Update : Medi-Cal Medi-Cal Annual Redetermination Questions and Answers

Transcription

1 Santa Clara County Social Services Agency page 1 Date: 07/02/12 References: ACWDL11-23, MEDIL I Cross-References: CalWIN Release Notes, Release 29 Clerical: Handbook Revision: Yes Yes Medi-Cal Annual Redetermination Questions and Answers Background The California Department of Health Care Services (DHCS) has provided clarification of numerous questions from counties on annual redetermination (RD) policies and procedures. Policy The following questions and answers refer to the annual RD process: Types of Redeterminations Question #1: What is the difference between an Annual RD, a Change of Circumstances and an Ex-Parte redetermination?: Answer: Annual Redetermination: The annual RD is a full eligibility review that is conducted at least once every 12 months. The annual RD due month is generally set from the first day of the application month. However, if the applicant is not eligible in the month of application, the annual RD is set 12 months from the approval month; the first month in which the applicant meets all eligibility criteria. Change-of-Circumstance Redetermination: A change-of-circumstance redetermination is an eligibility review conducted when information is received about a change in a beneficiary s circumstances. Any change-of-circumstances redetermination that occurs during the 12-month period will not change the annual RD due month. Ex-Parte Redetermination: An ex-parte redetermination is conducted when the MC 210 RV is returned incomplete, or when a change of circumstances is reported. Ex-parte means without beneficiary contact. The EW will follow each of the three steps of the SB 87 redetermination process sequentially until there is a determination of eligibility or ineligibility for Medi-Cal. The ex-parte redetermination is the first step of the SB 87 process.

2 page 2 Annual RD Date Question #2: What is the annual RD date? Answer: The annual RD must be completed by the last day of the 12th month from the month of application, approval month, or last annual RD. This is based on whole month eligibility (if eligible in any day of the month, eligible for the entire month). Therefore, the annual RD date is the last day of the 12th month. For example, if the application month was April 2011, the annual RD date is March 31, Question #3: If the beneficiary submits the MC 210 RV on the last day of the 12th month, is this considered timely? Answer: Yes. The annual RD form is considered timely if the form is received by the last day of the 12th month which is the RD month. Question #4:Does the annual RD due month change if the beneficiary submitted the MC 210 RV form within 30 days of discontinuance and the county completed the eligibility review? Answer: No. If the beneficiary submits the MC 210 RV within 30 days after Medi-Cal was discontinued, the annual RD due month does not change. Question #5: Does the annual RD due month change if the RD is completed early? Answer: No. The Annual RD due month does not change if the eligibility review is completed early as long as the MC 210 RV is mailed to the beneficiary in the 10th month or early in the 11th month and it is completed and returned promptly. Question #6: Does adding a person to an ongoing Medi-Cal case establish a new annual Redetermination date? Answer: No. Adding a person to an ongoing Medi-Cal case does not establish a new annual RD date. Question #7. How does a beneficiary add a person at the time of the annual RD? Answer. The MC 210 RV allows the beneficiary to add a person to the Medi-Cal case at annual RD. The EW may request additional information/verifications of the new person to establish eligibility. Question #8: If the beneficiary reapplied for Medi-Cal because there was a break in aid and good cause does not exist, is the annual RD date reset to the original application date or the new application date? Answer: The Annual RD date is based on the new application date.

3 page 3 Question #9: If there is more than a 30 day break in aid and Good Cause exists, how is the annual RD date set? Answer: If there is more than a 30 day break in aid and good cause exists, allow the beneficiary to complete the MC 210 RV form. The beneficiary's Medi-Cal benefits shall remain discontinued until it is determined if the beneficiary is eligible. Do NOT automatically rescind the discontinuance based on the fact that the MC 210 RV is received. If the beneficiary is found eligible, then rescind the discontinuance, restore benefits without a break in aid, and establish eligibility based on the prior 12-month annual RD. Since the annual RD is based on a 12-month cycle, the RD due month does not change. If the beneficiary is not eligible, then contact the client (by phone or by mail) and inform him/her that he/she is not Medi-Cal eligible and that the previous discontinuance is still valid. Do NOT send a second discontinuance Notice Of Action (NOA). Mail Date Question #10: Can the MC 210 RV be mailed out in the 10th month? Answer: Yes. The first day of the 10th month is the earliest date that the MC 210 RV can be mailed. The latest date by which the form must be mailed is by the last day of the 11th month. The annual RD processing time has not changed. The beneficiary must still be given at least 20 days to complete the form. If the form is received by the last day of the 12th month, it is considered timely. If the MC 210 RV is received by the last day of the 12th month and additional verification/information is needed to determine continued eligibility, then the SB 87 process applies. Performance Standards Question #11: For Performance Standards, must the county complete the annual RD within 60 days from the last day of the RD month? Answer: Yes. Medi-Cal Performance Standards require 90 percent of annual RDs to be completed within 60 days of the RD due date for annual RDs that are complete and returned timely by the last day of the RD due month. Question#12: For Performance Standards, if the 60th day falls on a Saturday, Sunday or holiday, can the following business day be considered as meeting this requirement: Answer: Yes Question #13: Do Performance Standards apply to annual RDs that are submitted by the beneficiaries within 30 days of termination?

