Inicio Noticias California trabaja para ampliar el apoyo a los afiliados a Medi-Cal afectados por incendios forestales en el sur de California​​ 

California trabaja para ampliar el apoyo a los miembros de Medi-Cal afectados por los incendios forestales del sur de California​​ 

17de enero de 2025​​ 

SACRAMENTO — In response to the devastating Southern California wildfires and Governor Gavin Newsom’s proclaimed State of Emergency and Executive Order issued on January 7, 2025, the Department of Health Care Services (DHCS) swiftly implemented key administrative flexibilities to protect Medi-Cal members in affected regions of the state. These efforts include simplified Medi-Cal enrollment and renewal processes, waived requirements to access prescription medications and medical devices, and other flexibilities to ensure all Medi-Cal members have access to care during this emergency.​​ 

Help for Medi-Cal members in Los Angeles County and Ventura County includes:​​ 

  • Simple renewal and enrollment: Simplified Medi-Cal enrollment and renewal processes to allow families to quickly secure or maintain Medi-Cal coverage. Allowed for self-attestation for residency and income if documentation is missing, and verification deadlines are extended. Local county offices are prioritizing Medi-Cal applications and any case restorations for affected Medi-Cal members, who are encouraged to contact their local clinic navigators or local county office if assistance is needed to resolve eligibility issues.​​ 
  • Fast refills for pharmacy and medical equipment: Waived prescription signature requirements for Medi-Cal members. Released a provider alert to allow for early refill authorizations and emergency override of existing utilization management and prior authorization controls to facilitate expedited access to medications and pharmacy products to ensure timely care.​​ 
  • Prioritized member transfers if moving out of Los Angeles or Ventura counties: Medi-Cal members 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.​​ 
  • Emergency response protocols: Medi-Cal managed care plans that operate in the areas subject to the emergency, including L.A. Care Health Plan, Health Net, Molina Healthcare, Gold Coast Health Plan, Kaiser Permanente, Anthem, Blue Shield of California Promise Health Plan, Senior Care Action Network, and Positive Healthcare California (AIDS Healthcare Foundation), 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; working to provide transportation to care; and ensuring members do not face any out-of-pocket costs for getting care from out-of-network providers, as needed.​​ 

DHCS understands recovering from these wildfires will be challenging and has developed an online resource to help answer Medi-Cal member questions about accessing services during this emergency.​​ 

Current flexibilities for Medi-Cal managed care plans and providers include:​​ 

  • Behavioral health services: Ensured relocated clients from evacuated facilities receive continuous care, with licensing and certification flexibilities supporting affected treatment programs.​​ 
  • Provider support: Extended reporting and administrative deadlines, enabling Medi-Cal providers to prioritize care delivery until the end of the emergency.​​ 
  • Managed care flexibility: Waived prior authorizations and referral requirements for applicable services to help Medi-Cal managed care plans and their network providers deliver timely care to members affected by evacuations and service disruptions.​​ 

Additionally, DHCS submitted requests to the federal Centers for Medicare & Medicaid Services (CMS) to help Californians covered by Medi-Cal impacted by the Southern California wildfires. Section 1135 of the Social Security Act provides flexibility during national public health emergencies.​​ 

“At DHCS, our members are our top priority, and our hearts go out to the families affected by the Southern California wildfires,” said DHCS Director Michelle Baass. “We are working closely with CMS to obtain speedy federal approvals for flexibilities to help our state and Medi-Cal members meet the challenges posed by the wildfires. We will continue to issue guidance to providers so they can quickly take advantage of the new flexibilities to deliver quality, equitable health care to Southern Californian Medi-Cal members.”​​ 

