DHCS has issued guidance on how Medi-Cal applications should be assessed during eligibility determinations. In this hierarchy, an application (which includes reporting change of circumstance, annual redetermination, and initial screening) should be determined by progressing through the chain of programs. Workers must determine eligibility at each group with potential eligibility, and the applicant must be placed into the program that is most beneficial.
First, the county must look at Mega Mandatory groups. These are programs that are categorical or mandatory under federal law, or the programs where eligibility for Medi-Cal is linked to eligibility for another program. If an applicant is not eligible here, the next check is with the MAGI programs, including MCAP and CCHIP. Next would the the Non-MAGI Optional Categorical programs, followed by Medically Needy/Medically Indigent programs, and Non-MAGI State Only programs.
If an applicant is not eligible for any Medi-Cal program at the MAGI stage, the applicant should be evaluated for APTC eligibility. Pregnant applicants have the option to enroll in either MCAP or Covered California, and may move from Covered California to MCAP during pregnancy and the post-partum period. Counties must evaluate all Medicare-eligible applicants for Medicare Savings Programs.
DHCS ACWDL 17-03 (January 25, 2017).