4 page 4 Answer: No. If the beneficiary submitted the MC 210 RV form within 30 days after Medi-Cal is terminated, these cases are not subject to Performance Standards, as the MC 210 RV form was not submitted by the last day of the RD month. Signature Requirements Question #14: Is the signature of the beneficiary required on the MC 210 RV? Answer: Yes. If the beneficiary submits the unsigned MC 210 RV timely (by the last day of the 12th month) and additional information is not needed, then mail the unsigned MC 210 RV back to the beneficiary and instruct him/her to sign and return the form within ten days. It is not necessary to telephone the beneficiary prior to mailing the unsigned form back to sign. The beneficiary shall remain Medi-Cal eligible while waiting for the signed MC 210 RV to be returned. This information must be thoroughly documented in the case narrative for audit purposes. If the beneficiary fails to return the form by the specified due date, then send a timely 10-day NOA to discontinue Medi-Cal benefits for failure to cooperate. The SB 87 process does NOT apply to an MC 210 RV that is otherwise complete, except for the signature. Note: The EW is not required to sign the MC 210RV form. However, documentation in the case file must identify the EW that authorized eligibility at the annual RD. Question #15: If the beneficiary submits an unsigned MC 210 RV within 30 days of the discontinuance and additional information is not needed, how the form processed? Answer: If the beneficiary submitted the unsigned MC 210 RV form within 30 days of the discontinuance and additional information is not needed, then mail the unsigned MC 210 RV back to the beneficiary and instruct him/her to sign and return the form within ten days. It is not necessary to telephone the beneficiary prior to mailing the unsigned form back to the beneficiary. The SB 87 process does not apply to an MC 210 RV that is otherwise complete except for the signature. The beneficiary s Medi-Cal benefits shall remain discontinued until the signed MC 210 RV is received. If the signed MC 210 RV is received and the beneficiary is found eligible, restore benefits without a break in aid, rescind the discontinuance, and establish eligibility based on the 12-month annual RD period. Since the annual RD is based on a 12-month cycle, the annual RD due month does not change. If the beneficiary does not return the signed MC 210 RV, then contact the individual (by phone or by mail) and inform him/her that he/she is not Medi-Cal eligible and that the previous discontinuance is still valid. Do NOT send a second discontinuance NOA.

5 page 5 Question #16. Can the annual RD be conducted over the telephone with the beneficiary? Is the beneficiary required to sign the MC 210 RV? Answer: Yes to both questions. The EW can conduct the annual RD over the telephone with the beneficiary. DHCS allows the flexibility to conduct a telephone annual RD based on county business needs. However, the information discussed on the telephone must be thoroughly documented in the case narrative and on the MC 210 RV and supplemental forms, such as the MC 210 PS. The EW must mail the MC 210 RV and applicable supplemental forms to the beneficiary for review. The beneficiary must sign and return the MC 210 RV and applicable supplemental forms, along with any requested verification by the specified due date. The annual RD process has not changed. The beneficiary must be given 20 days to complete the MC 210 RV and SB 87 applies for an incomplete MC 210 RV that is returned. If the beneficiary fails to return the MC 210 RV by the specified due date, send a timely 10-day NOA to discontinue Medi-Cal benefits for failure to cooperate. Question #17: Can the EW substitute the SAWS2 for the MC 210 RV? Answer: Yes. The SAWS 2 may be used instead of the MC 210 RV for telephone interviewing purposes. However, the EW must only ask the questions listed in the SAWS 2 that are subject to change and necessary for determining ongoing Medi-Cal eligibility, such as income and non-exempt property. The EW must not ask the beneficiary for information that is not subject to change. Question #18. Is the EW required to sign the MC 210 RV? Answer: No, the EW is no longer required to sign the MC 210 RV. The EW signature line has been removed. Original Document vs. Faxed Copy Question #19. Is a fax/scanned copy of the MC 210 RV acceptable or must the county receive the original form from the beneficiary? Answer: DHCS is in the process of clarifying policy for Electronic Signatures and Records. A future ACWDL will address this issue. Annual RD Processing Time and SB 87 The time lines for the return of the MC 210 RV are not related to the time lines for the SB 87 process. The SB 87 statute has specific time lines for when the MC 355 Request for Information is sent to the beneficiary. Question #20: Must the beneficiary be given 20 calendar days to return the MC 210 RV form?

