Medi-Cal is working closely with county eligibility offices, Medi-Cal managed care plans, county behavioral health agencies, and providers to ensure individuals and families affected by the disaster can quickly access the care and resources they need. DHCS has implemented several key flexibilities to streamline enrollment, extend benefits, and expedite access to critical health services for impacted communities.
Additionally, Medi-Cal managed care plans that operate in the areas subject to the emergency, including L.A. Care, Health Net, Molina, Gold Coast Health Plan, Kaiser Permanente, Anthem, Blue Shield of California Promise Health Plan and Senior Care Action Network, have activated their emergency response protocols. Protocols include deploying care management teams to conduct member outreach, especially for high-needs populations; waiving prior authorization requirements; providing transportation to care; and ensuring members do not face out-of-pocket costs for receiving care from out-of-network providers, as needed.
Eligibility and Enrollment
- DHCS issued Medi-Cal Eligibility Division Information Letter (MEDIL) 25-02 and 25-03 to provide reminders to counties on processing applications, delaying disenrollments, and reinstating coverage for individuals affected by the wildfires.
- Medi-Cal members in Los Angeles County, who reside in areas affected by the wildfires, with eligibility renewals in February, March, and April 2025 will have their renewals extended for six months. Also, Medi-Cal members who were disenrolled in January 2025 for being unable to return their Medi-Cal eligibility renewal packet will be reinstated immediately with no gap in their Medi-Cal coverage/benefits. Bulletin
- Families in affected areas can quickly enroll or renew Medi-Cal coverage, with streamlined processes to minimize delays in accessing care.
- Applicants impacted by the disaster can self-attest to residency and income when documentation is unavailable, ensuring they can secure timely coverage.
- Counties are required to extend benefits for affected populations, ensuring uninterrupted access to Medi-Cal services throughout the emergency.
- Applicants impacted by the disaster are provided additional time to submit verifications.
- When documentation is unavailable, applicants may self-attest to California residency and income through signed affidavits under penalty of perjury.
- Medi-Cal members needing assistance with their Medi-Cal eligibility can also contact a local clinic navigator.
Clinics and Facilities
- Allow clinics to deliver care in alternative settings, such as mobile clinics or temporary locations, when primary facilities are damaged or inaccessible.
Pharmacy (Medi-Cal Rx)
- Medi-Cal members can go to any Medi-Cal enrolled pharmacy.
- Waived in-person signature requirements for prescriptions.
- Enabled emergency overrides for pharmacy claims, allowing early refills and bypassing prior authorizations in disaster zones.
- Medi-Cal members can also use the emergency pharmacy locator, Rx Open 3.0 - Healthcare Ready, to find a nearby pharmacy.
Medi-Cal Dental
Durable Medical Equipment
- Streamlined authorization processes to ensure immediate dispensing of durable medical equipment to displaced members.
- Providers are authorized to submit claims under emergency provisions, enabling swift response to needs in disaster-impacted areas.
Managed Care Plan Flexibilities
Home and Community-Based Services
- Extend timelines for initial evaluations, reassessments, and care plan reviews to ensure uninterrupted care for individuals who need ongoing support due to age, disability, or chronic illness. Allow delivery of long-term services and supports in alternative locations, such as shelters or hotels.
Protections for Medi-Cal Members
- Extended timelines for fair hearing requests and benefit reinstatements, giving Medi-Cal members additional time to resolve eligibility or benefits issues.
- Adjusts home health service requirements to allow delays in face-to-face encounters due to current constraints.
Provider Support
- Expedite and streamline provider enrollment to make it easier for providers to offer care to impacted members.
- Impacted Medi-Cal providers received extensions for reporting deadlines, including cost reporting, administrative hearings, and scope-of-service changes, to prioritize care delivery during the emergency.
Intercounty Transfers
- Medi-Cal members in Los Angeles and Ventura counties who are displaced for an unknown amount of time may contact either their former county of residence or the new county to assist with transferring the case on a permanent or short-term basis. Members can visit the DHCS website to find their local county office.
