CALIFORNIA SECURES FEDERAL APPROVAL OF FLEXIBILITIES TO HELP MEDI-CAL MEMBERS AND PROVIDERS AFFECTED BY THE SOUTHERN CALIFORNIA WILDFIRES
SACRAMENTO — In response to the Southern California wildfires, the Department of Health Care Services (DHCS) requested and received federal approval from the Biden-Harris administration of several dozen flexibilities to prevent disruptions in health care delivery so Medi-Cal members can continue to receive needed care. 1135 waivers allow the U.S. Department of Health and Human Services (HHS) to waive various administrative requirements to increase access to medical services during a time of national emergency. 1135 waiver approvals remain in effect throughout the duration of the public health emergency declared by former HHS Secretary Xavier Becerra, which is 90 days.
“DHCS is committed to helping Californians access the care they need during this devastating crisis and as communities begin to emerge and recover," said
State Medicaid Director Tyler Sadwith. “The waivers granted by our federal partners will provide the necessary flexibilities for health care providers to address the immediate needs of Medi-Cal members. Whether it's ensuring continued access to clinic services in alternative settings, providing targeted flexibilities for home and community-based services, or streamlining provider enrollment, these measures are designed to remove barriers to care and support both patients and frontline providers during this emergency and throughout the recovery process."
Key flexibilities include:
- Protections for Medi-Cal Members: Extends 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.
- Flexibility in Provider Enrollment: Expedites and streamlines provider enrollment to make it easier for providers to offer care to impacted members.
- Flexibility for Home and Community-Based Services: Extends 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. Allows delivery of long-term services and supports in alternative locations, such as shelters or hotels.
- Support for Clinics: Allows clinics to deliver care in alternative settings, such as mobile clinics or temporary locations, when primary facilities are damaged or inaccessible.
ABOUT THE FLEXIBILITIES: Under 1135 waivers, the Centers for Medicare & Medicaid Services (CMS) is temporarily relaxing certain Medicare, Medicaid, and Children's Health Insurance Program requirements to help health care providers and facilities respond to an emergency or a disaster. Appendix K approvals provide additional flexibilities specific to home and community-based services programs. These actions are designed to reduce administrative burdens and provide flexibility in the delivery of health care during a critical time
GET HELP TODAY: Californians can visit
CA.gov/LAfires, a hub for information and resources from the state, local, and federal governments.
Covered California recently announced a special enrollment period for residents of Los Angeles and Ventura counties. This special enrollment period will last until March 8, 2025. Resources are available through
Los Angeles County and the
State of California. Of the 1.3 million uninsured Californians who qualify for subsidies through Covered California or are eligible for Medi-Cal coverage, 356,000 reside in Southern California.
California developed resources to help guide people through disasters and provide information about the different types of federal, state, and local services available in California:
Through the
BenefitsCal portal, Californians can get and manage benefits online. This includes food assistance (CalFresh, formerly food stamps), cash aid (CalWORKs, General Assistance, Cash Assistance Program for Immigrants), and affordable health insurance (Medi-Cal).
Individuals and business owners who sustained losses from the Southern California wildfires can apply for disaster assistance:
If you use a relay service, such as video relay service, captioned telephone service, or others, give FEMA the number for that service.
BACKGROUND: In response to the wildfires and Governor Gavin Newsom's proclaimed State of Emergency and Executive Order issued on January 7, 2025, DHCS swiftly implemented key administrative flexibilities to protect Medi-Cal members in affected regions of the state.
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. If Medi-Cal members need assistance, they should contact their health care provider or plan.