CALIFORNIA WORKS TO EXPAND SUPPORT FOR MEDI-CAL MEMBERS IMPACTED BY SOUTHERN CALIFORNIA WILDFIRES
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:
- Support for 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.
- Authorize full reimbursement for services provided in temporary care settings, including shelters and hotels.
- Additional protections for Medi-Cal members:
- Extend timelines for fair hearing requests and benefit reinstatements, giving Medi-Cal members additional time to resolve eligibility or benefits issues.
- Adjust home health service requirements to allow delays in face-to-face encounters due to current constraints.
- Medi-Cal provider enrollment and reimbursement:
- Expedite and streamline provider enrollment to make it easier for providers to offer care to impacted members.
- Flexibility for long-term services and supports (LTSS):
- 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 LTSS in alternative locations, such as shelters or hotels.
- Extensions for reporting and claiming requirements:
- Grant extensions for data reporting and claims submission, allowing impacted local agencies and educational institutions to meet deadlines.
- Allow health plans more flexibility in meeting reporting requirements to ensure they can continue serving members if the wildfires disrupt normal operations. Adjustments include adjusting rules about how far members may need to travel for care and how quickly they can access 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.Through coordinated efforts with state, local, federal, and Tribal partners, DHCS ensures that vital health care services remain accessible and timely for affected individuals. DHCS leverages the expertise of its teams and the flexibility of emergency regulations to address the unique needs of Southern California communities, from facilitating access to medical care and behavioral health services to ensuring the availability of medications and durable medical equipment.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. MORE INFORMATION: Resources and updates are available at the following links:Get help today:- Californians can visit CA.gov/LAfires, a hub for information and resources from state, local, and federal governments.
- Individuals and business owners sustaining losses from wildfires can apply for disaster assistance:
- Online at DisasterAssistance.gov.
- By calling 800-621-3362.
- By using the Federal Emergency Management Agency (FEMA) smartphone application.
- Assistance is available in more than 40 languages.
- If you use a relay service, such as video relay service, captioned telephone service, or others, give FEMA the number for that service.