You can change back and forth  LMHP Access:1-800-854-7771

Maternal and Child Health Access (MCHA) improves the health of low income women and families through advocacy, education, training and direct services.

1111 W 6th Street, 4th Floor, Los Angeles, CA 90017, (213) 749-4261 How do you access this benefit?

____

In a Medi-Cal HMO?

Anthem Blue Cross: .877.931-4755 Blue Shield Promise: 877.433.2178 Health Net: 800.675.6110 Kaiser: 844.299.6230 LA Care: 866.529.2141 MEDI-CAL’S Molina: 844.292.2688 ____

NON-MEDICAL Have Fee-For- Service, also called TRANSPORT BENEFIT Regular Medi-Cal?

What is Non-Medical transportation (NMT)? Click on the “Approved NMT Providers” link on the DHCS website: Round trip transportation to and from: a doctor’s visit; a pharmacy https://bit.ly/2LNTOwi to pick up prescriptions; a medical supplier to pick up medical OR equipment or devices; to visit a baby in the NICU; or to receive any Contact: [email protected] other Medi-Cal-covered service, including mental health and dental care.

Who qualifies for this NMT benefit? ALL Medi-Cal beneficiaries who lack other transportation to reach a NEED HELP ACCESSING Medi-Cal-covered service, and who do not require assistance NON-MEDICAL getting to and from the vehicle. TRANSPORT?

Consumers/Patients: Are parents and caretakers allowed in the transport? 818.492.5270 Yes, one attendant for an elderly person or one parent/guardian to take a child to the doctor. Advocates/Providers: 213.749.4261

¿Cómo puedo recibir éste beneficio? ____ ¿Tiene su Medi-Cal asignado a un plan de salud / HMO?

Anthem Blue Cross: 877.931-4755 Blue Shield Promise: 877.433.2178 Health Net: 800.675.6110 Kaiser: 844.299.6230 LA Care: 866.529.2141 Molina: 844.292.2688 ____ TRANSPORTE SIN ¿Tiene Medi-Cal regular sin plan de salud? ASISTENCIA MÉDICA ES Seleccione “Approved NMT Providers” en el sitio web del Departmento de servicios de atención médica de California BENEFICIO DE MEDI-CAL (DHCS): https://bit.ly/2LNTOwi

Envie correo electonico y ¿Que es transporte sin asistencia médica? solicíte el servicio a: Transporte de ida y vuelta a sus citas médicas, farmacia o tienda [email protected] de articulos mèdicos, a visitar a su bebé en el hospital, o para ¿ TEINE PREGUNTAS O recibir cualquier otro servicio cubierto por Medi-Cal, sea mèdico, NECESITA AYUDA CON mental o dental. SU PETICIÓN DE ¿Quién califica para este beneficio de tranporte sin TRANSPORTE SIN asistencia mèdica? ASISTENCIA MÈDICA? Toda persona que recibe Medi-Cal y no cuenta con tranporte a sus Línea de servcio al citas mèdicas o a cualquier otro servicio cubierto por Medi-Cal, y público : que no requiera asistencia física para subir a un auto. 818.492.5270 ¿Pueden los padres o alguna otra persona recibir asistencia de transporte sin asistencia mèdica? Línea telefónica para provedors medicos o Sí, un acompañante de un persona mayor o un padre/guardian de asistentes que abógan por un menor es permitido a viajar con el beneficiaro de Medi-Cal. los pacientes:

213.749.4261

Get Help Applying for Free or Low-Cost Health Coverage All agencies listed below serve clients in Los Angeles County. Bilingual staff assist families in enrolling in public and private health programs. Please contact the agencies listed below for more information.

• Tarzana Treatment Carson, Hawthorne, • Community Health Councils Antelope Valley, Center 661-726-2630, Inglewood, Lawndale, 323-295-5500 Lancaster, Palmdale Ext. 4330 or 4323 Lomita • Crystal Stairs 323-299-9295

