40-103.44 Medi-Cal for CalWORKs Ineligible Members

CalWORKs

40-103.44 Medi-Cal for CalWORKs Ineligible Members

Release Date

04/30/2019

Section Heading

Purpose

Revision of existing policy and/or form(s)

This document provides CalWORKs Eligibility Workers (EWs) with policy and procedures for processing:

State-funded full-scope Medi-Cal Assistance Only (MAO) benefits for ineligible noncitizen parents, or siblings, age 19 or older, of CalWORKs eligible children who are Permanently Residing in the United States (U.S.) Under Color of Law (PRUCOL). This includes household (HH) members approved under the Deferred Action for Childhood Arrivals (DACA) U.S. Immigration policy;
Full-scope MAO benefits to all eligible children under the age of 19, regardless of citizenship, alienage or immigration status;
Restricted MAO benefits for undocumented parents or siblings, age 19 or older, of CalWORKs eligible children (who are not PRUCOL);
MAO benefits of individuals when the CalWORKs application is denied or CalWORKs benefits are discontinued; and
MAO benefits for newborns prior to adding them to the CalWORKs segment of the case.

What changed?

This release provides information on a newly established Deemed Eligible (DE) toll-free telephone number and the release of the Deemed Eligible Children Important Information Notice. In addition, the document was revised to notify EWs of the elimination of the manual Systematic Alien Verification for Entitlements (SAVE) verification process and the implementation of a new secondary electronic SAVE verification process.

Note: Changes are shown highlighted in grey throughout the document.

Policy

Counties are required to ensure healthcare coverage is granted to all qualifying individuals.

MAO eligibility for CalWORKs ineligible family members must be processed within the CalWORKs case. Obtaining verification and updating pertinent information regarding the MAO of these persons is the responsibility of the CalWORKs Intake EW and the CalWORKs Case-Carrying EW.

When the family’s case is denied or discontinued from CalWORKs, MAO eligibility must be determined for all persons found ineligible for CalWORKs benefits prior to transferring of the case.

DE must be evaluated when the newborn is reported to Eligibility staff and the mother received Medi-Cal benefits through MAO, CalWORKs or Supplemental Security Income in the infant’s birth month. An infant is DE from the birth month until age one even if the CalWORKs case is pending, discontinued or the Head of HH’s MAO eligibility is discontined.

Full-Scope Medi-Cal Benefits for children under the age of 19

Children under the age of 19 are eligible to full-scope Medi-Cal benefits regardless of citizenship, alienage or immigration status.

Background

On June 24, 2015, Senate Bill (SB) 75 was signed into law and established provisions for full-scope Medi-Cal benefits to all eligible children under the age of 19, regardless of citizenship, alienage or immigration status.

Definitions

MAO

Full-Scope Medi-Cal

Federal and State law provides that full-scope Medi-Cal benefits may be received only by noncitizens who are in a Satisfactory Immigration Status (SIS) and children under age 19 who meet all Medi-Cal eligibility requirements including California residency.

Documented noncitizens are in SIS if they are:

Lawful permanent residents;
Amnesty noncitizens with valid and current lawful temporary resident cards (I-688);
In a Temporary Protected Status (TPS) and submit MC 13, Statement of Citizenship, Alienage, and Immigration Status declaring PRUCOL category 16; or
PRUCOL.

Note: The 16 PRUCOL categories are listed in Section B, question 5 of the MC 13.

Pursuant to SB 75, State law provides that noncitizen children under age 19 who meet all Medi-Cal eligibility requirements but do not have SIS must receive full-scope benefits.

Restricted Scope Medi-Cal

Undocumented HH members age 19 and older who meet all other Medi-Cal eligibility requirements, including California residency, may receive restricted benefits; and

Documented noncitizens age 19 and older without SIS who meet all Medi-Cal eligibility requirements may receive restricted benefits.

Medi-Cal eligibility requirements include meeting:

California residency; and
Income limits.

Examples of these documented noncitizens are individuals with:

TPS who do not declare PRUCOL;
Business Visa; and
Student Visa.

Restricted/Limited scope Medi-Cal benefits are restricted to:

Emergency-related services;
Pregnancy-related services:
- Prenatal care;
- Labor and delivery;
- Up to 60 days of post-partum care;
- Family planning services; and
- State-funded Long-Term Care.

Note: The individual may seek non-emergency health services at community health centers or safety-net hospitals.

An infant is DE for Medi-Cal from birth until age one under the following conditions:
Regardless if the infant and birth mother live together;
DE must be evaluated for an infant who is not living with the mother at the time of application;
The DE infant remains eligible regardless of the mother’s continued eligibility, even when the CalWORKs case is discontinued;
The infant must continue to reside in California; and
The DE period is not ended even if it was determined in error.

