Coronavirus - Accessing Medi-Cal Services During the COVID-19 Public Emergency
Coronavirus - Accessing Medi-Cal Services During the COVID-19 Public Emergency
Because of the COVID-19 emergency, the Department of Health Care Services (DHCS) which runs California’s Medi-Cal program, is helping Medi-Cal beneficiaries get the services and care that they need.
Coronavirus (COVID-19) COVID-19 Update: How to Get Your Medi-Cal Services
*This publication is up-to-date as of August 12, 2021.
- More information on COVID-19 is available here: https://www.disabilityrightsca.org/post/announcement-coronavirus-and-ho… and here https://www.covid19.ca.gov/healthcare
- You can find the public health emergency declaration and renewals1 here: https://www.phe.gov/emergency/news/healthactions/phe/Pages/default.aspx…;
Here are some changes to Medi-Cal services during the COVID-19 public health emergency.
Medi-Cal COVID-19 Testing
COVID-19 testing is free for all people who get Medi-Cal.2 Free Medi-Cal COVID-19 testing includes both the viral and the antibody tests.3 Also note that all healthcare insurance is required to pay for COVID-19 testing.4 Californians should not have to pay even if they receive testing and screening at emergency rooms or urgent care.
This means that:
- You should not pay out-of-pocket for any COVID-19 testing.
- Your healthcare provider does not need to wait for approval from Medi-Cal to test for COVID-19.
You can find more information about COVID-19 testing from your county public health department: https://www.cdph.ca.gov/Pages/LocalHealthServicesAndOffices.aspx.
Medi-Cal COVID-19 Vaccination
The COVID-19 vaccine will be provided at no cost to all Californians.5 Medi-Cal will pay for the cost of vaccine administration for full scope Medi-Cal beneficiaries and is seeking federal approval to cover the cost of vaccine administration for beneficiaries who have limited-scope Medi-Cal.6
The MyTurn website: https://myturn.ca.gov/ is an appointment request system. The MyTurn website added a check box that you can check if you need transportation or if you are homebound. If you check one of these boxes, then you will get a call to schedule your vaccine appointment transportation or in-home vaccination.7 Medi-Cal managed healthcare plans are required provide free COVID-19 vaccination, including in-home vaccinations.8 The vaccine will be provided to Medi-Cal beneficiaries according to California’s vaccination plan.9 For more information on the state’s vaccination plan visit https://covid19.ca.gov/vaccines/. You can also contact the Medi-Nurse Advice Line for information the COVID-19 vaccine roll-out in Medi-Cal. The “Medi-Nurse” line is available 24 hours a day for 7 days a week by calling 1-877-409-9052.
Medi-Cal COVID-19 Treatment
Fee-for-service Medi-Cal pays for COVID-19 treatment.10 All Medi-Cal managed care plans have to give free care to people who need COVID-19 treatment.11
This means that:
- You should not pay out-of-pocket for COVID-19 treatment.
- Medi-Cal or your Medi-Cal plan does not need to wait for approval for services related to COVID-19 treatment.
Another program called the COVID-19 Uninsured Program12 is available for California residents who have no insurance, currently have private insurance that does not cover diagnostic testing, testing-related services, or treatment service for COVID-19, or who are not otherwise eligible for Medi-Cal with no share of cost (Note: If you have Medi-Cal with a share of cost, you can still apply for the COVID-19 Uninsured Group Program if you have not met your share of cost obligation for the application month.).13 Examples include people who have incomes that are too high for Medi-Cal with no share of cost, are underinsured, or are not eligible for Medi-Cal due to immigration status.14 The COVID-19 Uninsured Program is not considered a public charge for immigration purposes.
The COVID-19 Uninsured Program is temporary, health coverage that starts on the date of application and ends after the twelfth month, or when the public health emergency ends, whichever comes first.15 Eligibility for the COVID-19 Uninsured Program can be retroactive to April 8, 2020.16 The application for this program is only available by visiting a qualified Medi-Cal provider. To find the nearest qualified provider, call the Medi-Cal Nurse Line at (877) 409-9052 and ask for help finding a qualified COVID-19 Uninsured Program provider. This number is staffed 24/7 and translation services are available. You can also search online for providers at this webpage: https://cadhcs.maps.arcgis.com/apps/webappviewer/index.html?id=62f87cad….
