Young Adult Full Scope Expansion

Young Adult Full Scope Expansion

Full Scope Medi-Cal for Young Adults Under Age 26

September 2019

Medi-Cal Eligibility Division Managed Care Operations Division

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Overview

? Senate Bill (SB) 104, enacted the Young Adult Expansion, which provides full scope Medi-Cal benefits for individuals ages 19 through 25, inclusive, who do not have satisfactory immigration status, or who are unable to verify citizenship, but meet all other eligibility requirements for the Medi-Cal program.

? The Young Adult Expansion implementation is modeled after the implementation of SB 75 (Chapter 18, Statutes 2015) as amended by SB 4 (Chapter 709, Statutes 2015) which provided full scope Medi-Cal to eligible children under the age of 19, regardless of citizenship or immigration status.

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System Readiness

Subject to approval of systems readiness:

? The California Healthcare Eligibility, Enrollment and Retention System (CalHEERS) and the Statewide Automated Welfare System (SAWS) will implement the system functionality to determine full scope Medi-Cal eligibility for the Young Adult Expansion population on January 1, 2020.

? The SAWS will initiate a batch process, beginning November 22, 2019, to transition Young Adult Expansion eligible individuals from restricted scope Medi-Cal to full scope Medi-Cal effective January 1, 2020.

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Populations Impacted

? New enrollee population ? Includes individuals ages 19 through 25, inclusive, who are eligible for Medi-Cal, do not have satisfactory immigration status for full scope Medi-Cal, (or are unable to verify citizenship) and are not yet enrolled in MediCal.

? Transition population ? Includes individuals 19 through 25, inclusive, who are currently enrolled in restricted scope Medi-Cal.

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Age Policy:

New Enrollee & Transition Populations

? Individuals who turn 26 between January 2, 2020 and January 31, 2020 are considered 25 for the entire month of January and will be eligible for full scope Medi-Cal under the Young Adult Expansion for January 2020.

? Individuals who turn age 26 on January 1, 2020 are considered to be 26 for the entire month of January 2020 and will not be eligible for full scope Medi-Cal under the Young Adult Expansion.

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