Medi-Cal Craig v Bonta Cases Restored

September 28, 2020

As of September 14, 2020, the Department of Healthcare Services (DHCS) has restored all Craig v Bonta Medi-Cal cases that may have been erroneously discontinued effective September 1, 2020.

All restored cases have active Medi-Cal eligibility, with the restoration going back to the first of the month in which they had lost their eligibility. Individuals have been placed back into the level of coverage (no share of cost or share of cost) that they had before the negative action mistakenly happened. They have also been reenrolled into their managed care plan (MCP) or fee-for-service delivery systems, as appropriate. DHCS will be sending out a notice to all impacted individuals to inform them of their reinstatement of Medi-Cal eligibility and plan enrollment, along with information on the reimbursement for any out-of-pocket expenditures they may have incurred.

Providers are reminded to refrain from directly billing affected individuals, as Medi-Cal will reimburse claims for covered medical and/or dental expenses for this population back to the date of discontinuance.

Medi-Cal beneficiaries may also receive reimbursements for covered medical and/or dental expenses they incurred since September 1, 2020. The Medi-Cal beneficiary is responsible for initiating the out-of-pocket reimbursement claims by calling (916) 403-2007. If the beneficiary has a Share of Cost (SOC), please direct them to contact their county office to submit out-of-pocket expense reimbursement for services. Providers may be contacted for additional information by the DHCS Beneficiary Services Center for information to support the reimbursement process. For more information on the reimbursement process, please review the information here.