6 page 6 Answer: Yes. Allow the beneficiary at least 20 calendar days to complete and return the MC 210 RV. If the county receives an incomplete MC 210 RV or requires additional verification or information to determine continued eligibility, utilize the SB 87 process. The third step of the SB 87 process is when the MC 355 form is sent to the beneficiary to obtain additional information. The EW must allow the beneficiary 20 days for gathering and submitting the required information. Question #21: If the beneficiary s due date for the annual RD form falls on a Saturday, Sunday, or holiday, is the due date extended to the following business day? Answer: Yes. Allow the beneficiary at least 20 days to complete and return the MC 210 RV. If the due date falls on a Saturday, Sunday, or holiday, extend the due date to the following business day. The beneficiary has until the last day of the 12th month to submit the MC 210 RV. Question #22: If the MC 210 RV form is not returned by the deadline, must a second request be sent allowing 10 more days? Answer: No. If the beneficiary fails to complete and return the MC 210 RV form by the deadline, it is a failure to cooperate and a second request allowing 10 additional days is not required. If the MC 210 RV is not returned by the requested due date and the form is not returned by the post office as undeliverable, then send a timely 10-day NOA to discontinue Medi-Cal benefits. Question #23: If the MC 210 RV form is returned within 30 days of the discontinuance and is signed but additional information is needed, what due date does the county use in requesting the information? Answer: When the county receives the MC 210 RV within 30 days of the discontinuance, do not immediately rescind the discontinuance. The county must determine if the person is Medi-Cal eligible before a rescission can take place. If the client returns the signed MC 210 RV within 30 days of the discontinuance but additional information is needed, use the information/verifications available in case records that are open or closed for not more than 45 days. If it is determined that additional information is still needed, continue to follow the next steps of the SB 87 process--attempt a telephone contact or send a written request (MC 355) to the individual for the needed information to determine continued eligibility. Allow a minimum of 20 days for the due date for additional information. This may extend the due date beyond the 30 days. The Medi-Cal case shall remain discontinued while waiting for the additional information. If the individual provides the additional information and there is continued eligibility, rescind the

7 page 7 discontinuance and restore benefits without a break in aid. If it is determined that Medi-Cal eligibility does not exist, contact the individual (by phone or mail) and inform him/her that the RD form has been reviewed and the previous discontinuance is still valid. Since the previous discontinuance NOA is still in effect, do not send a second discontinuance NOA. Question #24: Can the county conduct the ex-parte review prior to mailing out the Annual RD form? Answer: No. The county shall not conduct the ex-parte review (Step 1 of the SB 87 process) prior to mailing out the MC 210 RV or while waiting for the beneficiary to return the MC 210 RV. At Annual RD, the SB 87 process is utilized only when the MC 210 RV form is returned incomplete and additional information or verifications are required to determine continued eligibility. Question #25: If the beneficiary returns an incomplete MC 210 RV form after the deadline date but prior to the effective discontinuance date, shall the county restore benefits while they wait for verification from the beneficiary? Answer: Yes. If the county determines that the MC 210 RV form is incomplete or that additional verification is required, rescind the discontinuance, notify the beneficiary that benefits are restored, and utilize the SB 87 process to determine continued eligibility. If, after rescinding the discontinuance, there is no continued eligibility, issue a timely 10-day discontinuance NOA and the client will need to reapply. Question #26: Is the county required to send a 10-day NOA when a beneficiary returns the Annual RD form within 30 days of termination and the beneficiary is now Medi-Cal eligible with a share of cost (SOC)? Which correct budget months apply to the SOC? Answer: If a beneficiary returns the Annual RD form and verifications within 30 days of the Medi-Cal discontinuance and is determined Medi-Cal eligible with a SOC, then rescind the discontinuance, restore the beneficiary s Medi-Cal benefits at the same level prior to the discontinuance, and apply the appropriate SOC to the correct budget month(s). This information must be thoroughly documented in the case narrative. The correct budget month is determined by when a timely NOA can be issued. Per Title 22, California Code of Regulations (CCR), Section 50015; an increase in Medi-Cal Family Budget Unit s SOC is considered an adverse action. Per CCR Section 50179, NOAs, which are adverse actions, must be mailed at least 10 calendar days prior to the first of the month in which the action becomes effective. Example: Medi-Cal is discontinued on February 28, 2012 because the beneficiary did not return the Annual RD form. On March 26, 2012, the beneficiary returns the Annual RD form

