SAWS Soft Pause Removal

Currently, the Soft Pause feature of SAWS protects consumers from losing MAGI-based Medi-Cal eligibility when personal circumstances change.  The soft pause allows the county to run eligibility determinations for other programs while keeping the beneficiary on a MAGI aid code.  This generally happens when a MAGI beneficiary becomes eligible for APTCs, premium-based Medi-Cal, or limited scope/restricted/pregnancy-related Medi-Cal, or if the beneficiary becomes ineligible for MAGI Medi-Cal.

The county worker must screen the beneficiary for Non-MAGI programs before removing the soft pause or before sending the case for APTC evaluation.  If the individual is eligible for Non-MAGI Medi-Cal, the county can remove the soft pause to place the beneficiary into an appropriate aid code.  The same 90-day cure period applies to restore a beneficiary to a proper non-MAGI aid code if the individual did not respond to the Non-MAGI evaluation request.

County workers have the ability to remove the soft pause directly.  If an individual has been determined eligible for APTCs, the county worker can help the beneficiary complete plan enrollment in CalHEERS after removing the soft pause.

DHCS ACWDL 17-35 (October 5, 2017)