Medi-Cal  

  • In California: Cost-sharing is zero for all medically necessary screening and testing for the COVID-19. Commercial and public health insurance plans have been directed to reduce cost-sharing to zero including for emergency room, urgent care or provider office visits when the purpose of the visit is to be screened and tested for COVID-19. See: DMHC All Plan Letter (PDF)Insurance Commissioner Bulletin. It is now up to Medicare to provide no-cost testing as well. 

  • DHCS UPDATED COVID-19 Screening and Testing  

  • Other DHCS guidance: https://www.dhcs.ca.gov/Pages/DHCS-COVID%E2%80%9119-Response.aspx  

  • 03-17-20 DHCS federal 1135 waiver request provides (amongst other things):   

  • Greater provider flexibility for billing for tele-health, other COVID related services.   

  • Eases prior authorization rules for certain COVID-19 services  

  • Allows COVID-19 testing and any medically necessary follow-up care to be considered as “emergency services” even if they do not occur in a hospital emergency room. These services would be free of cost to all Medi-Cal beneficiaries, even the small percentage whose income places them in a group that normally must pay a share of cost.    

  • Expenditure authority related to temporary housing for homeless, as necessary for quarantining, isolating, or treating individuals who test positive for COVID-19 or who have had a high-risk exposure and are thought to be in the incubation period.    

  • Expanding presumptive eligibility to people who are over 65 or disabled, allowing hospitals to quickly enroll them into Medi-Cal coverage.  

  

  • 03-18-20 Executive Order waives eligibility re-determinations for 90 days for Californians who participate in:   

  • Medi-Cal health coverage  

  • CalFresh food assistance  

  • CalWORKs  

  • Cash Assistance for Immigrants; and  

  • In-Home Supportive Services  

  

Covered California  

  • Covered California What You Should Know About Coronavirus (COVID-19): English Spanish 

  • Update from Doreena @AJLA: Big news about Covered CA - because of the COVID-19 crisis, enrollment into Covered CA has been extended until June 30, 2020 with no need for a qualifying life event!!! Although we know it is challenging to enroll community members given the "shelter-in" restriction but we can still help clients enroll and provide assistance over the telephone and online. If you have come up with innovative ways to continue enrolling community members, please share!  

  • Notes shared by Jen @WCLP per Governor’s call on 3-19-2020 

  • Covered California Service centers are moving to working from home – do not have capability today to have service centers working from home.  Fresno still somewhat operating.  Rancho is not.  On crash course right now to set up the service centers remotely given the expected surge in calls.  Hoping to get 100 call-center staff working from home by Monday but no guarantees.  Consumers are being directed to health plans right now. 

  • Kaiser – converting as much care as possible to telehealth, allow online booking, turned off request for face to face care to better screen who should be coming in.  Limiting access on campuses, single point of entry to sort who should go in and where.  Reinforcing use of mail order pharmacies to limit in-person traffic.  Physicians reviewing all cases prior to cancellation and communicating directly with the patients. Reviewing prioritization on a daily basis. Postponing elective surgeries (anything not urgent) and GI procedures for at least next two weeks.  Repurposing physicians – have website, including info coping w/ mental health stresses, tool online for members to enter information and determine previously moved physicians between primary and emergency care given the integrated nature of their network. 

  • Blue Shield – complying w/ all mandated cost sharing waivers, encouraging teledoc/telehealth, dedicated covid-19 appropriate health setting to seek health to take some pressure of hospital phone lines, working to support Cov CA’s call center staff.  Lifted restrictions on Rx to allow for 90-days supplies and earlier refills.  Ensuring that members aren’t being terminated. 

  • Health Net – complying w/ all mandated cost sharing waivers, ad hoc telephonic & telehealth being done by providers.  (Less coordinated given nature of the network) 

  • Plans on the call are all reported following grace period rules and continuing to pay claims during the grace period anticipating that many consumers will have drops in income.  

  • I’m guessing we’ll be seeing similar across plans as things move along and this is likely how things are working for Medi-Cal and employer-based insurance as well. Consumers should absolutely be calling their provider, or if they can’t get through, their plan, if they need care.  Expect waits for anything not urgent and providers will be trying to do as much as possible over the phone or via webcam.