Conlan II Process

Since 1997, the Department of Health Care Services (DHCS) has been involved in litigation resulting in the decisions of Conlan I and Conlan II. The court ordered DHCS to ensure that Medi-Cal recipients receive reimbursement for medically necessary, out-of-pocket expenses received during specific time periods. In-Home Supportive Services (IHSS) recipients who are Medi-Cal eligible are included in this class action lawsuit.

On November 16, 2006, the State's revised Conlan II Implementation Plan was approved by the court. Specifically, DHCS is required to provide recipients reimbursements for medically necessary services received and paid for during the following time periods:

1. the retroactive period which is up to three months prior to the time of application for Medi-Cal;
2. the evaluation period which includes the time between the dates that an application for Medi-Cal eligibility was submitted and approved; and
3. the post approval period which is after the recipient was approved for Medi-Cal and addresses the excess Share of Cost (SOC) expenses.

Reimbursement Process

The California Department of Social Services (CDSS), Adult Programs Division, Conlan II Unit has the primary responsibility for adjudicating Conlan II claims for IHSS. In order to be considered for reimbursement, the recipient must have experienced an actual out-of-pocket expense for the excess SOC amount. IHSS recipients who paid their provider an excess SOC can file a Conlan II claim to request reimbursement.

In order to be reimbursed, the recipient must:

1. Contact the DHCS Beneficiary Services Center (BSC) at (916) 403-2007 to request a Conlan II claim packet for IHSS, and
2. Complete the claim packet and return it directly to the BSC at the address provided in the claim packet.

Once the Claim has been Submitted

Once the recipient has submitted their claim packet and the BSC determines the claim packet is complete, the packet will be forwarded to the CDSS Conlan II Unit for adjudication. A recipient may call the toll free number at 1 (877) 508-1327 to obtain the status of their claim.

If the claim is denied by CDSS, the recipient will be notified in writing the reason for the denial which will include a notice of the recipient's rights and instructions for requesting a state hearing.

Letters and Notices

The following are All County Letters (ACLs), All County Information Notices (ACIN) and County Finance Letters (CFLs) posted for the Conlan program (in date order with the most recent at the top). All letters and notices are pdf.

• ACIN I-03-10 (January 21, 2010)
  Conlan II Reimbursement Process
• ACL 07-32 (September 13, 2007)
  Additional Claims To Be Submitted Through The Conlan II Claims Process
• ACL 07-11 (February 20, 2007)
  Implementation Of Conlan II Court Order: Reimbursement Of Covered Services For In-Home Supportive Services (IHSS) Recipients