•Northeast Valley City of Long Beach • Long Beach Dept. of Health Burbank, Glendale, Health Corporation and Human Services San Fernando Valley, 866-696-3842 562-570-7979 Santa Clarita, Northridge • Valley Community Clinic 818-763-8836 ext 333 • Child and Family Guidance Pasadena, Altadena, • Pasadena Public Health Center 818-882-3147 Sierra Madre Department 626-744-6086 • Citrus Valley Health Partners, El Monte, Monrovia, G.E.M. 626-851-2748 •Asian Pacific Health San Gabriel Valley, LAUSD – CHAMP Helpline 866-742-2273 Pomona Care Venture 323-644-3882 •Maternal and Child Health Access 213-749-4261 • Worksite Wellness LA 323-758-9480 Culver City, Santa Monica, • Venice Family Clinic Venice, West Los Angeles 310-664-7509 Boyle Heights, • Maternal & Child Health Chinatown, Downtown Access 213-749-4261 LA, • California Hospital Medical Echo Park, El Sereno, Center 213-742-5537 Compton, Crenshaw, • Maternal & Child Health Elysian Park, Hollywood, • Asian Pacific Health Exposition Park, Florence, Access 213-749-4261 Koreatown, Westlake Care Venture 323-644-3882 Watts, Jefferson Park, • California Hospital Medical Little Toyko, Pico Union • Chinatown Service Center Leimert Park, Lynwood, Center 213-742-5537 213-808-1700 Paramount, University • Community Health Councils • Worksite Wellnes LA Park, North University Park, 323-295-5500 323-758-9480 South Central LA • Worksite Wellnes LA • K orean Health Education 323-758-9480 Information & Research Center 213-637-1080 For Countywide • Health Consumer Center Artesia, Bell, Bellflower, • Human Services Association Assistance with of Los Angeles Bell Gardens, Downey, 562-806-5400 healthcare advocacy, 800-896-3202 East L.A, Hunt. Park, • Maternal & Child Health Access troubleshooting • Maternal & Child Health Access Hawaiian Gardens, - - and training 213 749 4261 213 749-4261 Lakewood, Lynwood, • St. Francis Medical Center Montebello, Norwalk, 800-603-9355 Go Online to Find Help Near You: www.chigla.org Pico Rivera, South Gate, • Worksite Wellness LA Santa Fe Springs, Whittier 323-758-9480

8/2013 NEW Benefits Quick Reference Guide - 2018

Below is a benefits quick reference guide for Providers effective January 1, 2018. The benefits are based on aid codes and where a beneficiary resides. For a complete listing of procedures and their guidelines, please refer to the Manual of Criteria found in the Provider Handbook. Additional information is on the Denti-Cal website at www.denti-cal.ca.gov.

Benefit Not a benefit Restricted Pregnancy Related Residing in a Facility Procedure Full Scope Scope (SNF/ICF)

* Oral Evaluation (Under age 3)

Initial Exam (Age 3 and above)

Periodic Exam (Age 3 and above)

Prophylaxis

Fluoride Restorative Services – Amalgams/Composites/ Pre-fabricated Crowns * * Laboratory Processed Crowns * * * Scaling and Root Planing

Full Mouth Debridement

Periodontal Maintenance

Anterior Root Canals

Posterior Root Canals

Partial Dentures

Full Dentures

Extractions/Oral and Maxillofacial Surgery

Emergency Services Exceptions: ONLY a benefit under age 3 * 1. Not a benefit under age 13 * * 2. Over age 21, allowable under special circumstances for posterior teeth  A benefit only for the treatment of posterior teeth acting as an abutment for an existing removable partial denture with cast clasps and rest. OR  When the treatment plan includes an abutment crown and removable partial denture (D5213 or D5214). Both shall be submitted on the same TAR for prior authorization

* * * Not a benefit under age 13. Allowable under special circumstances. Health Care Countable Monthly Income Comparison Chart Effective January 1, 2020 through December 31, 2020 for MAGI Programs Non-MAGI income levels effective April 1, 2020 through March 31, 2021

# Non-MAGI 100% 109% 138% FPL 213% FPL 250% FPL 266% FPL 322% FPL 600% FPL Persons Medically Needy Federal MAGI MAGI MAGI Non-MAGI MAGI Medi-Cal Access Covered CA Medi-Cal Poverty Medi-Cal Medi-Cal Pregnancy Medi -Cal Medi-Cal Program (MCAP) Premium Tax Working Disabled & Level Parents Adults Medi-Cal TLICP formerly AIM Credits * Maintenance & 19-64 Children 214 - 322% FPL Need Level Caretaker Covered CA 0 to 19 MCAP babies in Cost-Sharing to calculate Relatives* Medi-Cal up to Share-of-Cost Reductions CHDP 322% FPL 1 $600 $1064 $1160 $1468 $2265 $2659 $2829 $ 3424 $6381 2 $934+ $1437 $1566 $1983 $3061 $3592 $3822 $ 4627 $8621 3 $934 $1810 $1973 $2498 $3856 $4525 $4815 $ 5829 $10860 4 $1100 $2184 $2380 $3013 $4651 $5459 $5808 $ 7031 $13101 5 $1259 $2557 $2787 $3529 $5446 $6392 $6801 $ 8233 $15341 6 $1417 $2930 $3194 $4044 $6241 $7325 $7794 $ 9435 $17580 Additional person, add: $14 $374 $ 407 $ 516 $796 $ 934 $994 $1203 $2241 +Pregnant woman or adult & child use: $750, 2 adults use: $934.