Significant additional flexibilities requested by DHCS include:​​ 

  • Apoyo a clínicas e instalaciones:​​ 
    • Permitir que las clínicas brinden atención en entornos alternativos, como clínicas móviles o ubicaciones temporales, cuando las instalaciones primarias estén dañadas o sean inaccesibles.​​ 
    • Autorizar el reembolso completo de los servicios prestados en entornos de cuidado temporal, incluidos refugios y hoteles.​​ 
  • Protecciones adicionales para los miembros de Medi-Cal:​​ 
    • Ampliar los plazos para las solicitudes de audiencias justas y el restablecimiento de beneficios, dando a los miembros de Medi-Cal tiempo adicional para resolver problemas de elegibilidad o beneficios.​​ 
    • Ajustar los requisitos del servicio de atención médica en el hogar para permitir retrasos en los encuentros cara a cara debido a las limitaciones actuales.​​  
  • Inscripción y reembolso de proveedores de Medi-Cal:​​ 
    • Acelere y agilice la inscripción de proveedores para que sea más fácil para los proveedores ofrecer atención a los miembros afectados.​​ 
  • Flexibilidad para servicios y soportes a largo plazo (LTSS):​​ 
    • Ampliar los plazos para las evaluaciones iniciales, las reevaluaciones y las revisiones de los planes de atención para garantizar la atención ininterrumpida de las personas que necesitan apoyo continuo debido a la edad, la discapacidad o la enfermedad crónica.​​ 
    • Permitir la entrega de LTSS en lugares alternativos, como refugios u hoteles.​​ 
  • Extensiones para los requisitos de informes y reclamaciones:​​ 
    • Extensiones de subvenciones para la presentación de informes de datos y reclamaciones, lo que permite a las agencias locales e instituciones educativas afectadas cumplir con los plazos.​​ 
    • Permitir que los planes de salud tengan más flexibilidad para cumplir con los requisitos de presentación de informes para garantizar que puedan continuar sirviendo a los miembros si los incendios forestales interrumpen las operaciones normales. Los ajustes incluyen el ajuste de las reglas sobre la distancia que los miembros pueden necesitar viajar para recibir atención y la rapidez con la que pueden acceder a LTSS.​​ 

DHCS is dedicated to safeguarding the health and well-being of Medi-Cal members and communities suffering from the devastating effects of the Southern California wildfires. DHCS’ purpose extends beyond routine health care services, focusing on proactive planning, rapid response, and continuous support in the face of challenges like these wildfires.​​ 

A través de esfuerzos coordinados con socios estatales, locales, federales y tribales, el DHCS garantiza que los servicios vitales de atención médica sigan siendo accesibles y oportunos para las personas afectadas. DHCS aprovecha la experiencia de sus equipos y la flexibilidad de las regulaciones de emergencia para abordar las necesidades únicas de las comunidades del sur de California, desde facilitar el acceso a la atención médica y los servicios de salud conductual hasta garantizar la disponibilidad de medicamentos y equipos médicos duraderos.​​ 

BACKGROUND: On January 8, 2025, in response to the catastrophic wildfires in Southern California, President Joseph R. Biden, Jr. declared that a major disaster exists in the State of California in the areas affected by wildfires. On January 10, 2025, U.S. Department of Health & Human Services Secretary Xavier Becerra declared a public health emergency for California, granting CMS additional flexibility to address the health needs of impacted individuals. These measures were made possible through extensive preparedness planning and proactive emergency response protocols. These efforts underscore a strong state and federal partnership, ensuring uninterrupted care and services during this emergency.​​ 

DHCS administers Medi-Cal, California’s version of Medicaid, providing health coverage to nearly 15 million people, including nearly 4 million members in Los Angeles County and more than 250,000 members in Ventura County.​​ 

DHCS encourages all affected residents to follow local evacuation orders, monitor air quality, and wear masks outdoors, if needed. If Medi-Cal members need assistance, they should contact their health care provider or plan.​​  

MÁS INFORMACIÓN: Los recursos y las actualizaciones están disponibles en los siguientes enlaces:​​ 

Obtenga ayuda hoy mismo:​​ 

  • Californians can visit CA.gov/LAfires, a hub for information and resources from state, local, and federal governments.​​ 
  • Las personas y los propietarios de negocios que sufran pérdidas por incendios forestales pueden solicitar asistencia por desastre:​​ 
  • En línea en DisasterAssistance.gov.​​ 
  • Llamando al 800-621-3362.​​ 
  • Mediante el uso de la aplicación para teléfonos inteligentes de la Agencia Federal para el Manejo de Emergencias (FEMA).​​ 
  • La asistencia está disponible en más de 40 idiomas.​​ 
  • Si utiliza un servicio de retransmisión, como el servicio de retransmisión de video, el servicio telefónico con subtítulos u otros, proporcione a FEMA el número de ese servicio.​​ 

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CONTACTO:​​ 
Office of Communications
(916) 440-7660
www.dhcs.ca.gov​​