加州努力擴大對受南加州野火影響的 Medi-Cal 成員的支持
一月 17, 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:
- 對診所和設施的支持：
- 當主要設施受損或無法訪問時，允許診所在其他環境（例如移動診所或臨時地點）提供護理。
- 授權在臨時護理環境中提供的服務，包括庇護所和酒店的全額補償。
- 為 Medi-Cal 會員提供的其他保護措施：
- 延長公平聆訊要求和福利恢復的時間表，讓 Medi-Cal 會員更多時間解決資格或福利問題。
- 調整家庭健康服務要求，以允許由於當前的限制而導致面對面對面的延遲。
- Medi-Cal 提供者註冊和退款：
- 加快並簡化提供者註冊，以使提供者更輕鬆地為受影響的會員提供護理。
- 長期服務和支持的靈活性（LTSS）：
- 延長初始評估、重新評估和護理計劃審查的時間表，以確保因年齡、殘疾或慢性疾病而需要持續支援的個人提供不間斷的照護。
- 允許在其他位置（例如避難所或酒店）交付 LTSS。
- 報告和索償要求的延伸功能：
- 授予資料報告和索償提交延伸功能，讓受影響的當地機構和教育機構能夠遵守截止日期。
- 讓健康計劃更靈活地滿足報告要求，以確保如果森林火災中斷正常運作時，他們可以繼續為成員服務。 調整包括調整有關會員可能需要多遠前往護理以及他們可以使用 LTSS 的速度的規則。
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.
通過與州、地方、聯邦和部落合作夥伴的協調努力，DHCS 確保重要的醫療保健服務可供受影響個人獲得和及時。 DHCS 利用其團隊的專業知識和緊急法規的靈活性來滿足南加州社區的獨特需求，從促進獲得醫療護理和行為健康服務到確保藥物和耐用醫療設備的可用性。
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.
更多資訊：資源和更新可透過以下連結取得：
- DHCS 南加州火災應變
- DHCS 緊急和災難協助信息常見問題解答
- 加州衛生 & 人類服務局緊急資源指南
- 加州老齡部緊急準備指南
- 卡爾霍普熱線和心理健康支持
- 中醫會會員協助
- 加州移民災民災害援助服務指南（英文/西班牙文）
- 當地縣政府目錄
- 診所健康註冊導航員
- 福利：Medi-Cal 會員可以訪問 BenefitsCal 更新聯繫信息。
立即取得協助：
- Californians can visit CA.gov/LAfires, a hub for information and resources from state, local, and federal governments.
- 因野火而遭受損失的個人和企業主可以申請災難援助：
- 在線，在災難協助。gov。
- 通過致電 800-621-3362。
- 通過使用聯邦緊急管理局（FEMA）智能手機應用程序。
- 提供超過 40 種語言的協助。
- 如果您使用轉送服務，例如視訊轉送服務、標題電話服務或其他服務，請為 FEMA 提供該服務的號碼。
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聯繫人：
Office of Communications
(916) 440-7660
www.dhcs.ca.gov