DHCS has issue guidance on not running CalHEERS business rules for certain household with no potential MAGI Medi-Cal eligibility. These include Mega-Mandatory beneficiaries in programs required by federal law or categorical programs (e.g., foster care, Pickle, SSI/SSP) and cases where the entire household is potentially non-MAGI eligible (aged/disabled, receiving Medicare, no dependent children or pregnant persons).
Currently, if an applicant is Mega Mandatory and CalHEERS returns a MAGI eligibility result, counties must not accept the MAGI result and must retain or establish eligibility under the Mega Mandatory aid code. In some cases, the county is unable to grant Mega Mandatory eligibility without running the case through CalHEERS rules, which requires information that is unnecessary for aged or Mega Mandatory individuals. SAWS will be making changes to address these workarounds for Mega Mandatory and non-mixed MAGI/Non-MAGI households. Otherwise, counties must run the CalHEERS rules for other individuals.
DHCS ACWDL 18-16 (July 11, 2018).