DHCS issued this letter to provide updated guidance on retroactive Medi-Cal coverage as a result of the Affordable Care Act.  Individuals could previously request retroactive coverage before a year from the date of service by completing an MC 210A for each month in which retroactive coverage was requested.

For ongoing MAGI cases, counties will ask for information in addition to the MC 210A when the information is needed to complete the determination.  If a current MAGI beneficiary is requesting retroactive months prior to December 31, 2013, eligibility would be based on non-MAGI rules.  For applications for retroactive months where no ongoing coverage is requested, counties must complete a SAWS 2 Plus for the other months requested.

The non-MAGI applications will continue to use the MC 210A along with property and income verification as needed.

This DHCS letter instructs counties to resume the remainder of negative case actions for non-MAGI-linked individuals determined eligible under non-MAGI rules.  Grandfathering protections do not apply for these individuals.  Counties should take these negative actions on non-MAGI linked individuals once SAWS functionality is in place.

Specifically, counties are directed to continue to disregard the 2014 COLA for now; to follow the 10-day notices for adverse action requirements; and to track cases where negative actions were delayed or certain workarounds were put in place until the next change in circumstances or annual redetermination.

This letter provides guidance for counties to screen MC 262 forms to see if beneficiaries are potentially eligible for Medi-Cal under MAGI rules.  Counties should collect tax household information, either by phone or by RFTHI, and use the CalHEERS BRE to determine eligibility for MAGI.  If ineligible for MAGI, counties should complete the non-MAGI eligibility determination based on MC 262.

Being screened for MAGI instead of a non-MAGI program does not deprive a beneficiary of long-term care services.

DHCS issued a letter providing information about AB 720, which requires counties to suspend rather than terminate Medi-Cal benefits for all inmates regardless of age who were Medi-Cal beneficiaries at the time they became inmates of a public institution.  County boards of supervisors may designate an entity to assist county jail inmates with insurance applications, as being an inmate shall not preclude the county from processing a Medi-Cal application from such an applicant.

An inmate’s Medi-Cal benefits must be suspended until the day an eligible inmate is no longer an inmate of a public institution (reinstate) or one year from the date he/she becomes an inmate (terminated), whichever is sooner.  Redetermination will still occur, and eligibility changes should be entered as appropriate.

Additionally, the letter addresses the Medi-Cal Inmate Eligibility Program application process.  MCIEP covers acute inpatient hospital services to eligible inmates if those services are provided off the grounds of the correctional facility.  The inmate must meet all Medi-Cal eligibility requirements.  The county will process applications received by a designate county entity for MAGI and non-MAGI programs.  Inmate cases might get pended in CalHEERS, so counties must take steps to complete the eligibility process.  If the inmate has a suspended case, the county must lift the suspension before MCIEP eligibility begins.