8 page 8 along with the verifications. On March 27, 2012, the county rescinds the discontinuance and determines ongoing eligibility with a SOC. As the county does not have sufficient time to provide a 10-day notice before April 1, the county will send out a timely NOA prior to April 20 indicating that the beneficiary has no SOC Medi-Cal for March 2011 and April 2011 and SOC Medi-Cal beginning May Discontinuance of Benefits at RD Question #27: What Medi-Cal Eligibility Data System (MEDS) termination code should be used for failure to submit the MC 210 RV? Answer: The county shall use MEDS termination code 65 when the beneficiary fails to submit the MC 210 RV form. Annual RD Packet Question #28: What forms are required in the annual RD packet? Answer: The required forms are as follows: Form # Description Required/Optional MC 210 RV Notice MC 210 RV Medi-Cal Annual RD Form MC 219 Important Information for Persons Requesting Medi-Cal MC 210 PS Property Supplement SCD 508 Medi-Cal Annual Redetermination Notice Medi-Cal RD Form Medi-Cal Rights and Responsibilities Medi-Cal Property Supplemental Form National Voter Registration Act Required Required Required Required if beneficiary answers Yes to Section 5(b) or 5(c). Counties may include this form in the RV packet instead of waiting for beneficiary to submit the MC 210 RV. Required PUB 183/184 CHDP Brochure Required if Applicable MC 003 Medi-Cal Important Notice -Early Periodic Screening Diagnosis and Treatment PUB 13 EPSDT Flyer Your Rights Under California Welfare Programs Required is Applicable Required MC 372 BCCTP Flyer Required

9 page 9 Form # Description Required/Optional MC 4034, GEN 1365 or DHCS approved county customized notification (SCD 1264) Business Reply Envelope Multilingual Notification Regarding Translation Services Postage Paid Return Envelope Required Required Question #29: Is the MC 212 a required form at Annual RD? Answer: No. The MC 210 RV form has a field for the beneficiary to document if there is a new address. The MC 212 Medi-Cal Residency Declaration is not included in the Annual RD packet. Question #30: Are the MC 007, DHCS 7077, and DHCS 7077A required forms at the Annual RD? Answer: No. The MC 007 (Medi-Cal General Property Limitation), the DHCS 7077 (Notice Regarding Standards for Medi-Cal Eligibility) and the DHCS 7077A (Notice Regarding Transfer of a Home for Both a Married and an Unmarried Applicant/Beneficiary) are not required to be included in the Annual Redetermination packet. These forms are part of the application packet for regular Medi-Cal and long term care (LTC) applicants. Refer to Medi-Cal Eligibility Procedures Manual, Section 4S-1A. Question #31: What forms are required for the LTC Annual RD packet? Answer: The packet listing for Annual RD for LTC is currently being researched. Information will be provided in a future ACWDL. Adding a Person Question #32: Can a parent who has been discontinued for failure to complete the annual RD due to failure to provide property verification be added back to his/her ongoing children s case with an Add a Person form (MC 371), or does the parent have to complete a new application or other forms? Answer: In this scenario, a signed MC 210 RV was submitted timely. However, the parent was discontinued for failure to provide property information, and as a result, the children were placed into ongoing Medi-Cal programs (i.e. children s FPL programs that have a Property Waiver provision). Refer to the following scenarios: Scenario #1: Medi-Cal discontinued less than 30 days. If the parent s Medi-Cal is discontinued less than 30 days, the parent can request to be added back to the ongoing case. The parent is not

