DHCS issued this letter to the counties regarding interim policies and procedures for Non-MAGI and Mixed Medi-Cal cases. Counties are to conduct ex parte reviews by consulting electronic records and information in other open cases (e.g., CalFresh, CalWORKS). Potential MAGI beneficiaries must be evaluated for MAGI. Non-MAGI beneficiaries will need a property evaluation. Where no MAGI eligibility exists, counties will make a SAWS determination on the case.
Where no member of the household is in LTC, county will send a Medi-Cal Annual Redetermination (MC 210 RV) with a 60 day return period and relevant beneficiary outreach. With the information, the county will make a MAGI determination (send a RFTHI if potentially eligible) or determine what missing information needs verification (e.g., property supplement). When a family member is in LTC and ex parte determination is not possible, counties should send out the MC 210 Rv along with an MC 262.
For Mixed Medi-Cal household without LTC members, the county will do an ex parte review. MAGI members are sent through CalHEERS for eligibility, while non-MAGI members will go through SAWS. MAGI members are designated ineligible for the Non-MAGI MFBU, while non-MAGI members are designated as “non-applying” household members of the tax filing unit for MAGI determinations. Where there’s an LTC member in a mixed Medi-Cal household, the household receives a pre-populated MAGI redetermination form and an MC 604 IPS.
The letter also contains a list of “Mega-Mandatory” aid codes that take priority over MAGI codes for non-MAGI eligibility determinations. These groups follow the pre-ACA rules.