DPSS ePolicy

To convert existing policy to new webpage – No content changes.

To provide an overview of the Medi-Cal (MC) Organ Transplant Anti-Rejection Medications Program.

Effective January 1, 2011, Assembly Bill (AB) 2352, authorizes Medi-Cal beneficiaries to be placed in the Anti-Rejection Medications Program for up to two years following an organ transplant when there is no coverage for the antirejection medications.

Before January 1, 2011, Medi-Cal beneficiaries who had an organ transplant received coverage for antirejection medications when they received full-scope Medi-Cal.  Should beneficiaries lose full-scope Medi-Cal coverage, they would lose coverage to the antirejection medications.  Without the antirejection medications, the body can potentially reject the transplant, and the beneficiary may need a new transplant, to be sent to the hospital, dialysis treatments, or possibly pass away as a direct result. 

Beneficiaries are eligible for this Medi-Cal - Organ Transplant - Anti-Rejection Medications Program when the following conditions apply:

1. A beneficiary had an organ transplant within the last two years.
2. A beneficiary does not have:
   • Full-scope Medi-Cal,
   • Medi-Cal based California Children’s Services (CCS),
   • Medicare, and
   • Other health insurance covering the anti-rejection medications.

Note:  There is no need to request income, resources, and residency/citizenship information, as these requirements are exempt for this program.

1. Letter from the treating physician.  The letter must include:
   • The National Provider Identifier (NPI) letterhead,
   • Beneficiary’s full name,
   • Statement explaining what type of organ transplant  beneficiary received, and
   • Date of the last organ transplant.
2. Proof that anti-rejection medications are not covered.