PROGRAM NAME INCOME LIMITS AND COSTS

Modified Adjusted Gross Income (MAGI) Medi-Cal for Adults covers parents, caretaker relatives and adults who qualify under the new Medicaid Expansion *MAGI MEDI-CAL FOR category up to 138% FPL. Disabled individuals may qualify for either MAGI Medi-Cal for Adults or Aged and Disabled Medi-Cal. The term MAGI is used both as a ADULTS methodology for calculating income and also for a grouping of Medi-Cal programs that use MAGI income counting rules. MAINTENANCE NEED (MNL) Medi-Cal allows families a portion of their income for living expenses, called the Maintenance Need Level (MNL). Once other eligibility requirements are met, NON-MAGI MEDI-CAL family size and income determines if family members can get Medi-Cal at no cost or with a Share-of-Cost (SOC). MNL determines the amount of SOC. MEDI-CAL TARGETED LOW- INCOME CHILDREN’S Medi-Cal for children up to 266% FPL. Children eligible for this program with income above 160% of FPL will be required to pay a monthly premium. MCAP-linked PROGRAM (TLICP) infants are automatically eligible for TLICP Medi-Cal at birth and through the second year of age, with family income up to 322% FPL. People who are 65 and over, or people who meet the Social Security definition of disabled can qualify for this program if their countable income (income after AGED & DISABLED allowed deductions) is less than $1,294 for an individual or $1,747 for a married couple (if both apply). All Supplemental Security Income (SSI) recipients qualify for NON-MAGI MEDI-CAL Medi-Cal. (please note that before April 1. 2020, the limits are $1271 for an individual and $1720 for a couple)

BREAST/CERVICAL CANCER Men or women diagnosed with breast cancer or women diagnosed with cervical cancer can qualify for this Medi-Cal program if income is below 200% FPL.

Maternal and Child Health Access - may be reprinted with permission (213) 749-4261 or [email protected]. FPL (Federal Poverty Level) is the amount of income the Federal Government says a family requires to meet its basic needs; also known as the Federal Income Guidelines (FIG).

Health Care Countable Monthly Income Comparison Chart Effective January 1, 2021 through December 31, 2021 for MAGI Programs Non-MAGI income levels effective April 1, 2021 through March 31, 2022

# Non-MAGI 100% 109% 138% FPL 213% FPL 250% FPL 266% FPL 322% FPL 600% FPL Persons Medically MAGI Needy Federal MAGI Medi-Cal MAGI Non-MAGI MAGI Medi-Cal Access Covered CA Medi-Cal Poverty Medi-Cal Adults* Pregnancy Medi -Cal Medi-Cal Program (MCAP) Premium Tax & Level Parents 19-64 Medi-Cal Working Disabled TLICP formerly AIM Credits Maintenance & & Children 214 - 322% FPL Need Level Caretaker Non-MAGI Covered CA 0 to 19 MCAP babies in Cost-Sharing to calculate Relatives* Aged & Medi-Cal up to Share-of-Cost Disabled**+ Reductions CHDP 322% FPL

1 $600 $1074 $1170 $1482 $2287 $2684 $2856 $ 3457 $6440 2 $934+ $1452 $1583 $2004 $3093 $3630 $3862 $ 4675 $8710 3 $934 $1830 $1995 $2526 $3898 $4575 $4868 $ 5893 $10980 4 $1100 $2209 $2408 $3048 $4704 $5521 $5875 $ 7111 $13250 5 $1259 $2587 $2820 $3570 $5510 $6467 $6881 $ 8330 $15520 6 $1417 $2965 $3232 $4092 $6316 $7413 $7887 $ 9548 $17790 Additional person, add: $14 $379 $ 413 $ 523 $806 $ 946 $1007 $1219 $2270 +Pregnant woman or adult & child use: +New Non-MAGI $750, 2 adults use: Income limits are $934. effective 4/1/21 PROGRAM NAME INCOME LIMITS AND COSTS

