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ACA Expansion of Medi-Cal Beneficiaries to Include Low-Income Adults

October 4, 2013

In compliance with the Patient Protection and Affordable Care Act (ACA), Section 2001, and the provisions of Welfare and Institutions Code (W&I Code), Section 14132.02(a), state Medicaid agencies are required to design and implement the Alternative Benefit Plan (also referred to as “benchmark” or “benchmark-equivalent” medical coverage) for specific groups of newly eligible adults, ages 19 – 64. The Department of Health Care Services (DHCS) will submit a State Plan Amendment to the Centers for Medicare & Medicaid Services.

The State of California intends to provide the same schedule of benefits provided to full-scope Medi-Cal beneficiaries to newly eligible adults qualifying under the modified adjusted gross income standard. Also in accordance with W&I Code, Section 14132.02(b), DHCS will seek federal approval to provide coverage for long-term services and supports for newly eligible adults who meet established asset requirements in accordance with current program policy.

Additional information will be released in a future Medi-Cal Update.