10 page 10 required to complete a new application or any forms. The parent must submit the property information and the county will determine if the parent is eligible. The original annual RD date is still in effect. Scenario #2: Medi-Cal discontinued more than 30 days with Good Cause If the parent s Medi-Cal is discontinued for more than 30 days and good cause exists, the parent can request to be added back to the ongoing case. The parent is not required to complete a new application or any forms. The parent must submit the property information and the county will determine if the parent is eligible. The original annual RD date is still in effect. Scenario #3: Medi-Cal discontinued more than 30 days; Good Cause does not exist. If a parent s Medi-Cal is discontinued more than 30 days and good cause does not exist, the parent can be added back to the case by completing the MC 371 and providing any needed income, property or other required verifications to determine eligibility. The SAWS2, MC 210, or MC 321 HFP must also be accepted if the form is submitted by the parent. The original annual RD date is still in effect. Question #33: At the time of annual RD, can people be added back to an ongoing Medi-Cal case using the MC 210 RV? Answer: Yes. Section 4: Living Situation on the MC 210 RV is revised to allow a parent discontinued from the case for failure to submit the Midyear Status Report (MSR) to be added back to the case at annual RD. The MC 371 is not required with the new MC 210 RV. Property Question #34: May the Medi-Cal Property Supplement (MC 210 PS) be included with the MC 210 RV? Answer: Yes. The MC 210 PS may be included in the annual RD packet. The county will not need to wait for the beneficiary to answer Yes to property questions 5(b) or 5(c) on the MC 210 RV before mailing out the MC 210 PS. Question #35: How does the county clarify the disposition of property that is reported at the annual RD? Answer: If real or personal property has been previously reported and the beneficiary reports a change to these items on MC 210 RV and the MC 210 PS but no information is reported on the disposition of that property, then the county shall follow the SB 87 process to obtain the needed information to ensure that the property was disposed of in a manner consistent with Medi-Cal policies and procedures and notate this in the case record. Question #36: Can the Real and Personal Property Supplement to Medi-Cal Mail in Application (MC 322) be used instead of the Medi-Cal Property Supplement (MC 210 PS)?

11 page 11 Answer: No. The MC 322 was designed to be used with the MC 321 HFP Application. The MC 210 PS must be used if the beneficiary answers yes to property questions 5(b) or 5(c). Question #37: Must the Medi-Cal Property Supplement (MC 210 PS) be part of the case file? Answer: Yes. Property is a condition of eligibility and must be verified before eligibility can be established. If the beneficiary answers yes to property questions 5(b) and 5(c) on the MC 210 RV, then the MC 210 PS must be sent to the beneficiary. Since the MC 210 PS is a required form to complete at annual RD when question 5(b) and 5(c) are answered yes, this form must be part of the RD packet in the case file. If the beneficiary sends verification (i.e. bank statement) but fails to return the MC 210 PS, the annual RD process is not complete and the county must contact the beneficiary to obtain the completed MC 210 PS. The county must note the actions taken to obtain the MC 210 PS in the case file. Setting Annual RD Date from CalWORKS Question #38: If a person has Medi-Cal and later applies for CalWORKs, but is denied CalWORKs, does the CalWORKs application change the Medi-Cal annual RD date? Answer: No. The Medi-Cal annual RD date will not change. However, any new information contained in the CalWORKs application that affects eligibility shall be used to determine continued eligibility. for Medi-Cal purposes. Question #39: In the above scenario, if the CalWORKs application is approved, does the Medi-Cal annual RD date change? Answer: Yes. The annual RD date changes. The county will determine eligibility for all family members using the new information contained on the CalWORKs application and update the eligibility status of the entire case. If all the family members are approved for CalWORKs, then the Medi-Cal only case no longer exists and the annual RD date is set based on the CalWORKs application month. If there are family members that remain Medi-Cal only, the next Medi-Cal annual RD date will be set 12 months from the CalWORKs application month. CalWORKS Discontinued Question #40: If a family fails to submit the CalWORKs annual RD form and is discontinued, what Aid Code is the family placed in while pending the Medi-Cal only determination? Answer: The transitional Aid Code is 38.

