DHCS is providing counties initial guidance on dealing with MAGI Medi-Cal cases where all individuals on the case need to be denied or terminated from the program.  The letter outlines five steps:

1. Counties will identify pending and active cases that should be denied or terminated where all members on the case are MAGI Medi-Cal within three priority areas: duplicate applications, failure to complete redetermination, and failure to complete determination.
2. SAWS will receive the county lists and send them to CalHEERS.
3. SAWS or MEDS will take negative action through a backend data fix.
4. SAWS will generate and send NOAs.
5. CalHEERS will take negative action using a backend data fix.

The letter includes a list of negative actions (Attachment A) and an overview of the different systems (Atttachment B).  DHCS MEDIL I 14-56

This letter notifies counties of the DHCS-required process for reducing the pending backlog of Medi-Cal cases.   DHCS will cull through lists for a preliminary determination of eligibility, which counties will then evaluate by December 1.  DHCS will then start granting preliminary eligibility coverage included on these lists.  DHCS MEDIL I 14-55, 14-55 E

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.