Fact Sheet Detailing Two Important Beneficiary Protections—Deeming and Aid Paid Pending
Low income Californians, including beneficiaries dually eligible for Medicare and Medi-Cal, can often temporarily lose Medi-Cal eligibility or move between different eligibility levels. This can often result in disruptions in coverage and care. Under the CCI, a dually eligible beneficiary in a Cal MediConnect health plan who loses full Medi-Cal eligibility can remain in their Cal MediConnect plan for a period of time before being disenrolled—a process known as “deeming.” Deeming periods provide beneficiaries time to resolve eligibility issues. In addition, if a beneficiary is disenrolled from the CCI or Cal MediConnect due to a loss of or change in Medi-Cal eligibility and files an appeal, they have the right to continue receiving services for the duration of the appeals process, provided they make this request—also known as “aid-paid pending”—within 10 days of being notified about the change in eligibility or coverage. More information on deeming and aid-paid pending can be found in a new fact sheet, including how each can minimize disruption in care for dual eligible beneficiaries in CCI counties.
Balance Billing Toolkit for Advocates
When doctors, hospitals, or other providers charge beneficiaries with both Medi-Cal and Medicare for services—it is called balance billing. Balance billing is illegal under federal law. Recently, Justice in Aging released a toolkit for advocates that walks through the basics of balance billing and the federal protections for beneficiaries. It provides examples of how the problems manifest, how to fix them when they arise, and contains letters advocates can use when helping low income clients facing balance billing. The toolkit also includes a webinar that explains balance billing protections and how to work with providers to prevent erroneous billing. Access the toolkit and other balance billing-related materials here.