Support for Low-Income Veterans Enrolled in Medi-Cal
The Medi-Cal program in California, the state's Medicaid program, provides coverage for over 16 million individuals, including children, pregnant women, seniors, and low-income adults. This program has seen a significant increase in enrollment since the implementation of the Affordable Care Act. Specifically, the Medi-Cal Cost Avoidance Program, which is administered under the California Military & Veterans Code Section 972.5, plays a crucial role in funding county veteran services. Through this program, County Veteran Service Officers (CVSOs) report workload activities to CalVET to ensure funding allocation and eligibility determination for applicants. The process involves verifying veterans' benefits status and coordinating outreach efforts.
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HELPING LOW-INCOME VETERANS ENROLLED IN MEDI-CAL https://adpapps.dhcs.ca.gov/datar/images/dhcs_logo.gif https://www.calvet.ca.gov/_catalogs/masterpage/images/CalVet_Color.png CVSO PROFESSIONAL TRAINING CONFERENCE October 3, 2023 LAUREN ORTEGA Veteran Benefit Enhancement California Department of Health Care Services
The Medi-Cal Program Medi-Cal, California s Medicaid program, covers more than 16 million Californians: children, their parents, pregnant women, seniors and people with disabilities, and low-income nonelderly adults. The program underwent a major expansion due to the Affordable Care Act (ACA). Medi-Cal saw a total increase of more than 8 million enrollees between 2013 and 2023. MEDI-CAL ENROLLMENT (IN MILLIONS) 16 14.5 14.1 13.6 13.5 13 12.8 12.7 12.4 9.9 82% 83% 80% 7.9 64% 83% 68% 63% 75% 76% 56% 53% 47% 44% 37% 36% 32% 25% 24% 20% 18% 17% 17% 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2 Fee For Service Managed Care
Medi-Cal Cost Avoidance Program The Medi-Cal program has been directly funding county veteran services since 1987. The Medi-Cal Cost Avoidance Program is administered under the provisions of the California Military & Veterans Code Section 972.5. Funding is allocated to the CVSOs based upon a pro-rata share of reported/audited workload units for the current fiscal year. 3
Medi-Cal Cost Avoidance Work Load Units (WLU) CVSOs report workload activities to CalVET semiannually. For Medi-Cal Cost Avoidance activities, CVSOs report: one (1) unit for a verification ten (10) units for opening a claim/Benefit Enhancement The current CDVA & DHCS interagency agreement provides a total payment of $838,000 for distribution under this program. Each county s share will be based upon a pro-rata share of "Medi-Cal workload units" allowed for the current fiscal year. CVSOs should return the MC 05 form to the CWD or DHCS (whomever sent the form originally) as soon as possible in order for DHCS to determine the applicants eligibility. 4
Medi-Cal Referrals (From CWD) MC 05s are used by county Medi-Cal eligibility workers to verify the status of veterans benefits being received. The CWD gives the CVSO the aid code or anticipated aid code if eligibility is not yet determined. Upon receipt of the MC 05 from the CWD, the CVSO checks VA data systems to determine if the Medi-Cal applicant that reported military service is receiving VA benefits. The CVSO provides verification and/or outreach, completes their section of the MC 05 and returns the form to the CWD. 5
MC05 Form 6
Medi-Cal Referrals (From DHCS) Since July 1, 2015, CVSOs have received additional veterans referrals directly from the state. The MC 05 is used for Medi-Cal applicants/recipients. It does not apply to other public assistance programs. CVSOs fill out the bottom portion of the MC 05 and return them to DHCS (by email or fax). The veterans signature is not required on this form. CVSOs are to help veterans apply for both monetary benefits and VA Health. 7
MC05 Typical Case Scenarios Veteran s with a high level of service connected disability Compensation payments greater than $1500.00 Disability rating greater than 50% Veteran s with an incomplete application or renewal of benefits Payment of $0 due to denied application or renewal for the following reasons: Failure to furnish requested evidence Failure to report for physical examination Claim withdrawn or benefits renounced Whereabouts unknown Failure to file income questionnaire Veteran s no longer in a Long Term Care (LTC) facility who need an increased income Pension payment of $90 No longer in a LTC aid code 8
Medi-Cal Work Load Units (WLU) By Fiscal Year (FY) Fiscal Year County WLU Total WLU 30000 FY 2011-2012 23,589 FY 2012-2013 25,493 25000 FY 2013-2014 24,679 20000 FY 2014-2015 17,170 15000 FY 2015-2016 21,552 10000 FY 2016-2017 23,969 5000 FY 2017-2018 25,558 0 FY 2018-2019 25,301 FY 2019-2020 21,988 FY 2020-2021 15,508 FY 2021-2022 15,142 Fiscal Year FY 2022-2023 (1st Half) 9 7,355
CVSO Funding Opportunities and Support MC05 WLUs provide funding opportunities for CVSO offices Increase WLUs FY23/24 County Collaboration Direct relationship with your local County Welfare Department Support from DHCS County Summit Meetings Training Veteran Contact Information 10
Contact Information https://adpapps.dhcs.ca.gov/datar/images/dhcs_logo.gif Lauren Ortega Medi-Cal Eligibility Division Department of Health Care Services Lauren.Ortega@dhcs.ca.gov