The COVID-19 Uninsured Program pays for COVID-19 treatment. If you were found eligible for the COVID-19 Uninsured Program but you are receiving bills for COVID related services, then you should contact COVIDApps@dhcs.ca.gov.
Medi-Cal Eligibility during the COVID-19 Public Health Emergency
Changes to your Medi-Cal Eligibility
During the public health emergency, the state will continue all Medi-Cal coverage until the end of the COVID-19 public health emergency.17 Counties must ensure people keep their Medi-Cal.18 This means Counties should not terminate or decrease your Medi-Cal benefits.19
If your Medi-Cal benefits terminated or decreased after April 1, 2020, then you should call your County to request that your Medi-Cal be reinstated back to April 1, 2020.20 For this request, Counties should not require you to submit additional documents, verifications and/or information to reinstate your benefits.21 Counties must prioritize these requests to reinstate Medi-Cal benefits that have been terminated or decreased.22 In addition, you may flag the county’s erroneous decrease or termination of Medi-Cal benefits for the Department of Health Care Services (DHCS) by sending an email to email@example.com. In the initial email to DHCS, do not share your personal and confidential information. Instead, ask DHCS to send you an encrypted email response so you can share your specific confidential information.
If you received a Medi-Cal renewal packet after March 17, 2020, and you choose to send your renewal information, then your county worker might not process it right away.23
However, if your renewal information would result in a beneficial Medi-Cal action or an increase in Medi-Cal benefits, then the County should prioritize processing your information.24 For example, the county should prioritize processing information that would: move a person from Medi-Cal with a Share of Cost to Medi-Cal with no Share of Cost; move a person from restricted-scope Medi-Cal to full-scope Medi-Cal, etc.
If the information provided would result in a negative Medi-Cal action, then the negative action will be suspended until the COVID-19 public health emergency ends. Again, this is because counties cannot terminate or decrease your Medi-Cal benefits during the COVID-19 public health emergency.25
For more information about Medi-Cal eligibility during the public health emergency, review our publication, “COVID-19: Medi-Cal Applications and Eligibility” found at https://www.disabilityrightsca.org/post/coronavirus-medi-cal-applicatio….
Changes to Medi-Cal Services Because of COVID-19
Important: now is not the time for our medical community to ration care for people with disabilities. In response, the State of California clarified that “rationing care based on a person’s disability status is impermissible and unlawful under both federal and state law.”26 For more information, go to “Know Your Disability Healthcare Rights” for more information: https://dredf.org/wp-content/uploads/2020/03/DREDF-Know-Your-Rights-COV… or https://dredf.org/wp-content/uploads/2020/03/DREDF-Know-Your-Rights-COV…;
Medi-Cal is giving additional services to people who receive Medi-Cal due to the COVID-19 public health emergency.
Nurse phone line: The toll-free phone line is called the “Medi-Nurse” line. It is for Medi-Cal patients without a health plan (fee for service) and uninsured Californians. The “Medi-Nurse” line is 1-877-409-9052. It is available 24 hours a day for 7 days a week for COVID-19 concerns or for general medical issues.
Phone lines to call if you cannot reach your doctor: Some doctor’s offices in your area may be closed for now due to the COVID-19 public health emergency.
- If you are in a managed care plan, call your health plan to find out your choices. Your health plan can help you find the best way to get medical care. If you need more help, call the DHCS Ombudsman, Monday through Friday, 8 a.m. to 5 p.m. at 1-888-452-8609.
- If you get services in fee-for-service Medi-Cal and are not in a Medi-Cal health plan, you can get help to find a Medi-Cal provider. Call the DHCS COVID Line at 1-877-409-9052.