12 page 12 Question #41. In the above scenario, when must the Medi-Cal annual RD form be mailed to the beneficiary? Answer: The MC 210 RV) must be mailed to the beneficiary during the month after the CalWORKs case is discontinued using the same procedures required for processing a regular Medi-Cal annual RD. For example, the beneficiary must be given at least 20 days to complete the MC 210 RV. The SB 87 process applies only when the MC 210 RV form is signed and returned timely, but is incomplete. Question #42: In the above scenario, how is the next annual RD date set? Answer: The first month of the new 12-month period starts the month after the completion of the Medi-Cal only redetermination. The next annual RD shall be completed by the last day of the 12th month. Setting the Annual RD Date for a DDSD Case Question #43: DDSD-SP disability evaluation received within 90 days During the application process, if the applicant alleges a disability, but no other Medi-Cal linkage exists, forward the disability packet to the DDSD-SP for a disability evaluation. The county has 90 days to make a final eligibility decision for applications based on disability, excluding delays by the State. When the county receives the disability determination confirming an applicant s disability, then complete the eligibility process. The applicant is determined eligible for Medi-Cal effective the first day of the month of application. The annual RD must be completed by the last day of the 12th month. Example: Application Date 01/05/12 DDSD Packet Sent 01/14/12 DDSD Decision Approved 03/10/12 Eligibility Effective Month 01/ th Month of Eligibility Ends 12/2012 Annual Redetermination Due 12/2012 Next Annual Redetermination 12/2013 Question #44: DDSD disability evaluation received after 90 days but prior to the last day of the 11th month.

13 page 13 If the DDSD decision approving disability is received after 90 days, but prior to the last day of the 11th month, complete the normal annual RD process. Mail the RD packet to the beneficiary allowing 20 days for it to be completed. The annual RD must be completed by the last day of the 12th month. Example: Application Date 01/05/12 DDSD Packet Sent 01/12/12 DDSD Decision: Date Approved 06/21/12 Eligibility Completed by County 08/20/12 Eligibility Effective Month 01/12 12th Month of Eligibility Ends 12/12 Annual RD Due Next Annual RD 12/12 (regular process) 12/13 (regular process) Question #45: DDSD disability evaluation received after the 11th month. There are some instances where receipt of the disability evaluation decision extends beyond the 11th month from the application date. The county has 90 days to make a final eligibility decision for applications based on disability, excluding delays by the State. If the DDSD decision confirming disability is received after the 11th month, do not complete the normal annual RD process. Instead, complete the initial eligibility determination upon receipt of the DDSD decision. Review the case and determine if an eligibility determination can be made based on information in the case or other available information. If there is insufficient information available to make an eligibility determination, contact the client to find out if there were changes that occurred since the application date. Follow the Second Contact policies.the SB 87 process does not apply in this situation because the person has not been determined Medi-Cal eligible and is not a beneficiary. Do not send the MC 210 RV form to obtain this updated information. If the applicant is determined Medi-Cal eligible as of the application date, then the beginning date of eligibility shall be the first day of the application month. The annual RD due month shall be set 12 months from the date the county determined the applicant eligible for Medi-Cal. Example: Application Date 01/05/11 DDSD Packet Sent 01/05/11

