On September 3, 2019, the California Department of Health Care Services (DHCS) issued an alert clarifying that Medi-Cal coverage is available for residents who need “intermediate care,” not just for those who required “skilled” care. This confirmation became necessary because CenCal Health, a Medi-Cal health plan serving San Luis Obispo and Santa Barbara Counties, has aggressively sought to deny Medi-Cal coverage to nursing facility residents on the basis of its assessments that they do not need “skilled” care. The DHCS alert helpfully confirms that nursing facility residents on Medi-Cal are allowed to remain while either intermediate or skilled care services are needed.
CANHR is working with an advocacy coalition to seek broader solutions to increasing coverage denials that are caused by the combination of outdated Medi-Cal regulations on nursing facility coverage and perverse financial incentives for Medi-Cal health plans to cut costs by denying nursing facility care to their members who need it.