Durable Medical Equipment (DME)
Medi-Cal will replace DME that is lost, damaged or unusable due to COVID-19. DME are items such as braces and wheelchairs. During the public health emergency, Medi-Cal is not requiring a face-to-face meeting, a new doctor’s order, or new medical necessity documentation to replace DME due to COVID-19 during this emergency.27
Prescription and Over-the-Counter Drugs
During the public health emergency, Medi-Cal has put into place special rules to make it easier to access prescription drugs.28 Medi-Cal can provide up to a 100-day supply of most prescriptions and permit early refills.29 You may also be able to obtain some prescription drugs directly from a pharmacy, rather than a provider’s office.30 Prescription drugs, supplies, and equipment can be provided by mail and home delivery at no additional cost.31 In addition, Medi-Cal will cover over-the-counter acetaminophen (Tylenol) and cough medications during the public health emergency.32 Call your doctor or Medi-Cal managed care plan for information about accessing prescription drugs.
Medi-Cal is expanding telehealth coverage.33 Telehealth helps people get services from their doctors without having to travel. Telehealth services include outpatient care, preventive services, ambulance services, and durable medical equipment like wheelchairs.34 Call your doctor or Medi-Cal managed care plan for information on telehealth.
Medi-Cal is expanding virtual communication.35 Virtual communication allows you to speak with your healthcare providers without needing a face-to-face visit. This includes visits with doctors, therapists, and specialists. Call your doctor or Medi-Cal plan for information on virtual communications.
During the public health emergency, Associate Clinical Social Worker (ACSW) and Associate Marriage and Family Therapist (AMFT) services are temporarily available to help Medi-Cal beneficiaries with behavioral health at Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs).
If you have a dental pain or a dental emergency, call your dentist’s office. If you or your dentist need more information on Medi-Cal Dental services during COVID-19 then you or your dentist can visit this website: https://www.dental.dhcs.ca.gov/DC_documents/providers/provider_bulletin…; If you do not have a dentist or your dental office is closed or cannot see you, call the Medi-Cal Dental Telephone Service Center. They can help you find a dentist. Their number is 1-800-322-6384.
Medi-Cal still pays for Non-Medical Transportation (NMT) and Non-Emergency Medical Transportation (NEMT).
Medi-Cal provides help with transportation during the COVID-19 emergency.36 This includes paying for rides to the hospital and appointments for testing or treatment in some situations.
Medi-Cal may pay for private or public transportation if you show you cannot travel without help. This could include a taxi. This is called Non-Medical Transportation.
You can get Non-Medical Transportation by:
- Calling your Medi-Cal plan and telling them you can’t get to your medical appointment without help.
- Calling your county Medi-Cal office to see if they can help you find NMT providers.
- Calling your Medi-Cal provider and ask about a transportation provider in your area.
- You can find providers here: http://dhcs.ca.gov/mymedi-cal.
In some cases, you may not be able to travel using normal public or private transportation. Medi-Cal may pay for medical transportation, such as an ambulance or wheelchair van. You must get your doctor to submit a Treatment Authorization Request (TAR) saying you need medical transportation. This is called Non-Emergency Medical Transportation.
You can get Non-Emergency Medical Transportation by:
- Calling your Medi-Cal plan. Normally, you would need a prescription from your doctor about your need for NEMT; however, this is not needed during the COVID-19 emergency.37 Instead, the doctor needs to submit a TAR for NEMT and write “Patient impacted by COVID-19” in the “Miscellaneous Information” field.38
- Calling the medical provider who prescribed NEMT. The prescribing provider will put you in touch with a transportation provider to coordinate your ride to and from your appointment(s).
See here for more information about Medi-Cal covered transportation: https://www.disabilityrightsca.org/publications/transportation-services…
Community Based Adult Services (CBAS) Centers
During the public health emergency, CBAS providers are required to conduct a COVID-19 wellness check and risk assessment for COVID-19 at least once a week, with greater frequency as needed.39
CBAS centers are reducing day center activities. CBAS centers are only offering individual activities.40 Individual activities may include one person coming to the center to pick up supplies, meals, or to get help with a shower. CBAS centers can help with home delivered meals, food items, hygiene products, medical supplies and transportation.41
CBAS Centers can give you services at your house, by phone, or video conferencing.42 CBAS at home may include nursing services and therapy.
If you have a Medi-Cal plan, then your Medi-Cal plan may conduct the CBAS eligibility determination by phone.43 If you already have CBAS through your Medi-Cal plan then the plan may extend CBAS eligibility re-determinations for up to 12 months.44
In-Home Support Services (IHSS)
IHSS helps people stay safe in their own homes. For more information on IHSS you can go here: https://www.disabilityrightsca.org/publications/in-home-supportive-serv…;
If you need more services, you should call your county now. For more information about IHSS and COVID-19, see our fact sheet here: https://www.disabilityrightsca.org/post/coronavirus-rights-of-people-wh….
