A previous letter directed counties to deny pending SAWS Medi-Cal applications after completing an ex parte review and making two 10-day requests for income verification.  A third 10-day request was required when the prior requests were sent before March 15, 2014.  Counties were directed to use the appropriate SAWS denial Notice of Action for failure to cooperate.

This letter from DHCS instructs counties to use the same procedures for applications that originated in CalHEERS.  The third 10-day request for income verification is required if an ex parte review was completed and two 10-day requests were sent prior to May 22, 2014.  After that date, only two such requests are required prior to denying the application for failure to provide income verification.  Counties will contact SAWS for denial instructions until CalHEERS functionality is implemented.

This letter extends the suspension of paper verification of state residency status until August 1, 2014.  Verbal attestation or listing of a California address will be sufficient

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.