Modified Adjusted Gross Income (MAGI) Medi-Cal for Adults covers parents, caretaker relatives and adults who qualify under the new Medicaid Expansion *MAGI MEDI-CAL FOR category up to 138% FPL. Disabled individuals may qualify for either MAGI Medi-Cal for Adults or Aged and Disabled Medi-Cal. The term MAGI is used both as a ADULTS methodology for calculating income and also for a grouping of Medi-Cal programs that use MAGI income counting rules. MAINTENANCE NEED (MNL) Medi-Cal allows families a portion of their income for living expenses, called the Maintenance Need Level (MNL). Once other eligibility requirements are met, NON-MAGI MEDI-CAL family size and income determines if family members can get Medi-Cal at no cost or with a Share-of-Cost (SOC). MNL determines the amount of SOC. MEDI-CAL TARGETED LOW- INCOME CHILDREN’S Medi-Cal for children up to 266% FPL. Children eligible for this program with income above 160% of FPL will be required to pay a monthly premium. MCAP-linked PROGRAM (TLICP) infants are automatically eligible for TLICP Medi-Cal at birth and through the second year of age, with family income up to 322% FPL. People who are 65 and over, or people who meet the Social Security definition of disabled can qualify for this program if their countable income (income after **2021 AGED & DISABLED allowed deductions) is less than $1,482 for an individual or $2,004 for a married couple (if both apply). For retroactive applications prior to December 1. 2020, use NON-MAGI MEDI-CAL $1294 for an individual and $1747 for a couple. All Supplemental Security Income (SSI) recipients qualify for Medi-Cal.

BREAST/CERVICAL CANCER Men or women diagnosed with breast cancer or women diagnosed with cervical cancer can qualify for this Medi-Cal program if income is below 200% FPL.

Medi-Cal and the Medi-Cal Access Program (MCAP) Launch 12-month Post-Pregnancy Mental Health Expansion on August 1, 2020

New 12-months total post-pregnancy coverage: How to enroll:

At present, Medi-Cal and MCAP continue coverage to To be enrolled in the expansion, a the end of a “postpartum period”, which lasts until the midwife, clinic, doctor, nurse, mental end of the month in which the 60th day after the end of a health or other provider must pregnancy occurs. complete a form, the MC 61, certifying that the individual has a As of August 1, eligibility for Medi-Cal or MCAP can be mental health diagnosis. extended an additional ten months for people diagnosed For Medi-Cal, the completed form with a maternal mental health condition, such as anxiety, must be online sent to the county by depression, or bipolar disease. fax or mail, or uploaded to the individual’s Medi-Cal case. This means that Medi-Cal or MCAP coverage For MCAP, send the form to the continues for a full 12 months after the end of the state in Sacramento by fax, mail or pregnancy for individuals who meet the requirements. call 1-800-433-2611 for options. MCAP will not charge premiums for the additional ten months of coverage.

This new eligibility category is discussed at the Provisional Postpartum Care Extension page for providers and the All County Welfare Directors Letter 20-14. Download the Enrollment Form MC 61 Frequently Asked Questions PPCE Informational Flyer - English and Spanish In other languages soon. Please help distribute information to potentially eligibl pregnant beneficiaries! How Will Eligible Individuals Know About The Right To Ask For The Eligibility Extension?

The state has developed a flyer. It will be sent to all

individuals in MCAP or who have reported a pregnancy to Medi-Cal. But this means that the lowest-income women in

Medi-Cal may not be sent the flyer directly.

Please help distribute information to potentially eligible pregnant beneficiaries!