Long-Term Care and Assisted Living Facilities
If you live in a long-term care or assisted living facility, you should be able to keep your COVID-19 stimulus payment or economic impact payment. This stimulus payment is a tax credit which means long-term care and assisted living facilities should not be taking that money from you, even if you get Medi-Cal.45
For more information about Medi-Cal services during the public health emergency, you can also review NHelps publication, “Advocate's Guide to Medi-Cal Services COVID-19 Addendum” found at https://healthlaw.org/wp-content/uploads/2021/08/COVID-19-Addendum-to-A….
Medi-Cal State Fair Hearings
The state will continue to have hearings. Specifically, individuals for whom the 90-day deadline would have occurred between March 1, 2020, through the end of the COVID-19 public health emergency are now allowed up to an additional 120 days to request a State Fair Hearing.46 This means that you have the initial 90-days from the date of your Notice of Action to request a hearing, plus an additional 120 days, for a total of up to 210 days.
If you filed an appeal with your Medi-Cal Managed Care Plan, then you have 240 days from the date of the Plan’s Notice of Appeal Resolution (NAR) to request a Medi-Cal State Fair Hearing.47 Through the duration of the public health emergency, your Medi-Cal Managed Care Plan must provide “Aid Paid Pending,” which means continue the service you are appealing instead of terminating, suspending, or reducing your service, if you file your appeal:
- Within 10 calendar days of the Notice of Action (NOA), or
- Prior to your Medi-Cal Managed Care Plan’s intended date of the proposed action, or
- If Medi-Cal Managed Care Plan has not made a final decision on the appeal and it is between 11 and 30 days of the NOA.48
Note: Your Medi-Cal Managed Care Plan must provide aid paid pending regardless whether you requested aid paid pending when you filed your appeal.49 The Medi-Cal Managed Care Plan is prohibited from seeking reimbursement or payment from you for aid paid pending services.50
Hearings will be only by phone until further notice.51 If you have requested an in-person hearing, then the State Hearings Division will contact you to inform you that they will be scheduling your hearing via video-conference or tele-conference.52 When the state contacts you, if you require an in-person hearing due to your disability, then let the state representative know that you need an in-person hearing as a reasonable accommodation due to your disability.
If you have already gone to hearing and you receive a negative hearing decision, then the County will delay the negative action resulting from a fair hearing decision through the duration of the COVID-19 public health emergency.53
- 1. The Biden Administration has promised states at least 60 days prior notice if it intends to end the public health emergency (PHE). The public health emergency declaration was extended. The federal statute (Section 319 of the Public Health Service Act (PHSA)) requires a determination remain in effect for 90 days or until the secretary determines that the emergency no longer exists, whichever occurs first. If the same or additional conditions continue to warrant a public health emergency, the Secretary may renew the determination for additional 90-day periods.
- 2. https://www.dhcs.ca.gov/Documents/COVID-19/COVID-19-Antibody-Testing.pdf; http://files.medi-cal.ca.gov/pubsdoco/newsroom/newsroom_30339.asp?utm_s…
- 3. https://www.dhcs.ca.gov/Documents/COVID-19/COVID-19-Antibody-Testing.pdf
- 4. https://www.cdph.ca.gov/Programs/OPA/Pages/NR20-012.aspx, APL 21-011 (March 10, 2021).
- 5. APL 20-022 (REVISED, May 5, 2021) - https://www.dhcs.ca.gov/formsandpubs/Documents/MMCDAPLsandPolicyLetters…; DHCS COVID 19 Vaccine Administration FAQ - https://www.dhcs.ca.gov/Documents/COVID-19/COVID-19-Vaccine-Administrat…; 1115 Waiver - https://www.dhcs.ca.gov/Documents/COVID-19/CA1115Waiver-COVID-19.pdf.
