Medi-Cal Update 2023-2 FPL and CSRA Value Changes

Medi-Cal 2023 FPL and CSRA Value Changes

Date	References	Clerical	Handbook(s) Revised
2/27/2023	ACWDL 23-01 and ACWDL 23-03	No	Chart Book: 5-MC Charts

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Background

The Federal Poverty Level (FPL) amounts change annually and are derived from FPL figures published in the Federal Register.

Changes

The 2023 monthly FPL amounts for Medi-Cal, Medi-Cal Access Program (MCAP), MCAP Linked Infants, and County Children’s Health Initiative Program (C-CHIP) have been updated. The 2023 Community Spouse Resource Allowance (CSRA) has increased to $148,620 and the Community Spouse Income Allocation (CSIA) value increased to $3,716.

 

The MC topics below in the Chart handbook have been revised to reflect the changes:
Federal Poverty Level Programs Monthly Income Comparison Chart
Community Spouse Resource Allowance (CSRA)
Community Spouse Income Allocation (CSIA)

 

Implementation  

 

The 2023 FPL amounts are effective as follows:

•January 1, 2023 - Modified Adjusted Gross Income (MAGI) coverage groups, Medicare Savings Programs (MSP) coverage groups who do not receive Title II Retirement Survivors and Disability Insurance (RSDI) income.
•March 1, 2023 - MSP coverage groups who do receive Title II RSDI.
•April 1, 2023 - Aged, Blind and Disabled (ABD) FPL programs and 250% Working Disabled Program (WDP)
Note: Eligibility will need to be run back to the specified effective date for individuals in these groups who may be positively impacted by the FPL increase.

 

Upon request from the beneficiary (or parent/legal guardian, AR), EW can retroactively change eligibility for the following:

• Optional Targeted Low-Income Children’s Program (OTLICP) eligible children - maybe eligible for premium reimbursements if redetermined eligible for free, nonpremium coverage.
• Advance Premium Tax Credit (APTC) individuals - eligibility can only be changed retroactively for those individuals who did not enroll in a Qualified Health Plan (QHP), did not pay a premium, or who did enroll in a QHP and pay a premium but have MC covered medical or dental expenses that were not covered by their QHP during the retroactive period - in this case they may be eligible for retroactive MC out-of-pocket expense reimbursements (Conlan), but cannot be reimbursed for premiums paid to Covered CA QHPs.
• Individuals with a Share-of-Cost (SOC) - if redetermined eligible for zero or lower SOC, may be eligible for retroactive MC out-of-pocket expense reimbursements. (Conlan)

Data Systems

CalSAWS and CalHEERS are scheduled to be updated with the 2023 FPL amounts in April 2023. DHCS will send notices to individuals who may be positively impacted by the new FPL values to allow them to request a re-evaluation.

Forms

“Medi-Cal Budget Chart” (SCD 1470) and “CW-CF-MC Limits Chart” (SCD 2338) have been updated to reflect the 2023 FPL amounts.

Supervisors

Please share this information at your next unit meeting.

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Angela Shing, Director
Department of Employment & Benefit Services
Contact Person(s): Erica De La Pena, ADSS I, 408-755-7540.