Medi-Cal Relaxes Verifications For Eligibility During Covid-19 Pandemic

The Department of Health Care Services (DHCS) in a letter to all County Welfare Directors states,

As outlined in the above guidance, for all populations affected by a public health crisis or disaster, counties shall:

• Continue to provide benefits beyond the certification period, as needed, to provide additional time to submit renewals or verifications, and
• Modify eligibility requirements at application or renewal to allow for self-attestation
  • Important Reminder: Counties may accept a signed and dated affidavit, under penalty of perjury, to verify California residency, income, and property from applicants who are unable to provide necessary verifications due to the public health crisis or disaster. Letter L 20-06

Medi-Cal Relaxes Requirements Adds Home Services

Medi-Cal also recognizes that many people in the state are relocating due to job loss. This change of residency may be to a different county. Each of California’s counties manage the eligibility and enrollment of qualified individuals and families into Medi-Cal health plans. A change of residency to another county necessitates a transfer of the case to the new county of residence.

As beneficiaries find it necessary to relocate to be with family or friends in another county, counties may begin receiving urgent requests for inter-county transfers (ICTs). Please remember that Medi-Cal beneficiaries may contact either the Receiving County or Sending County to assist with transferring their case on a permanent or short-term basis. – Letter L 20-06

DHCH is also instructing counties to delay processing of the annual redetermination notices and any notices of negative action such as terminations.

The purpose of this Medi-Cal Eligibility Division Information Letter (MEDIL) is to instruct counties to delay the processing of Medi-Cal annual redeterminations and delay discontinuances and negative actions for Medi-Cal, Medi-Cal Access Program (MCAP), Medi-Cal Access Infant Program (MCAIP), and County Children’s Health Initiative Program (CCHIP) based on the declared State and National Emergency due to COVID-19. The delay shall be effective for 90 days from the date of this MEDIL.

To allow for counties to prioritize processing of access to care issues, and concentrate staffing resources where needed during this public health crisis, the county shall stop processing annual renewals immediately and may exceed the timeliness standard for all administrative processing of Medi-Cal or Children’s Health Insurance Program (CHIP) redeterminations. The delay shall be effective for 90 days from the date of this MEDIL. County Eligibility Workers shall document the reason for the delay in processing in the case file, and should include the following statement for auditing purposes:

“Delayed redetermination processing for Medi-Cal or CHIP benefits approved due to state or federally declared major public health crisis or natural disaster.”

In addition, the county shall delay discontinuances and negative actions as a result of renewals and reported changes in circumstances to ensure beneficiaries remain eligible for Medi-Cal. The delay shall be effective for 90 days from the date of this MEDIL. The county shall continue to process determinations or redeterminations for those individuals who would gain access to health care coverage and resolve barriers related to access to care such as new applications, intercounty transfers, adding a person, a decrease in income, or prioritizing 90-day cure period restorations. – Letter I 20-07

In an effort to reduce people crowding clinics – making it difficult to comply with social distancing regulations – DHCS sent out a letter to the Medi-Cal HMO plans to enhance telehealth and home-based services. APL 20-007

POLICY: The following guidance will remain in effect until further notice.

Congregate services provided inside the center are not allowed during the period of this public health emergency. Essential services to individual participants may be provided in the center or the home so long as they meet criteria defined in this APL and with proper safety and infection control precautions…including but not limited to:

• Professional nursing care
• Personal care services
• Social services
• •Behavioral health services
• Speech therapy
• Therapeutic activities
• Registered dietician-nutrition counseling

Further, during the effective dates of this guidance, CBAS centers may provide these additional services at a participant’s home, with appropriate infection control precautions and equipment:

• Physical therapy
• Occupational therapy

Covered California Medi-Cal Applications

Covered California has also provide additional guidance with respect to Medi-Cal eligibility through their online application.

Medi-Cal Application Processing

The process for verifying Medi-Cal eligibility, from the time the completed application is received to a Benefits Identification Card (BIC) is received, normally takes 45 days. The general process for verification is as follows:

• Apply – complete the application, and submit either in person, by mail, by phone, or online
• Receive a Notification of Likely Eligibility by mail
• The county social services office may contact the applicant by mail or by phone to request paper verification if income, citizenship, and other criteria cannot be verified electronically
• Receive Final Notice of Action notifying the applicant of whether they can receive Medi-Cal or not
• Receive BIC – when the BIC is received in the mail, the individual can use the many Medi-Cal benefits available

Reporting Changes on Mixed Household Cases

• Renewal dates for Medi-Cal are based on the application date and not a designated time period in the year
• When changes are reported and an individual becomes ineligible to MAGI Medi-Cal, the county must screen them for other Medi-Cal programs before discontinuing benefits
  • The individual will continue to receive Medi-Cal while the screening is taking place
• The county determines if individuals are eligible to any of the following programs:
  • Consumer protection program (still considered to be eligible to Medi-Cal and cannot qualify for tax credits)
  • Non-MAGI Medi-Cal
  • Refer individuals to the county with questions regarding the status of reported changes

Income Reminders for Mixed Households

• Medi-Cal uses current monthly income to determine eligibility unless an individual reports a projected annual income amount that is less than the monthly income amount
  • Current monthly income is used even if the individual’s annual income is over the MAGI Medi-Cal limits but the current monthly income is under the MAGI Medi-Cal limit
• Individuals are responsible for self-attesting to income and should not be coached on how to answer income or tax household questions
• When self-attested information does not match electronic sources, additional verifications are required
  • The county must use the beneficiary provided income verification to determine eligibility which may differ from the income amount that was self-attested
  • The income verification amount could lead to someone who was previously eligible to Covered California becoming eligible to Medi-Cal

Please Note:

• If a household’s income has decreased to under 138% monthly (266% dependents), they will correctly be referred to Medi-Cal.
• Most people will need to provide some proof of income to the County since these new changes to income will not likely be E-Verified. Remind consumers to be prepared with proof of income to provide to the County in order to aid in processing the referral.

County Online Portals

Each county has online portals available where individuals can do the following:

• Apply for Medi-Cal
• Complete and Submit a Medi-Cal Renewal
• Upload verification documents
• View case status information
• View notices (Notices of Action)

Online Portals by County

Your Benefits Now: Los Angeles County

MyBenefits CalWIN: Alameda, Contra Costa, Fresno, Orange, Placer, Sacramento, San Diego, San Francisco, San Luis Obispo, San Mateo, Santa Barbara, Santa Clara, Santa Cruz, Solano, Sonoma, Tulare, Ventura, Yolo

C4Yourself: Alpine, Amador, Butte, Calaveras, Colusa, Del Norte, El Dorado, Glenn, Humboldt, Imperial, Inyo, Kern, Kings, Lake, Lassen, Madera, Marin, Mariposa, Mendocino, Merced, Modoc, Mono, Monterey, Napa, Nevada, Plumas, Riverside, San Benito, San Bernardino, San Joaquin, Shasta, Sierra, Siskiyou, Stanislaus, Sutter, Tehama, Trinity, Tuolumne, and Yuba

---