What is the timing for requesting the eligibility What is the scope of the Medi-Cal or extension? MCAP coverage during the eligibility To avoid any gaps in coverage, the completed MC 61 form extension? It’s the same as what the should be submitted as soon as there is a mental health individual had during the pregnancy and diagnosis, either during the pregnancy or the postpartum 60-day postpartum period: either Full- period. This is especially important for MCAP enrollees. Scope Medi-Cal or Pregnancy-Related Medi-Cal. For Medi-Cal, the completed MC 61 form can also be Reminder: Pregnancy-Related provides submitted within 90 days after the end of the traditional all medically necessary care during postpartum period. This is called Medi-Cal’s “90-day cure pregnancy that Medi-Cal covers, period”. It is OK if the mental health diagnosis was made including dental and substance use during the 90-day cure period, in which would be about the disorder treatment, in addition to mental third, fourth or fifth month postpartum. You can still qualify for health services. the eligibility extension if the mental health diagnosis was made during the 90-day cure period, and the Medi-Cal will go back “retroactively” to the end of the usual postpartum

period, to pay bills incurred during the gap. We aren’t sure yet whether there will be a 90-day cure period for MCAP,

so please stay tuned.

The state refers to this program as “Provisional Postpartum Care Extension”, or PPCE. The state uses the word For More Information Contact: Lynn Kersey at “provisional” because funding for the program must be [email protected] or renewed each year. But advocates are hoping to make the Lucy Quacinella at program permanent. Please stay tuned for how you can [email protected] get involved with that! Medi-Cal and Medi-Cal Access Program (MCAP) Protections During the Public Health Crisis

BACKGROUND On March 4, 2020, Governor Gavin Newsom declared a State of Emergency in response to the global COVID-19 pandemic. This fact sheet outlines the current protections in place for both Medi-Cal and the Medi-Cal Access Program (MCAP) as well as who is eligible for the newly created COVID-19 Medi-Cal program.

Protection Policy Change

Discontinuance and negative actions for Medi-Cal and Medi-Cal Access Program are As of March 26, 2020 delayed until the end of the COVID-19 public health crisis. This means that no one with No Medi-Cal or MCAP Medi-Cal, including Minor Consent or MCAP coverage should have their benefits Terminations terminated or reduced during this public health crisis! Exceptions to this are death, moving out of state or by request. MEDIL I 20-25 If you cannot pay your Medi-Cal or MCAP premium during the COVID-19 emergency you can call to get your premium waived (stopped for now). For children's Medi-Cal, call 1-800-880-5305. As of March 26, 2020 For the 250 Percent Working Disabled Program, call 1-916-445-9891 or online: Medi-Cal and MCAP https://apps.dhcs.ca.gov/AutoForm2/default.aspx?af=5692 Premium Waivers For MCAP, call 1-800-433-2611 If your income has dropped, you can also call your county worker. Ask if you are eligible to have no premium. All Medi-Cal beneficiaries can get COVID-19 testing, testing-related services, Full Scope Medi-Cal and treatment including hospitalization, during this emergency. All Medi-Cal beneficiaries & can get medically necessary services for COVID-19 no matter if they are in full-scope Emergency Medi-Cal or emergency scope Medi-Cal. You can get COVID-19-related services in both Medi-Cal Coverage of COVID-19 managed care and fee-for-service Medi-Cal, regardless of your immigration status. See also COVID-19 Uninsured Group on the next page. * Providers may provide medically necessary services, such as medication, without an in- person visit or signature. Flexibities for Abortion * Flexibilities to remove requirements for a Medicare denial for certain abortion services. Services Due To COVID-19 To read more: https://files.medical.ca.gov/pubsdoco/newsroom/newsroom_30339_77.aspx

If you get your services in a Medi-Cal health plan and have questions you can contact your Medi-Cal Beneficiary plan's member service center. The number is listed on your health plan card. If you get Outreach Letter and your care in fee-for-service Medi-Cal and are not in a Medi-Cal health plan, you can talk Medi-Nurse Advice line with a nurse through Medi-Nurse. Call the DHCS COVID Line at 1-877-409-9052. For more information: https://www.dhcs.ca.gov/Documents/Beneficiary-Outreach-Letter.pdf

Medi-Cal for pregnant women, all children and young adults up to 26 do not count in the public charge test. The federal government says the public charge rule does not count for medical services related to COVID-19: https://www.uscis.gov/green-card/green-card-processes-and-procedures/public-charge 10/15/2020 New COVID-19 Medi-Cal Program New COVID-19 Presumptive Eligibility Medi-Cal Program COVID-19 Uninsured Group: The new COVID-19 Uninsured Group program was implemented by the Department of Health Care Services (DHCS) on August 28, 2020, and covers COVID-19 diagnostic testing, testing-related services, and treatment services, including hospitalization and all medically necessary care, at no cost to the individual, for up to 12 months or the end of the public health emergency, whichever comes first.