For Medi-Cal purposes a physical copy of the documents listed below are not required to aid the infant:

Birth Certificate;
Social Security Number or Card;
Income documentation;
MC 13; and
CW 2.1, Notice and Agreement for Child, Spousal, and Medical Support and CW 2.1Q, Support Questionnaire.

Note: DE infants are exempt from Deficit Reduction Act citizenship and identity verification requirement.

Infants are generally placed in the same category of coverage as the mother; however, infants born to mothers with restricted coverage are entitled to full-scope benefits. Changes in income and property that result in ineligibility for the HH are disregarded for the infant until age one. The infant under the age of one must continue to meet California residency requirements during this period.

The “Important Information Notice – Deemed Eligible Children” form was developed to inform parents/caretaker relatives of Deemed Eligible infants about:

Eligibility for Medi-Cal DE; and
Instructions to call the DE hotline (833) 735-9359, if they are informed by DPSS or a Medi-Cal provider that the DE infant is not eligible for Medi-Cal.

Note: The notice is available in English and Spanish.

CalWORKs Ineligible Family Members

This pertains to persons living in the CalWORKs AU who are:

Undocumented parents or siblings of CalWORKs eligible children;
Documented noncitizen parents or siblings without SIS of CalWORKs eligible children;
Optional CalWORKs family members including step-children and/or the spouse of a CalWORKs eligible parent who are not eligible to CalWORKs or choose to be excluded from the CalWORKs Assistance Unit (AU);
Newborns prior to adding them to the CalWORKs segment of the case; and
Children age 18 to 21 years no longer eligible to CalWORKs due to age.

PRUCOL

PRUCOL is not an immigration status (such as Lawful Permanent Resident, etc.). PRUCOL is a public benefit category created by the federal courts to describe categories of noncitizens who are potentially eligible for certain public benefits in California.

For a person to be residing “Under Color of Law,” the United States Citizenship and Immigration Services (USCIS) must know of the person’s presence in the U.S., and must provide the person with written assurance that enforcement of deportation is not planned.

The first 15 categories of the MC 13 require written assurance/documentation when the self-attested status cannot be electronically verified by any of the following means:

Federal Data Hub;
SAVE; and
Medi-Cal Eligibility Data System (MEDS).

However, this does not apply to category #16. PRUCOL can be claimed under category #16 without documentation.

Medi-Cal Eligibility

Persons are eligible to full-scope Medi-Cal:

Upon declaring PRUCOL and electronic verification of the self-attested status of PRUCOL; or
Claiming PRUCOL category #16 on the MC 13 form, Section B, questions 4 and 5.

Note: Undocumented individuals who are not eligible to full-scope Medi-Cal benefits under PRUCOL but meet all other program requirements for Medi-Cal are eligible to receive restricted/limited scope Medi-Cal benefits.

Medi-Cal benefits for immigrants who are PRUCOL did not change with the implementation of Health Care Reform.

DACA

On June 15, 2012, the Secretary of Homeland Security announced that certain individuals, who meet specific guidelines, could request consideration of DACA status. DACA status is valid for a period of two years, subject to renewal. USCIS lists the following guidelines for DACA consideration:

Came to the U.S. before the age of 16;
Continuously resided in the U.S. since June 15, 2007;
Under the age of 31 as of June 15, 2012;
Physically present in the U.S. on June 15, 2012, and at the time of requesting DACA;
Did not have lawful immigration status as of June 15, 2012;
Pursuing education or military service; or
No prior convictions (felony or significant misdemeanor).

DACA individuals will check Category #12 in Section B, question 5 of the MC 13 which indicates he/she is:

An alien in deferred action status
- DACA status verification includes:
  - Employment Authorization Document with status code “C-33.”
  - Form I-797 Notice of Action.
  - Documents other than those noted above may require a secondary electronic SAVE request (G-845, Verification Request).

TPS

Individuals who have been granted TPS are eligible to restricted scope Medi-Cal, unless the TPS individual submits an MC 13 declaring PRUCOL, category 16.

Federal Data Hub

Electronic Verification System used to compare and verify information with other federal and State systems.

Requirements

Application

Separate MAO applications for the CalWORKs ineligible parents and children, including children age 18 to 21, are not required if at least one family member is applying or approved for CalWORKs.

CalWORKs Application is Denied

When the family’s CalWORKs case is denied, MAO eligibility must be determined for all persons found ineligible for CalWORKs benefits.

The MAO portion of a CalWORKs application must be processed within the 45-day processing time required by the California Department of Health Care Services for non-disability related applications. The 45-day processing period for the MAO portion begins with the CalWORKs application date.

CalWORKs Discontinuance

When CalWORKs discontinues, Medi-Cal benefits must continue unless the CalWORKs discontinuance reason is also a reason for the Medi-Cal discontinuance.

