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Medi-Cal Update 2023-13 Full-Scope Expansion Ages 26-49
Full-Scope Medi-Cal Expansion for Persons 26 Through 49 Years of Age
| Date | References | Clerical | Handbook(s) Revised |
| 12/12/2023 | ACWDL 23-08 | N/A | MC HB Ch 5 Citizenship/Immigration Status |
Background
Under current policy, if all other eligibility requirements are met, citizenship or immigration status determines the level of Medi-Cal (MC) benefits a client is eligible for; restricted scope MC or full scope MC. Individuals who are 26-49 years of age and who do not have certain satisfactory immigration statuses are not eligible to receive full-scope Medi-Cal benefits.
Changes
Senate Bill (SB) 184 amended the Welfare and Institutions Code to expand eligibility for full-scope Medi-Cal to individuals who are 26 through 49 years of age that do not have satisfactory immigration status, if otherwise eligible for Medi-Cal. This new coverage is being referred to as the Age 26-49 Adult Expansion. There are no new aid codes for the Age 26-49 Adult Expansion. Medi-Cal beneficiaries who are eligible under this expansion will be placed into existing full-scope MAGI and Non-MAGI Medi-Cal aid codes respectively. An individual who is 26 through 49 years of age on any day in January 2024 will be eligible for full-scope Medi-Cal, including MAGI and Non-MAGI, for the entire month of January if otherwise eligible.
Under federal regulations and state law, the requirement to verify citizenship for Medi-Cal applicants and beneficiaries who are citizens of the United States remains in effect. In addition, the requirement to verify immigration status for individuals who claim satisfactory immigration status (SIS) remains in effect. Individuals who do not claim SIS are not required to provide immigration status verification. If after the Reasonable Opportunity Period (ROP), verification of U.S . Citizenship or SIS is not obtained or provided, otherwise eligible individuals will no longer be reduced to restricted scope benefits.
The following sections in the MC HB have been revised to reflect the changes.
Citizenship/Immigration Status
Full-Scope Expansions: SB 75, SB 104, SB 184, and AB 133
Inconsistent Birthdates and SAVE Process
Implementation
This policy change is effective January 1, 2024.
Data Systems
Upon implementation, the California Healthcare Eligibility, Enrollment, and Retention System (CalHEERS), and the Statewide Automated Welfare System (SAWS) will grant full-scope Medi-Cal to eligible new applicants who previously would have been granted restricted-scope Medi-Cal. The Department of Healthcare Services (DHCS), CalHEERS, and CalSAWS will also transition existing restricted-scope Medi-Cal beneficiaries who are 26 through 49 years of age to full-scope Medi-Cal.
Forms
All individuals in the Age 26-49 Adult Expansion transition population will be notified of the change by mail approximately 60 days before implementation in January 2024. DHCS will also mail out the Medi-Cal Managed Care Plan Enrollment Notice and a Health Plan choice packet which provides information for transitioned beneficiaries who are required to enroll in a Medi-Cal managed care plan.
Other Programs
This change only affects the Medi-Cal program.
Supervisors
Supervisors, please share this information with your staff.
Angela Shing, Director
Department of Employment & Benefits Services
Contact Person: Megan Turney, SSA BPIS, 408-755-7540.