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.

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.