DHCS recently released information about making sure that individuals determined Medi-Cal eligibility by CalHEERS should be considered eligible even when other members of the household are pending eligibility. CalHEERS should determine the lowest potential eligibility for an individual and electronically verify eligibility and/or ask for relevant verification before placing in the appropriate program. Counties must ensure that individuals with eligibility get authorized through SAWS without delay. Counties must not hold the eligible
The State notes in this letter that children granted AE are to be provided eligibility immediately. Children also are protected through continuous eligibility for children (CEC) if there is a change that would disadvantage the child or if there is loss of contact with the family. Upon verification of an income change or loss of contact, affected children are placed in a CEC aid code until their next redetermination period. Affected adults would be denied.
When the county recognizes a data entry error, the county should edit and rerun the CalHEERS determination. If the county determines that an individual already receives full-scope Medi-Cal, the county can discontinue the new MAGI eligibility as long as the existing eligibility remains in MEDS.
DHCS ACWDL 16-16 (7/5/16)