Who is Eligible? To qualify for the new Medi-Cal COVID-19 uninsured group, individuals must: Have no health insurance, or Have private health insurance that does not cover diagnostic testing, treatment services, including hospitalizations and any medically necessary care for COVID-19, or CulminaNot eligible underting any Tasks of the other Medi-Cal programs Be a California resident. Immigration status is not considered. Income is not considered.

Individuals who have not met their Medi-Cal Share of Cost obligation also qualify.

What is covered? Testing as well as treatment of COVID-19, including in-patient hospitalization related to COVID-19. The program uses Aid Code V 2.

Where Do I Apply? You enroll at a hospital, clinic, or other provider’s office that participates in the program. Call the Medi-Nurse Line: (877) 409-9052 to find a location near you.

Coverage starts only from the day the application is submitted, not the first of the month and lasts 12 months unless the COVID public health emergency is declared to be over before that.

Except that: "Retroactive” coverage, to pay bills for COVID-related medical services already received is available back to April 8, 2020 but you have to apply for that coverage separately.

Resources: Call the Medi-Nurse Line: (877) 409-9052 California has launched an advice line that can connect you with a nurse, day or night, to talk about COVID-19 symptoms and help connect you with local resources in your area. The Medi-Nurse line is available around the clock, 7 days a week. Medi-Nurse provides services in multiple languages, with steps in place that allow callers to access interpreters, as needed. If you have a regular doctor or a health plan, call them first. If you don’t, the Medi-Nurse line can help! The federal government says the public charge rule does not count for medical services related to COVID-19: https://www.uscis.gov/green-card/green-card-processes-and-procedures/public-charge

Protecciones de Medi-Cal y del Programa Medi-Cal Access (MCAP, por sus siglas en inglés) durante la crisis de salud pública

ANTECEDENTES El 4 de marzo de 2020, el gobernador Gavin Newsom declaró un estado de emergencia en respuesta a la pandemia global por COVID-19. Esta hoja informativa delinea las protecciones actuales en vigor para los programas de Medi-Cal y Medi-Cal Access (MCAP). También describe quiénes son elegibles para el programa recién creado de Medi-Cal para COVID-19. Protección Cambios en la política

Se pospondrán las suspensiones y acciones negativas a Medi-Cal y al programa Medi- A partir del 26 de Cal Access hasta el final de la crisis de salud pública por COVID-19. Esto significa que marzo de 2020, a ninguna persona que cuente con cobertura de Medi-Cal, incluyendo Minor exención de las Consent o MCAP se le deberán suspender o reducir sus beneficios durante esta primas de Medi-Cal y crisis de salud pública. Las excepciones para esto son fallecimiento, mudarse fuera del MCAP estado o por petición propia. MEDIL I 20-25

Si no puede pagar sus primas de Medical o MCAP durante la emergencia por COVID-19, puede llamar para pedir que se le exente del pago de sus primas (en pausa por ahora).

Para Medi-Cal de niños, llame al 1-800-880-5305. A partir del 26 de marzo de 2020, Para el programa 250 Percent Working Disabled, llame al 1-916-445-9891 o visite el sitio: exención de las https://apps.dhcs.ca.gov/AutoForm2/default.aspx?af=5692 primas de Medi-Cal Para MCAP, llame al 1-800-433-2611 y MCAP Si sus ingresos han disminuido, también puede llamar a su trabajador del condado. Pregunte si reúne los requisitos para no pagar primas.

Todos los beneficiarios de Medi-Cal pueden obtener la prueba de COVID-19 y los servicios relacionados con la prueba y tratamiento, incluyendo hospitalización, durante esta emergencia. Todos los beneficiarios de Medi-Cal pueden obtener servicios Cobertura de Medical de médicamente necesarios para COVID-19 sin importar si tienen Medi-Cal de cobertura cobertura completa y completa o Medi-Cal de cobertura de emergencia. Puede obtener servicios relacionados Medi-Cal de emergencia del con COVID-19 ya sea mediante los servicios obtenidos a través de un plan de Medi-Cal o a COVID-19 través de Medi-Cal regular (conocido como Pago Por Servicio o “FFS” por sus siglas en inglés), sin importar su estatus migratorio También vea el apartado de Grupo COVID-19 sin seguro en la siguiente página.

