This letter updates counties about the process they should use for terminating TLICP beneficiaries for non-payment of premiums.  For clients in non-payment of premium status, there are no redetermination requirements prior to sending a NOA to discontinue the client unless there’s a change in circumstances.  The letter also provides a sample discontinuance notice.

For clients in aid codes H3 and H5, counties will provide a timely notice and terminate eligibility through MEDS.  For clients in aid code 5D (Healthy Families Program transition), counties would need to submit a remedy ticket to DHCS after providing timely notice.

To cure the situation and prevent termination, clients must pay past premiums prior to date of discontinuance.  If client misses that date but pays within 30 days of date of discontinuance to cure, county must verify payment and reinstate or submit a remedy ticket.  After the 30 day cure period, the client would need to reapply; any owed amounts would be charged as part of the first month’s premium.

This letter notifies counties that printing of Single Streamlined paper applications in threshold languages is being suspended for revisions.  Translated applications are still available online in all threshold languages.

This letter instructs counties to use the existing SAWS negative case action functions when discontinuing pre-ACA cases for failure to provide the RFTHI or other requested information.  The letter also reminds counties that the RFTHI form is only a means to collect information and does not have to be completed for a beneficiary to comply with the annual redetermination requirement.

DHCS issued this letter to provide guidance to counties regarding the transfer of L1 Aid Code cases (former LIHP cases) through the described workaround process.  This workaround is necessary because SAWS does not yet support L1 aid code cases.  Cases where a Medi-Cal beneficiary reports a change in county of residence do not require an eligibility review.  Instead, the receiving county will assist the transferring beneficiary with enrolling in a new local plan (as needed).

This letter from DHCS provides a workaround for MAGI beneficiaries who report a change in circumstance due to pregnancy.  A woman in one of the new adult coverage groups (M1, M2) who reports a change in circumstance due to pregnancy will remain in her current coverage group aid code; this policy applies to all MAGI aid codes.

Counties are not to accept any transactions from CalHEERS that move a woman from an M1 to M4 aid code into any of the pregnant woman coverage group aid codes when a woman reports her pregnancy.  If CalHEERS attempts to do that, counties should change the case to show not pregnant to keep the beneficiary in the same aid code.  Counties are to document use of this workaround and pregnancy due date until the design gap is fixed.