Family PACT Update

March 2023 | Bulletin 186

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1. 2023 Income Eligibility Guidelines for the Family PACT Program

Effective for dates of service on or after April 1, 2023, providers are to use the following income guidelines when determining recipient eligibility for the Family Planning, Access, Care and Treatment (Family PACT) Program.

Federal Income Guidelines
200 Percent of Poverty by Family Size
Effective April 1, 2023
Number of persons in family/household Monthly Income Annual Income
1 $2,430 $29,160
2 $3,287 $39,440
3 $4,143 $49,720
4 $5,000 $60,000
5 $5,857 $70,280
6 $6,713 $80,560
7 $7,570 $90,840
8 $8,427 $101,120
For each additional member, add $857 $10,280

Provider Manual(s) Updates Page(s) Updated
Family Planning, Access, Care, and
Treatment Program
client elig (9)

2. Updated Rates for Unclassified Drugs Billed with HCPCS Code J3490

Effective retroactively for dates of service on or after July 1, 2022, reimbursement rates are updated for claims billed with HCPCS code J3490 (unclassified drugs) with modifiers U5, U6, and U8 as follows:

Procedure Code with Modifier Description Rate
J3490 U5 Ulipristal Acetate, 30 mg oral $37.24
J3490 U6 Levonorgestrel, 1.5 mg oral $8.04
J3490 U8 Medroxyprogesterone acetate, 150 mg/ml injection $44.99

No action is required of providers. An Erroneous Payment Correction (EPC) will be implemented to reprocess the affected claims on or after the implementation date of the updated reimbursement rate. Providers may also elect to correct and resubmit previously denied claims as described in the CIF Submission and Timeliness Instructions section of the Provider Manual.

Providers should refer to the Medi-Cal Rates page of the Medi-Cal Providers website for other general rates information.

3. Breast and Cervical Cancer Treatment Program: End of Medi-Cal Continuous Coverage

On December 29, 2022, the Consolidated Appropriations Act of 2023 (also referred to as the Omnibus spending bill), was enacted with broad implications for the Medi-Cal program and the resumption of Medi-Cal redeterminations.

Previously, the resumption of Medi-Cal redeterminations was tied to the termination of the COVID-19 public health emergency. The Omnibus spending bill delinks the continuous coverage requirements that paused all Medi-Cal redeterminations since March 2020.

Effective April 1, 2023, Medi-Cal redeterminations will resume.

The Breast and Cervical Cancer Treatment Program (BCCTP) will begin sending annual redetermination packets to recipients starting April 1, 2023, to determine if they may continue receiving treatment coverage. Included in the annual packet is the Physician Statement and Certification (PSC) form that requires the treating physician to complete, sign, and certify if the patient is still in need of breast and/or cervical cancer treatment. The PSC must be completed and signed by the treating physician (MD or DO only) and returned to the recipient or BCCTP within 20 days.

As a reminder, all BCCTP recipients not receiving county Medi-Cal benefits must complete a Medi-Cal application at their local county social services office to remain eligible for services under BCCTP. A recipient’s benefits will be discontinued if they fail to complete a Medi-Cal application by the date that their BCCTP benefits expire.

The completed and signed PSC can be sent to BCCTP by:


Fax: 1-916-440-5693


Department of Health Care Services
Medi-Cal Eligibility Division
Breast and Cervical Cancer Treatment Program
P.O. Box 997417, MS 4611
Sacramento, CA 95899-7417

4. April 2023 Medi-Cal Provider Coffee Break Event

Medi-Cal Outreach and Education (O&E), along with the Department of Health Care Services (DHCS) is offering a series of Coffee Break events in April.

Topics discussed will include the following:

Topic Date
Remittance Advice Details April 4 and April 18
Medi-Cal Resources April 4 and April 18
Claims Follow-up April 5 and April 19
Eligibility/Share of Cost (SOC) April 5 and April 19
Lab Services April 6 and April 20
Home Health/Early and Periodic Screening Diagnostic and Treatment (EPSDT) April 6 and April 20
Medical Transportation April 11 and April 25
Durable Medical Equipment (DME) April 11 and April 25
Inpatient Obstetrics (OB) April 12 and April 26
Family Planning, Access, Care and Treatment (Family PACT) April 12 and April 26
California Children's Services (CCS)/Genetically Handicapped Person's Program (GHPP) April 13 and April 27
Obstetrics (OB)/Comprehensive Perinatal Services Program (CPSP) April 13 and April 27

Please visit the Medi-Cal Learning Portal (MLP) to view available coffee break times and to register in the Event Calendar.

Providers are encouraged to bring questions relating to the coffee break session topic. This is an open forum, therefore, claim examples are not needed for this event.

For additional assistance, please contact the Telephone Service Center (TSC) at 1-800-541-5555.

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After submitting the form, a welcome email will be sent to the provided email address. If you are unable to locate the welcome email in your inbox, check your junk email folder.

For more information about MCSS, please visit the MCSS Help page.

6. Provider Manual Revisions

Pages updated due to ongoing provider manual revisions:

Download PDF (Portable Document Format) reader from the Web Tool Box.