DHCS provided an update on the batching process for dealing with processing Medi-Cal applications in a more timely manner in the wake of the Rivera decision.  DHCS was to issue a Notice of Inaction mailer for individuals who have not received a final Medi-Cal determination and NOA.   The letter describes the different batches and what counties must do.

DHCS provides weekly results files to SAWS counties, which includes individuals whose applications are nearing the 45 days.  Counties must review these files for the Rivera mailing.

The batch process to transition beneficiaries from Covered California to Medi-Cal will continue on a monthly basis until the process is automated.

DHCS MEDIL I 15-13 (5/15/15).

DHCS issued guidance about notice requirements for Medi-Cal applicants whose applications have not been processed within 45 days per the Rivera decision.  These beneficiaries have a right to file an appeal and request a hearing when the Medi-Cal determination has not been made within 45 days of application.

To comply with these requirements, DHCS has implemented in two phases a Rivera notice that foregoes the 90 day deadline to file for a hearing (applicable only for Rivera notices).  Notices are available only in English and Spanish; samples are available with the letter.

DHCS MEDIL I 15-11 (4/7/15)

DHCS has issued guidance and resources materials on the remote identity proofing process for CalHEERS.  The letter contains a guide compiling a number of job aids about the RIDP process, as well as two reference sheets to address additional questions.

Currently, there are three methods for identity proofing in CalHEERS:

1. Visual verification (mail, upload, or scan an identity document)
2. RIDP (connect to data hub for in-person, online or telephone application)
3. Signature (paper application)

DHCS MEDIL I 15-10 (3/24/15).

DHCS has instructed counties to evaluate all RMA beneficiaries for eligibility for MAGI and Covered California back to January 1, 2014.  New RMA applicants will be screened for Medi-Cal up to 138%, 8 months of RMA from 138% to 200%, and Covered California above 200%.

For current RMA beneficiaries whose 8 month time limit has not expired, counties must restore eligibility back to 1/1/14 for those who would have been eligible for MAGI Medi-Cal; those who are not eligible for MAGI or for other Medi-Cal linkage will be assessed for Covered California APTCs once their eight month eligibility period has run.  Reviews should be ex parte to the fullest extent possible, with requests for information used only if counties can not get the information through available sources.

For RMA/RCA cases closed after 1/1/14, counties must redetermine them for MAGI or Covered California eligibility.

RCA beneficiaries must stay in the RCA aid code for the full eight months until further notice.  DHCS ACWDL 15-16 (3/20/15).

DHCS has provided instructions on how the county should enter income information when applicants enter both or neither current monthly income or projected annual income.  Currently, CalHEERS and SAWS are not programmed with appropriate changes for projected annual income.  The letter includes information on how to deal with certain situations.  DHCS MEDIL I 15-07 (3/9/15).