Counties are required to send Notices of Action when an individual is denied MAGI Medi-Cal as a result of being over MAGI income limits (138% FPL) during any of the three retroactive months prior to the application month. In most cases, SAWS will generate the relevant notice. CalHEERS will generate an over income denial NOA when there’s a tax subsidy approval.
Counties are encouraged to avoid sending multiple NOAs. When individuals who are not eligible for MAGI Medi-Cal are approved for Non-MAGI Medi-Cal in a retroactive coverage month, counties must send only the NOA that provides the final Non-MAGI eligibility determination for that month. If an individual is not eligible for either MAGI or Non-MAGI Medi-Cal, the county must send both MAGI and Non-MAGI denial NOAs for the retroactive month.
DHCS ACWDL 18-11 (June 29, 2018)