DHCS issued this letter focusing on annual redeterminations for MAGI Medi-Cal and Covered California mixed coverage household.  Since different annual redetermination periods and processes are involved, there will be two different annual redetermination dates for mixed coverage household members based on program: any time during the year for Medi-Cal, and before January 1 for Covered California.

Medi-Cal annual redeterminations are set for 12 months after the initial application date or most recent redetermination.  Covered California redeterminations start processing in early October (for 2014) via CalHEERS.  Covered California beneficiaries will be defaulted into their current plans if they don’t make an affirmative change, but they will have the option to switch plans during open enrollment.

When a mixed household population has the same annual redetermination date for Medi-Cal and Covered California, the Medi-Cal redetermination process will initiate the annual redetermination process.  That means the county will go through the ex parte process and request of verifications to confirm Medi-Cal eligibility.

When a mixed household population has different redetermination dates for Medi-Cal and Covered California cases, the redetermination for one will be processed as a change of circumstances for the other, unless the county receives beneficiary information that does not change the information currently on file.

Counties are responsible for Medi-Cal eligibility determinations and ongoing case management of Medi-Cal cases with regards to cases that may have contact with the Exchange.  The counties are required to assist with renewals for mixed households where changes are reported for Covered California that may impact Medi-Cal eligibility.

DHCS issued this letter to remind counties to extend eligibility for Hospital Presumptive Eligibility individuals who have applied for Medi-Cal beyond the two months allotted under HPE.  HPE beneficiaries who submit a timely application should not lose coverage.  Counties need to send the appropriate transaction to MEDS in order to prevent MEDS from automatically terminating the HPE beneficiary; CalHEERS should automatically submit the appropriate transaction to MEDS.

DHCS issued this letter to the counties regarding interim policies and procedures for Non-MAGI and Mixed Medi-Cal cases.  Counties are to conduct ex parte reviews by consulting electronic records and information in other open cases (e.g., CalFresh, CalWORKS).  Potential MAGI beneficiaries must be evaluated for MAGI.  Non-MAGI beneficiaries will need a property evaluation.  Where no MAGI eligibility exists, counties will make a SAWS determination on the case.

Where no member of the household is in LTC, county will send a Medi-Cal Annual Redetermination (MC 210 RV) with a 60 day return period and relevant beneficiary outreach.  With the information, the county will make a MAGI determination (send a RFTHI if potentially eligible) or determine what missing information needs verification (e.g., property supplement).  When a family member is in LTC and ex parte determination is not possible, counties should send out the MC 210 Rv along with an MC 262.

For Mixed Medi-Cal household without LTC members, the county will do an ex parte review.  MAGI members are sent through CalHEERS for eligibility, while non-MAGI members will go through SAWS.  MAGI members are designated ineligible for the Non-MAGI MFBU, while non-MAGI members are designated as “non-applying” household members of the tax filing unit for MAGI determinations.  Where there’s an LTC member in a mixed Medi-Cal household, the household receives a pre-populated MAGI redetermination form and an MC 604 IPS.

The letter also contains a list of “Mega-Mandatory” aid codes that take priority over MAGI codes for non-MAGI eligibility determinations.  These groups follow the pre-ACA rules.

DHCS issued this letter instructing counties to search for and identify potential MAGI-eligible individuals.  These individuals need to meet all of the following criteria:

1. Must not have been evaluated under MAGI rules,
2. Must be eligible of retroactively eligible for the month of December 2013 or after under specific coverage groups and aid codes (MN/MI with Share of Cost, 250% Working Disabled, State-only funded or limited-scope Medi-CAl), and
3. Must be MAGI-linked (parents, caretaker relatives, children, or pregnant women, or non-Medicare recipients aged 19-64)

Counties are to search their case loads for MAGI-linked individuals and sent RFTHIs to those who were denied eligibility due to excess property in December 2013 or later, and those who have not been evaluated under MAGI rules.  If an individual is MAGI eligible, the county must rescind the discontinuance notice, reestablish eligibility back to the discontinuance, and send a new notice.

Counties will send a translated version of a letter informing affected Medi-Cal beneficiaries of this process along with the RFTHI.  If the form is returned and the individual is MAGI eligible, the county will take the actions outlined in this letter.  If the beneficiary does not return the RFTHI, counties must keep the beneficiary in the same aid code until the next annual redetermination or a change in circumstances.

Those MAGI-eligible beneficiaries who are later found ineligible at redetermination or change in circumstances must be evaluated under non-MAGI criteria before being discontinued.

DHCS issued this MEDIL regarding aid code deactivation in the SAWS and MEDS systems.  Pre-ACA programming will stay active in both systems until further notice.  When all beneficiaries are transferred to MAGI aid codes, counties will receive instructions on the deactivation of the older aid codes.