PPL 21-015: Unsatisfactory Immigration Status Beneficiaries in the LEA Billing Program

On July 16, DHCS released an email regarding Policy and Procedure Letter (PPL) 21-015 titled, “Unsatisfactory Immigration Status Beneficiaries in the LEA Medi-Cal Billing Option Program.” This PPL, dated June 15, 2021, informs LEAs participating in the LEA Billing program that claims for beneficiaries with an Unsatisfactory Immigration Status (UIS) are not eligible for federal financial participation reimbursements through the LEA Billing program. Furthermore, PPL 21-015 indicates that DHCS has adjusted the Fiscal Intermediary and data match process to ensure that these claims are appropriately denied for FFP and excluded from the Medi-Cal Eligibility Ratio (MER) process.

At this time, there is nothing required of LEAs as DHCS has made the corrections to the program process on their end. Paradigm will continue to monitor the changes pertaining to this PPL and provide updates accordingly.

Click here to read how UIS beneficiaries are identified in the PPL 21-015.