DHCS Seeks Section 1115 Amendment on Asset Limits

This week, the California Department of Health Care Services (DHCS) submitted to the U.S. Centers for Medicare and Medicaid Services (CMS) an application to amend the California Advancing and Innovating Medi-Cal (CalAIM) Section 1115 demonstration to increase and eventually eliminate asset limits for certain low-income individuals whose eligibility is not determined using the modified adjusted gross income (MAGI)-based financial methods.

AB 133 (Chapter 143, Statutes of 2021) directed DHCS to seek federal approval to implement a two-phased approach to increase and eventually eliminate the asset limits for non-MAGI coverage groups. Under Phase I, effective July 1, 2022, DHCS must apply a disregard of $130,000 in nonexempt property for a single Medi-Cal enrollee and $65,000 for each additional household member, up to a maximum of ten members. Under Phase II, effective January 1, 2024, DHCS must eliminate the asset test for non-MAGI Medi-Cal programs.

To date, DHCS has submitted and CMS approved State Plan Amendment (SPA) 21-0053 to implement the resource disregard under Phase I to increase asset limits for most non-MAGI coverage groups. DHCS has not yet submitted to CMS a SPA for Phase II but intends to do so in the near future. However, because the statutory authority to apply disregards is limited to certain enumerated coverage groups, SPA 21-0053 does not apply to “Deemed Supplemental Security Income (SSI) groups,” specifically those mandatory Medi-Cal eligibility groups comprised of individuals who would be eligible for Medicaid if they were receiving SSI and/or State Supplementary Payments, but are not longer receiving such payments and are thus “deemed” eligible for Medi-Cal. Therefore, to maintain access to coverage for individuals in the Deemed SSI groups under both phases, DHCS is requesting that CMS approve a Section 1115 demonstration amendment to permit the state to increase and eventually eliminate asset test limits for these groups.

Additional information from DHCS is available here.