14 page 14 Application Date 01/05/11 DDSD Decision: Date Approved 06/09/12 County Received DDSD Decision 06/15/12 Eligibility Completed 08/15/12 Eligibility Effective Month 01/2011 First Annual RD Due 07/2013 Next Annual RD Due 07/2014 Question #46: Using the same scenario above except that the case was originally approved under Presumptive Disability (PD) as of January 2011 pending the disability determination from DDSD, is the annual RD conducted in December 2011 on this PD case? Answer: Yes. Question #47: Both husband and wife are claiming a disability: If Spouse 1 and Spouse 2 submit applications and allege disabilities, then the annual RD month is based on Spouse 1 s application month. If Spouse 2 is determined Medi-Cal eligible based on disability, then Spouse 2 s annual RD month will be set by the annual RD month of Spouse 1. Since Spouse 1 and Spouse 2 are in the same case, they will share the same annual RD. Spouse 1 - Application Date 01/05/12 Spouse 1 - DDSD Packet Sent 01/12/12 Spouse 2 - Application Date 01/05/12 Spouse 2 - DDSD packet Sent 01/12/12 DDSD Decision Approved for Spouse 1 06/19/12 DDSD Decision Received for Spouse 1 06/25/12 Spouse 1 - Eligibility Determination Completed 08/25/12 Spouse 1 - Eligibility Effective Month 01/12 Spouse 1-12th month of eligibility ends 12/12 Spouse 1 - Annual Redetermination due 12/12 DDSD Decision Approved for Spouse 2 04/20/12 DDSD Decision REceived for Spouse 2 05/01/12 Spouse 2 - Eligibility Determined 07/01/12 Spouse 2 - Eligibility Effective Month 01/12 Spouse 1 & Spouse 2 - Annual RD due 12/12

15 page 15 Fair Hearing Decision Question #48: If the Administrative Law Judge (ALJ) decision stated that a claimant is otherwise eligible and ongoing Medi-Cal benefits must be issued retroactively over a span of years, what information must the beneficiary provide to the county? Answer: Each fair hearing decision is unique to the specifics of the particular case and how it would impact the annual RD. If there are questions about implementing the ALJ decision, contact the Medi-Cal Program Coordinator. The Medi-Cal Coordinator will contact DHCS to review the decision and to provide instructions on case processing. MC 210 RV Substitutes Question #49: Can the CalFresh Statement of Facts (DFA 285-A2) be used as a substitute for MC 210 RV? Answer: No. Statement of Facts forms that may be accepted are the SAWS 2, MC 210 or the prior version of the MC 210 RV are appropriate for the substitution of the MC 210 RV. These documents are for the Medi-Cal program. Since the DFA 285-A2 is used for CalFresh, there is no authority for it to be used as a substitute for the MC 210 RV. If the beneficiary returns an incomplete MC 210 RV, then the county must follow the SB 87 process. If a DFA 285-A2 is in the case file, then the county may use this new information as part of the first step of the SB 87 process. CalFresh Statement of Facts form DFA 285-A2 to determine Medi-Cal eligibility when a CalFresh recipient requests Medi-Cal benefits. Other information may be requested if sufficient information is not available to make an eligibility determination. This policy applies to the application process and does not apply to the annual RD. Question #50: If the RD packet is returned with a new address from the post office, can the address be used to update our records? Answer: If the annual RD packet is undeliverable, the SB 87 process be used to locate the beneficiary. Question #51: In the above scenario, does the process start over with the new address and is the beneficiary given 20 days to provide information? Answer: Yes. If the county received a new address and has r ed the annual RD packet, the beneficiary must be given 20 days to submit the annual RD forms. Implementation The information in this Update is effective immediately upon receipt.

16 page 16 Data Systems Some of the changes to CalWIN functionality required by these policy clarifications went into production with Release 29. The remainder will be included in Release 30. [Refer to CalWIN Release Notes, Release 29 pp. 9-10] Effective May 22, 2012, the CalWIN Medi-Cal Redetermination Notice (CSC 76) is modified to match the MC 210 RV state informing notice. Forms MC 210 RV The MC 210 RV is revised (05/11). The changes are as follows: Instructions on how to complete the form were revised for clarity. An organ transplant question is added in Section 3(c). A question is added if there is anyone in the home that wants Medi-Cal in Section 4 (b). A question is added for pregnant women to indicate the number of babies expected in Section 4(e). New instructions for the Property Supplement (MC 210 PS) were added. The EW signature line was removed from the County Use Section. A reference to DHCS 6155 was removed from County Use Section. The MC 210 RV is now 4 pages in booklet format and perforated along the 11 side to allow the pages to be separated for document imaging purposes. The MC 210 RV has been translated in all threshold languages and is available in the DEBS Forms Library. A supply of these forms will be distributed to district offices as soon as they are received. Clerical See Forms above. Other Programs The information in this Update only applies to the Medi-Cal program. UMESH POL, DIRECTOR CalWIN Division KATHERINE BUCKOVETZ, DIRECTOR Department of Employment and Benefit Services Contact Person(s): Alice M. Turney, Medi-Cal Program Coordinator/ADSS, (408)

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