Note: Medi-Cal benefits for the DE infant will continue if the HH fails to complete the CalWORKs/Medi-Cal Renewal (RE).

MC 13

The MC 13 must be provided to ineligible noncitizen individuals in a CalWORKs AU to determine if they are eligible to State-funded full-scope MAO due to a declaration of PRUCOL. The form must be provided:

At application;

RE; or

When an individual is newly reported in the home and not eligible to CalWORKs due to immigration status.

The MC 13 is used by applicants/participants to declare their citizenship, alienage, and immigration status. The form should be completed by noncitizen individuals who are ineligible members of a CalWORKs AU. This usually includes parents or siblings of eligible CalWORKs children and includes:

Undocumented individuals; and
Documented individuals who are ineligible due to their immigration status. For example, the father of a U.S. citizen child with a visitor visa who has been granted an indefinite stay of deportation.

Note: The form should not be completed by individuals eligible for CalWORKs.

CalWORKs Application is Approved

The MC 13 must be provided when CalWORKs ineligible noncitizen individuals are in the CalWORKs AU.

The MC 13 must be used to determine whether the individual is eligible to State-funded full-scope MAO benefits due to a declaration of PRUCOL status.

Eligibility to State-funded full-scope MAO benefits exists when the individual checks any one of the categories in Section B, question 5 on the MC 13.

Note: Staff is not to advise the individuals on what Alienage, or immigration status to declare on the form. The individual must declare his/her present status without any assistance from staff.

SAVE

The SAVE System is used to verify USCIS status information including PRUCOL status based on the information provided on the CalWORKs application or Section C of the MC 13.

90-Day Reasonable Opportunity Period (ROP)

If an applicant’s immigration status cannot be initially verified via the Federal Data Hub or the existing automated SAVE, then the applicant must be allowed a 90-day ROP to provide satisfactory immigration status verification. During the ROP the applicant shall be granted full scope benefits, if otherwise eligible. If citizenship/immigration status cannot be verified within the 90-day ROP, then the benefits must be reduced to restricted scope benefits.

Medi-Cal Share of Cost (SOC)

Parents and/or children under age 18 related to and in the HH of CalWORKs eligible members are entitled to zero SOC Medi-Cal benefits.

Periodic Reports

Medi-Cal Status Reports are not required for ineligible CalWORKs AU members receiving MAO benefits.

Adding Persons to the CalWORKs Case

As soon as it is known that a child has been born or a family member has moved into the HH, they must be added immediately to the CalWORKs case to determine the family’s eligibility.

CalWORKs Ineligible Members

The MC 13 must be provided for each undocumented noncitizen member or ineligible documented noncitizen member.

Newborns

When a newborn is reported to an active CalWORKs case by the parent or the MC 330, Newborn Referral is received, DE must be evaluated and the newborn must be immediately issued a Medi-Cal Beneficiary Identification Card (BIC) thru MEDS beginning in the infant’s birth month. The BIC must be issued regardless of their anticipated CalWORKs eligibility so that they may receive MAO coverage immediately. Staff should contact CalWORKs Program if they encounter any issues.

Discontinuance reasons NOT eligible to continuing Medi-Cal

Individuals or programs discontinued for the following reasons are not eligible to continuing Medi-Cal:

Death;
Participant’s written request for discontinuance from both CalWORKs and Medi-Cal Programs;
Child placed in Foster Care;
In jail or other ineligible institution;
Moved out of State;
Approved for Supplemental Security Income;
Individuals who failed to comply with their RE.

Note: Failure to comply with the RE discontinuance does not apply to the DE infants.

Inter-County Transfers that have been completed; or
Individuals who failed to comply with verification requests. This does not apply to the DE infants.

Note: Medi-Cal benefits for incarcerated minors are to be suspended, not discontinued.

Verification Docs

Noncitizen status documents and verification requirements

For Medi-Cal purposes, noncitizens can claim to be in an SIS by:

Submitting USCIS documents;
Submitting USCIS receipts which show that they have applied for replacements when the USCIS document cannot be provided or the document is unreadable; or
Self-attesting to be in SIS if they cannot obtain a USCIS document or replacement receipt.

The noncitizens SIS will be verified through the Federal Data Hub, SAVE or by submitting the G-845 through the secondary electronic SAVE process.

CalWORKs ineligible members

The MC 13 must be provided to each noncitizen CalWORKs AU member requesting aid.
If PRUCOL is declared on the MC 13, full-scope Medi-Cal must be approved for the individual by completing instructions within the Procedures Section of this release:
- PRUCOL is declared when Section B, Question 4 on the MC 13 is marked Yes and one of the categories within Section B, question 5 is checked.

If MC 13, Section B, Question 5 indicates: A conditional entrant admitted to the U.S. before April 1, 1980, then Medi-Cal eligibility is: MAO full-scope