Earlier this year, the CMSP Governing Board issued guidance regarding eligibility for CMSP after the expansion of Medi-Cal and implementation of Covered California.  All applicants will be considered for MAGI Medi-Cal and Covered California before being evaluated for CMSP.  For full details, read the letter here.

For applications subject to the Covered California open enrollment period, applicants not otherwise eligible for Medi-Cal must provide evidence to the county of a Covered California application and, when required, evidence of the first month’s premium payment.

• Applicants who provide the evidence will receive CMSP coverage for the period between the application date and the start of Covered California coverage.
• Applicants who fail to provide evidence will be denied eligibility for CMSP due to non-compliance.  The start date of CMSP aid will be the first of the month after Covered California enrollment ends.

For applications not subject to the Covered California open enrollment period, applicants not otherwise eligible for Medi-Cal must provide evidence that any Covered California coverage was terminated due to lack of monthly premium payment and attestation that no special circumstances for enrollment exist.

• If no special circumstances exist, the county will determine an applicant’s CMSP eligibility.
• If a special circumstance exists, the applicant must provide evidence of application to Covered California and evidence of the first month’s premium payment.
• If no evidence is provided, the county will deny the CMSP application.

This letter, in conjunction with DHCS ACL 14-03, provides instructions on Medi-Cal annual redeterminations to convert pre-ACA Medi-Cal to MAGI Medi-Cal during 2014.  Read the full letter with example timelines here.

For renewals normally scheduled January through June, the original month of renewal will remain the same for 2015 regardless of when the county processed the 2014 renewal.

For the 2014 annual redetermination, the county will send beneficiaries the Request for Tax Household Information (RFTHI) redetermination packet.  Beneficiaries will have 60 days to complete and return the packet (via mail, phone, fax, in person, or any other available means) and will not need to submit paper verifications for information in the federal/state data hub unless requested.  The County should follow up during the 60 days, give 10 days for the beneficiary to submit the packet, and send a 10-day termination notice depending on beneficiary response.  When the county receives the packet, SAWS will use CalHEERS rules to determine continued Medi-Cal eligibility.

When a beneficiary fails to return the redetermination packet, the Medi-Cal case is discontinued for lack of cooperation.  When an application is missing information or when there is incompatible information based on available sources, the county will request this information from the beneficiary.  Failure to submit the information will result in termination.  Beneficiaries will have a 90-day cure period; if found eligible, the county will restore benefits back to the date of discontinuance.  In non-foster youth cases, if the county is unable to contact the beneficiary after attempting by any means available to the county, the case is discontinued.

Former foster youth up to the age of 26 will receive a simplified annual renewal packet and not the RFTHI packet.  Former foster youth will not be discontinued due to loss of contact; instead, they will be placed in fee-for-service Medi-Cal.

To expedite processing of pending and current CalHEERS and SAWS applications, counties can accept self-attestation of residency in lieu of paper verification until May 1, 2014.  Read the letter here.

This letter explains the State’s intent to leverage electronic processes to provide beneficiaries with notices on an opt-in, opt-out basis.  MAGI notices should be available online through Covered California accounts.  Further guidance is forthcoming.  Read the letter here.

This letter furthers guidance already provided by DHCS that requires counties to continue not to make any negative changes to Medi-Cal cases for a period of time until certain programming can be completed by CalHEERS and SAWS that allow an accurate redetermination of Medi-Cal eligibility. This letter, linked here, tells counties how to continue cases that are age-limited or time-limited.

This letter instructs counties that when CalHEERS pends a MAGI Medi-Cal application because it is not reasonably compatible with data hub information, counties must conduct ex parte review to determine if income is already verified elsewhere. Also, the letter indicates that MAGI Medi-Cal applicants can only get retroactive coverage to January 1, 2014 but that individuals who applied with single streamlined applications can get coverage back to 2013 if otherwise eligible. Click here to read the letter.