Caring for our aging loved ones has always been an important issue. California has made some changes regarding Medi-Cal. As of January 1, 2022, seniors and their families in the Golden State have some new things to consider when it comes to Medi-Cal eligibility. 

Medicaid Eligibility Changes 

In 2021, California passed laws that made several changes to how Medi-Cal eligibility is determined. While some of the changes are statewide, others are specific to the seven counties in California’s Coordinated Care Initiative (CCI): Los Angeles, San Diego, San Bernardino, Orange, Riverside, San Mateo and Santa Clara. The recent changes include the following.

Share-of-Cost to Fee-for-Service Transition

As of January 1, 2022, all active enrollees with a Medi-Cal share-of-cost plan were automatically transitioned to a fee-for-service Medi-Cal plan. This can affect how benefits are accessed, how care is accessed and even how a patient pays for their prescription drugs. 

Managed Care Enrollment and the Multipurpose Senior Services Program

Though many Medi-Cal enrollees are already part of managed care plans, the state’s new changes will expand the number of individuals (including many seniors) who will be mandatorily enrolled. Meanwhile, the Multipurpose Senior Services Program (MSSP) will be transitioned from a managed care benefit to a “carved-out” waiver benefit, though this change is unlikely to create any disruption to enrollees.

Prescription Drugs Under Medi-Cal

Applicable to enrollees statewide, the Medi-Cal prescription drug benefit will be moving from a managed care benefit to a fee-for-service. This means that managed care plans will no longer provide or approve coverage for prescription drugs for Medi-Cal beneficiaries.

Medi-Cal Coverage for Undocumented Seniors

One of the most significant changes to benefit eligibility in the state is that individuals aged 50 years and older who meet the program’s financial requirements will receive “full-scope” benefits regardless of their immigration status. Beginning May 1, 2022, individuals 50 years old and over — including those who are undocumented — will automatically be transitioned to full-scope benefits for applicable services, including:

• Primary care
• Specialty care
• Long-term care
• In-home services
• Vision & hearing aid coverages

The End of Cal MediConnect Plans

Residents of the seven CCI counties in California who are also members of Cal MediConnect health plans should also be aware that these plans will be eliminated and automatically transitioned into Dual Special Needs Plans (D-SNPs), which are operated by the Medi-Cal plans of those counties.

Asset Test Elimination

Previously, enrollees aged 65 years and older were only eligible for benefits if their assets (minus a home and a car) were valued at $2,000 or less (or $3,000 for a couple). This difficult qualification has finally been addressed by the new eligibility changes: Starting in July 2022, the asset limitation will be raised to $130,000, and in July 2024, the “asset test” for benefit eligibility will be eliminated completely. This is a significant change, and one that will hopefully keep California seniors covered, safe and cared for.

Regardless of how these new changes in California’s eligibility requirements may affect you or your elder loved ones, having a helping hand to lead you in the right direction is valuable. At 1on1Eldercare, we believe that long-term eldercare should be available to everyone, regardless of their background or bank account. We make it our priority to understand your unique needs and circumstances while helping you make informed decisions. If you have questions regarding your eligibility status and how California’s new Medi-Cal changes may affect your benefits, or if you need support and assistance in your eldercare choices, reach out to our team today.