This week, the Department of Health Care Services has issued guidance to counties about verifying income for pending Medi-Cal cases.  Those cases currently pending in SAWS are first to be rerun through the federal data hub when available.  If the information available in the hub is not reasonably compatible with the income reported in the application, counties are to do an ex parte review for that information.  If the county cannot verify income through ex parte review, the county is to mail a three ten-day requests for verification before denying the application; this is a temporary change from the normal two requests in order to deal with the backlog of pending applications.

For more information, the full letter is available here.

DHCS issued guidance on how Medi-Cal NOAs are being generated by CalHEERS and SAWS beginning 4/15/14.  The full letter is available here.  Two sets of NOAs will be released:

1. A “one-time batch” of NOAs from pre-enrollment and pre-CalHEERS/SAWS interface (applications filed 10/1/13 to 1/20/14) and post-interface (1/21/14-3/10/14)
2. Ongoing as part of regular processing of NOAs dating from 3/11/14 onwards

The letter identifies some issues that may cause confusion among Medi-Cal beneficiaries:

1. Both CalHEERS and SAWS may issue separate NOAs regarding MAGI and Non-MAGI Medi-Cal, respectively.  SAWS will reflect the correct eligibility category.
2. CalHEERS NOAs may have the wrong coverage effective date, using the date of eligibility determination instead of the correct effective date of eligibility.
3. CalHEERS is generating NOAs for each month of eligibility or conditional eligibility in certain circumstances.

This week, DHCS issued a letter clarifying what counties should do when discontinuing Medi-Cal beneficiaries at annual or change in circumstance redeterminations.  The letter explains that beneficiaries should be reviewed for all programs, including MAGI Medi-Cal and non-MAGI Medi-Cal, before terminating them from the program and evaluating for APTCs/CSRs.  The letter is posted here with attachments.