DHCS has issued this letter to guide SAWS and counties on implemented annual redeterminations for 2015 for MAGI Medi-Cal beneficiaries.
First, counties are to review any ex parte information available to the county about the beneficiary or beneficiary’s immediate family members, including cases that are either open or closed within the last 90 days. If the ex parte review is sufficient to confirm eligibility, a redetermination form is not required. This information is entered into SAWS and sent to CalHEERS for a MAGI eligibility determination. For pre-ACA beneficiaries, counties will attempt to obtain RFTHI information ex parte. If CalHEERS confirms MAGI eligibility, SAWS will receive the result back with a NOA confirming eligibility.
If a beneficiary is found ineligible through ex parte review, the county will send a pre-populated redetermination form (MC 0216) from SAWS and given at least 60 days to complete and return it. Beneficiaries may complete this through many methods. Counties are to contact the beneficiary if they have not yet received the form. If the beneficiary fails to provide the requested information, county will issue a discontinuance NOA with a 90-day cure period.
When information from MC 0216 is received and entered into SAWS, CalHEERS will determine Medi-Cal eligibility. MAGI eligible will be sent a NOA for a new 12-month eligibility period. Those who are not MAGI eligible will go through the process described here. Where there isn’t enough information, counties will work with beneficiaries to gather the necessary information.