- 6. Note: DHCS is also seeking federal approval to cover the cost of the vaccine administration for Medi-Cal beneficiaries who are in restricted scope coverage, the COVID-19 Uninsured population and enrollees of the Family Planning, Access, Care, and Treatment (Family PACT) program. https://files.medi-cal.ca.gov/pubsdoco/newsroom/newsroom_30717_14.aspx; APL 20-022 (Dec. 28, 2020); DHCS COVID 19 Vaccine Administration FAQ - https://www.dhcs.ca.gov/Documents/COVID-19/COVID-19-Vaccine-Administrat….
- 7. APL 20-022 (REVISED, May 5, 2021), p. 5.
- 8. Note: DHCS will carve out the COVID-19 vaccine from Medi-Cal managed care health plans and will reimburse providers under the fee-for-service delivery system for both medical and pharmacy claims. APL 20-039 (Dec. 11, 2020) - https://dmhc.ca.gov/Portals/0/Docs/DO/APL20-039-COVID-19VaccineCoverage…; APL 20-022 (REVISED, May 5, 2021), p. 3.
- 9. https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/COVID-19/COVID-19Vaccin…
- 10. https://www.dhcs.ca.gov/Documents/COVID-19/COVID-19_Medi-Cal_Services_a…
- 11. https://www.dhcs.ca.gov/Documents/COVID-19/COVID-19_Medi-Cal_Services_a…
- 12. The COVID-19 Uninsured Group program is a new COVID-19 program that replaces Presumptive Eligibility (PE) for COVID-19.[xii] Information on the prior PE for COVID-19 is found at https://www.dhcs.ca.gov/Documents/COVID-19/COVID-19-Emergency-Services…; https://files.medi-cal.ca.gov/pubsdoco/newsroom/COVID19_FAQ_30339_27.pdf; http://files.medi-cal.ca.gov/pubsdoco/newsroom/COVID-19_Step_by_Step_Gu….
- 13. The COVID-19 Uninsured Group program is a new COVID-19 program that replaces Presumptive Eligibility (PE) for COVID-19.[xii] Information on the prior PE for COVID-19 is found at https://www.dhcs.ca.gov/Documents/COVID-19/COVID-19-Emergency-Services…; https://files.medi-cal.ca.gov/pubsdoco/newsroom/COVID19_FAQ_30339_27.pdf; http://files.medi-cal.ca.gov/pubsdoco/newsroom/COVID-19_Step_by_Step_Gu….
- 14. The COVID-19 Uninsured Group program is a new COVID-19 program that replaces Presumptive Eligibility (PE) for COVID-19.[xii] Information on the prior PE for COVID-19 is found at https://www.dhcs.ca.gov/Documents/COVID-19/COVID-19-Emergency-Services…; https://files.medi-cal.ca.gov/pubsdoco/newsroom/COVID19_FAQ_30339_27.pdf; http://files.medi-cal.ca.gov/pubsdoco/newsroom/COVID-19_Step_by_Step_Gu….
- 15. MEDIL 20-37 (Dec. 7, 2020); http://files.medi-cal.ca.gov/pubsdoco/newsroom/COVID-19_Step_by_Step_Gu….
- 16. MEDIL 20-37 (Dec. 7, 2020). Note: Qualified providers can submit retroactive applications to COVID19Apps@dhcs.ca.gov for review and processing.
