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24-072m Medi-Cal Expands Coverage to Adults Ages 26-49, Effective January 1, 2024

Date: 02/02/24

Adults ages 26 to 49 may now qualify for full Medi-Cal coverage, no matter their immigration status

As of January 1, 2024, a new law in California gives full Medi-Cal coverage to adults ages 26-49, regardless of immigration status. All other Medi-Cal eligibility rules, including income limits, still apply.​​This new coverage is referred to as the Age 26-49 Adult Expansion.

Much of this adult expansion population is presently served through county uninsured programs for the uninsured and low-income populations and public health care systems. As these individuals transition from county uninsured programs and public health care systems to full scope Medi-Cal, California has prioritized two goals:

  1. Maintain primary care provider (PCP) assignment to the maximum extent possible for the adult expansion population; and
  2. Support and strengthen traditional county health providers who treat a high volume of uninsured and Medi-Cal patients.

How does this affect providers?

On or after January 1, 2024, providers may see an increase in the number of Health Net, on behalf of Community Health Plan of Imperial Valley, Medi-Cal patients they serve.

Coordination of transition and service

The Plan and its delegated participating physician groups (PPGs) are required to maintain PCP assignments to minimize disruptions in services. The Plan and delegated PPGs must:

  • Put into effect a data sharing process with the county uninsured programs and public health care systems that currently serve the adult expansion population.
  • Accept data from, transmit data to, and coordinate with, the county uninsured programs and public health care systems. 
  • Designate a point of contact for the county uninsured programs and public health care systems. 
  • Engage with all such organizations that are able and willing to share data per the requirements detailed in the Department of Health Care Services’ (DHCS’) All Plan Letter (APL) 23-031.
  • Review and use the data provided by the county uninsured programs and public health care systems to assign PCPs for these members.

Data sharing requirements

Health care providers, health plans, and health care clearinghouses are considered covered entities and must ensure compliance with the Health Insurance Portability and Accountability Act (HIPAA) privacy and security rules. Covered entities are permitted to share health care data with other covered entities for treatment, payment or health care operations purposes.

The Plan and its delegated PPGs must begin accepting data from county uninsured programs and public health care systems immediately and continue accepting data through June 30, 2024, as necessary.

For information on data transmission requirements, refer to APL 23-031 (PDF).

Who is impacted by this expansion?

  1. New enrollee population. Individuals who are:
    • Ages 26 through 49 in January 2024.
    • Not currently enrolled in full scope Medi-Cal, but who may apply for Medi-Cal after January 1, 2024.
    • Qualified under any eligibility group, including Modified Adjusted Gross Income (MAGI) and Non-MAGI, except for satisfactory immigration status.
  2. Transition population. Individuals who are:
    • Ages 26 through 49.
    • Currently enrolled in restricted scope Medi-Cal because they do not have satisfactory immigration status or are unable to establish satisfactory immigration status for full scope Medi-Cal under any eligibility group, including MAGI and Non-MAGI, before January 1, 2024.

Impact on immigration status

Using Medi-Cal benefits under this expansion does not affect an individual's immigration status, in accordance with the U.S. Department of Homeland Security and the U.S. Citizenship and Immigration Services guidelines.

Learn more

For more detailed information on the New Medi-Cal Adult Expansion for Individuals Aged 26-49, refer to DHCS announcements, FAQs and general information notice at Ages 26 through 49 Adult Full Scope ​Medi-Cal Expansion.

Additional Information

Providers are encouraged to access the provider portal for real-time information, including eligibility verification, claims status, prior authorization status, plan summaries, and more.
If you have questions regarding the information contained in this update, contact Community Health Plan of Imperial Valley at 833-236-4141.

 

This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, Ancillary Providers, Community Supports (CS) Providers, and Enhanced Care Management (ECM) Providers.

This information applies to Medi-Cal in Imperial county.
 



Last Updated: 01/29/2024