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Affordable Care Act

Under the Affordable Care Act (ACA), states were authorized to expand Medicaid, effective January 1, 2014, to many low-income individuals under age 65 who were previously ineligible for coverage. The ACA established a new income eligibility limit of 138 percent of the federal poverty level, increasing the number of Californians eligible.  As of March 2016, more than 4.7 million Californians have begun receiving comprehensive health care benefits provided by Medi-Cal since the ACA was implemented.  

 
The Department of Health Care Services’ (DHCS) vision is to preserve and improve the physical and mental health of all Californians, and the department’s mission is to provide Californians with access to affordable, high-quality health care, including medical, dental, mental health, substance use treatment services, and long-term care.  The ACA's expansion of Medi-Cal allows California to make significant strides toward supporting a healthier, more productive state.  Medi-Cal also assists the most vulnerable among us, whose circumstances may prevent them from accessing health coverage or vital health care services.  Below are various programs and services members are benefitting from as a result of the ACA.

 

Individuals

Hospital Presumptive Eligibility Program
The Hospital Presumptive Eligibility (PE) program, effective January 1, 2014, provides individuals with temporary, no-cost Medi-Cal benefits for up to two months.

Medi-Cal Eligibility and Covered California
DHCS has partnered with Covered California to create an online “one-stop shop” for health coverage. 

Medi-Cal Eligibility and Covered California FAQs
DHCS has developed frequently asked questions for current and potential Medi-Cal coverage recipients to help them access the care they need.

Counties

The County Eligibility & Enrollment (E&E) Workgroup is responsible for providing a way for DHCS, counties, SAWS Consortia, the Department of Social Services, and others to identify and assess issues related to ACA-driven changes in Medi-Cal eligibility, enrollment, and case management that impact county eligibility operations, system development, and program fiscal needs.
 
As part of California’s efforts to implement the ACA, the Legislature and Governor, authorized by Assembly Bill (AB) 82, have approved a proposal to accept private foundation funds with a 1:1 federal match.

Stakeholders

The redirection of 1991 State Health Realignment includes the ACA.
 
The California Mental Health Planning Council is mandated by federal and state law to advocate for children with serious emotional disturbances and adults and older adults with serious mental illness.  The council provides oversight and accountability for the public mental health system, advises the Administration and Legislature on priority issues, and participates in statewide planning.
 
Medi-Cal has implemented new programs as part of the enactment of the ACA.

Providers

Effective July 1, 2012, all providers are required to report provider-preventable conditions that occur during the treatment of Medi-Cal patients.
 
The Centers for Medicare & Medicaid Services published a final rule on February 2, 2011, in the Federal Register (42 CFR Parts 405, 424, 447 et al.) with provisions to be implemented as they relate to Medicare, Medicaid, and Children’s Health Insurance Programs for provider screening and prevention of provider fraud and abuse.  This rule implemented provisions of the ACA.
 
Last modified on: 3/15/2016 10:05 AM