- 17. Any beneficiaries in areas affected by public health crises or disasters that were discontinued due to not providing required documents may have their benefits reinstated to the previous benefit level and be allowed additional time to provide required documents., https://www.gov.ca.gov/wp-content/uploads/2020/03/3.17.20-N-29-20-EO.pdf. MEDIL 20-14, MEDIL 20-15
- 18. Any beneficiaries in areas affected by public health crises or disasters that were discontinued due to not providing required documents may have their benefits reinstated to the previous benefit level and be allowed additional time to provide required documents., https://www.gov.ca.gov/wp-content/uploads/2020/03/3.17.20-N-29-20-EO.pdf. MEDIL 20-14, MEDIL 20-15
- 19. MEDIL 20-07, MEDIL 20-08, MEDIL 20-14, MEDIL 20-15
- 20. MEDIL 20-07, MEDIL 20-08, MEDIL 20-14, MEDIL 20-15
- 21. MEDIL 20-25, MEDIL 20-26
- 22. MEDIL 20-08, MEDIL 20-14, MEDIL 20-15
- 23. https://www.dhcs.ca.gov/Documents/Beneficiary-Outreach-Letter.pdf
- 24. MEDIL 20-25, MEDIL 20-26
- 25. MEDIL 20-07, MEDIL 20-08, MEDIL 20-14, MEDIL 20-15
- 26. https://www.dhcs.ca.gov/Documents/COVID-19/Joint-Bullletin-Medical-Trea…
- 27. https://www.dhcs.ca.gov/Documents/COVID-19/CA-1135-Waiver-COVID-19-0316… at p. 3, and https://www.cms.gov/files/document/covid19-emergency-declaration-health… at p. 1
- 28. DHCS Fee-for-Service Pharmacy Benefit Reminders and Clarifications Updated (2020) - https://www.dhcs.ca.gov/Documents/COVID-19/Guidance-for-FFS-Pharmacy-Be…; APL 20-004 (Aug. 18, 2020) - https://www.dhcs.ca.gov/formsandpubs/Documents/MMCDAPLsandPolicyLetters….
- 29. DHCS Fee-for-Service Pharmacy Benefit Reminders and Clarifications Updated (2020) - https://www.dhcs.ca.gov/Documents/COVID-19/Guidance-for-FFS-Pharmacy-Be…; APL 20-004 (Aug. 18, 2020).
- 30. DHCS Fee-for-Service Pharmacy Benefit Reminders and Clarifications Updated (2020) - https://www.dhcs.ca.gov/Documents/COVID-19/Guidance-for-FFS-Pharmacy-Be…; APL 20-004 (Aug. 18, 2020).
- 31. California SPA #20-0024 - https://www.dhcs.ca.gov/formsandpubs/laws/Documents/SPA-20-0024-COVID-A…; DHCS Waiver of Requirement for Patient Signature On-File for Mailed or Delivered Prescriptions (2020) - https://www.dhcs.ca.gov/Documents/COVID-19/Pharmacy-In-person-Signature…;
- 32. DHCS Fee-for-Service Temporary Reinstatement of Acetaminophen, and Cough and Cold Medicines for Adults (2020) - https://www.dhcs.ca.gov/Documents/COVID-19/Coverage-of-Acetaminophen-an….
- 33. https://www.dhcs.ca.gov/Documents/COVID-19/Telehealth_Other_Virtual_Tel…
- 34. APL 10-009 https://www.dhcs.ca.gov/formsandpubs/Documents/MMCDAPLsandPolicyLetters…
- 35. https://www.dhcs.ca.gov/Documents/COVID-19/COVID-19_Medi-Cal_Services_a…
- 36. https://www.dhcs.ca.gov/Documents/COVID-19/Managed-Care-COVID-19-Memo-0…
- 37. https://www.dhcs.ca.gov/Documents/COVID-19/Updated-NMT-NewsFlash-COVID-…
- 38. https://www.dhcs.ca.gov/Documents/COVID-19/Updated-NMT-NewsFlash-COVID-…
- 39. APL 20-007 (Revised)
- 40. ACL 20-06
- 41. ACL 20-06, APL 20-007 (Revised)
- 42. ACL 20-06
- 43. APL 20-007 (Revised)
- 44. APL 20-007 (Revised)
- 45. https://www.consumer.ftc.gov/blog/2020/05/did-nursing-home-or-assisted-…, https://www.cms.gov/newsroom/press-releases/nursing-home-residents-righ….
- 46. https://www.dhcs.ca.gov/Documents/COVID-19/State-Fair-Hearing-Timeframe…
- 47. APL 17-006 Supplement: https://www.dhcs.ca.gov/formsandpubs/Documents/MMCDAPLsandPolicyLetters…
- 48. APL 20-004 (REVISED – March 9, 2021), p. 3.
- 49. Id.
- 50. Id.
- 51. https://acms.dss.ca.gov/acms/login.request.do
- 52. Executive Order N-63-20, see #11 - https://www.gov.ca.gov/wp-content/uploads/2020/05/5.7.20-EO-N-63-20-tex…
- 53. MEDIL 20-18, MEDIL 20-25, MEDIL 20-2