* Los profesionales de los servicios de salud pueden proporcionar servicios médicamente Flexibilidad para los necesarios, tales como medicamentos, sin consulta en persona o firma. servicios de aborto debido * La flexibilidad de quitar la necesidad de obtener una negación del programa de a COVID-19 Medicare para ciertos servicios de aborto. Para mayor información, visite: https://files.medical.ca.gov/pubsdoco/newsroom/newsroom_30339_77.aspx

Carta informativa Si recibe sus servicios en un plan de salud de Medi-Cal y tiene alguna pregunta, puede sobre los beneficios de contactar al centro de servicio de su plan. El número está en su tarjeta del seguro médico. Medi-Cal y línea de Si obtiene su atención médica a través de Medi-Cal regular (FFS) y no participa en un plan asesoría de enfermería de Medi-Cal, puede hablar con una enfermera en Medi-Nurse. Llame a la línea COVID del Medi-Nurse Departamento de Servicios de Salud al 1-877-409-9052. Encontrará más información en: https://www.dhcs.ca.gov/Documents/Beneficiary-Outreach-Letter.pdf

Los servicios de Medi-Cal recibidos por mujeres embarazadas y niños y jóvenes menores de 26 años no son parte de la prueba de Carga Publica, El gobierno federal dice que la prueba de Carga Pública tampoco considera los servicios médicos relacionados con COVID-19: https://www.scis.gov/green-card/green-card-processes-and-procedures/public- charge 10/15/2020

Nuevo programa de Medi-Cal para COVID-19

Nuevo programa de elegibilidad presunta para Medi-Cal por COVID-19 Grupo COVID-19 sin seguro: El nuevo programa para grupos COVID-19 no asegurados, fue implementado por el Departamento de Servicios de Salud (DHCS, por sus siglas en inglés) el 28 de agosto de 2020 y cubre las pruebas diagnósticas para COVID-19, servicios relacionados con las pruebas y servicios de tratamiento, incluyendo hospitalización y toda la atención médica necesaria sin costo para la persona, durante hasta 12 meses o hasta que termine la emergencia de salud pública, lo que ocurra primero.

¿Quién reúne los requisitos? Para tener derecho ser parte del nuevo grupo COVID-19 sin seguro, las personas deberán reunir los siguientes requisitos: No contar con seguro médico, o Contar con seguro médico privado que no cubra las pruebas diagnósticas, servicios de tratamiento incluyendo hospitalizaciones y cualquier atención médica necesaria para COVID-19, o No ser elegible bajo ningún otro programa de Medi-Cal. Ser residente de California. No se tomará en cuenta el estatus migratorio. No se toma en cuenta el ingreso.

Las personas que tienen Medi-Cal con costo también reúnen los requisitos. ¿Qué se incluye en esta cobertura? La prueba, así como el tratamiento para COVID-19, incluyendo hospitalización relacionada con COVID-19. El programa usa el código (Aid Code) V 2. ¿Dónde hago mi solicitud? Puede inscribirse en un hospital, clínica o consultorio médico que participe en el programa. Llame a la línea Medi-Nurse al (877) 409-9052 para encontrar una sucursal cerca de usted. La cobertura comienza sólo a partir del día en que presente la solicitud, no el día primero de mes y dura 12 meses a menos que la emergencia de salud pública por COVID se declare terminada antes de eso. Excepto que: La cobertura “retroactiva” para pagar las facturas por servicios médicos relacionados que ya haya recibido, relacionados con COVID está disponible a partir del 8 de abril de 2020, pero debe solicitar esa cobertura por separado.

Recursos: Llame a la línea Medi-Nurse: (877) 409-9052 California ha establecido una línea de asesoría que puede conectarlo con un(a) enfermero(a) día y noche para hablar sobre los síntomas de COVID-19 y ayudar a vincularlo con recursos locales en su área.

La línea Medi-Nurse está disponible a toda hora los 7 días de la semana. Medi-Nurse ofrece servicios en varios idiomas, con los pasos necesarios para que la persona que llama, tenga acceso a un intérprete en caso necesario. Si tiene un médico o un plan de salud convencional, primero comuníquese con ellos. Si no es así, la línea Medi-Nurse puede ayudarle.

El gobierno federal dice que los servicios médicos relacionados con COVID-19 no son parte de la prueba de carga pública: https://www.uscis.gov/green-card/green-card-processes-and- procedures/public-charge