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).

The State has revised Notices for individuals who are not eligible for Non-MAGI Medi-Cal due to lack of linkage.  Counties will manually issue these NOAs until SAWS is updated.

Counties are to send denial notices to applicants who are not eligible for MAGI Medi-Cal and are found to have no Non-MAGI linkage after a full Medi-Cal determination.  Additionally, those who lose MAGI Medi-Cal and are found to have no Non-MAGI Medi-Cal linkage will receive a denial notice.  These applicants and beneficiaries should immediately be assessed for Covered California subsidy eligibility.

Counties will send discontinuance notices after annual renewal or change in circumstances reporting when beneficiaries no longer have linkage to Non-MAGI Medi-Cal and cannot establish eligibility on any other basis.

DHCS ACWDL 18-12 (July 2, 2018)

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)

DHCS has updated its charts for thresholds for Medi-Cal, MCAP, and APTC eligibility to reflect 2018 Federal Poverty Levels.  Updated thresholds for Non-MAGI Medi-Cal will not be effective until April.

DHCS ACWDL 18-03 (January 30, 2018).

Under current State and Federal regulations, a parent or caretaker relative with a dependent child under 19 living in the home does not qualify for MAGI Medi-Cal if the child does not have minimum essential coverage (MEC).

Applicants and beneficiaries can self-attest that a dependent child has MEC at the time of application, renewal, or change in circumstance unless the county has information that states otherwise.  If a County worker learns that a dependent child does not have MEC, the worker should do an ex parte review to confirm MEC status.

As with any other discontinuance or denial, the County must send a NOA with proper language.  DHCS has provided sample language for such notices.

DHCS ACWDL 18-01 (January 8, 2018).