Changes to Medi-Cal Notices of Action

MEDI-CAL

Changes to Medi-Cal Notices of Action

Release Date

05/12/2016

Section Heading

Purpose

To convert existing policy to the new webpage – No content changes
To release a new policy

The purpose of this release is to provide information on the changes that have been made to the Modified Adjusted Gross Income (MAGI) and Non-MAGI Medi-Cal Notices of Action (NOAs). These changes affect Medi-Cal approval, denial, and termination NOAs.

The changes have been made as a result of Senate Bill (SB) 1341, which requires the counties to generate and issue NOAs for MAGI Medi-Cal eligibility determinations. Previously, MAGI NOAs were generated by CalHEERS.

Changes have also been made to Medi-Cal NOAs for failure to comply with the annual Renewal (RE) process and/or failure to provide verification documents.

Policy

Title 42, Code of Federal Regulations, Section 435.912, requires that an applicant/beneficiary be given proper written notice when approving, denying, or discontinuing Medi-Cal benefits.

Medi-Cal policy requires that applicants/beneficiaries who are denied or discontinued for failure to provide verification documents or failure to comply with the annual RE, must be issued an adequate NOA that lists the specific information or verification(s) requested.

Also, beneficiaries must be informed about the 90-day cure period for Medi-Cal. This policy informs beneficiaries that they have 90 days after discontinuance of benefits to provide the requested information, and have their eligibility reinstated without having to re-apply.

Background

Prior to implementation of SB 1341, counties were only able to issue NOAs for Non-MAGI Medi-Cal. As of March 7, 2016, counties are able to generate and issue NOAs for MAGI eligibility determinations, and have control over all Medi-Cal NOAs.

Also, as a result of a preliminary injunction issued on June 23, 2015, in Korean Community Center of the East Bay v. Department of Health Care Services (DHCS), instructions were issued to stop all discontinuances for failure to provide verification documents or failure to comply with the annual RE.

The injunction prevented discontinuances because NOAs, at the time, did not list the specific information or verification(s) needed to redetermine eligibility. The NOAs also did not contain information about the 90-day cure period for Medi-Cal.

Subsequently, Medi-Cal denials at application were also suspended for failure to provide information.

Definitions

N/A

Requirements

MAGI and Non-MAGI NOA Content

The following provides information on the required content for both MAGI and Non-MAGI Medi-Cal NOAs.

MAGI Notice of Action

Header

MAGI NOAs can be identified by the Medi-Cal and Covered California logos that are incorporated into the header. The header also contains the district office name and address, and the primary applicant/beneficiary’s name and mailing address. Refer to the sample below.

The following case information will also be included in the header:

Notice Date
Case Name
CalHEERS Case Number
LEADER or LRS Case Number
Worker Name
Worker ID
Telephone Number (Worker Number or Customer Service Center Number)
Customer ID

Sample

Body

The body contains information for each applicant/beneficiary about the status of their Medi-Cal eligibility. This information includes:

Effective date of approval, denial, or discontinuance (for denials, this will be the date of application).
Eligibility determination information for approvals, denials, and discontinuances.
Verifications that were requested from an applicant/beneficiary, but were not provided; for example, verification of income. Once negative action is taken, the following will occur:

If the NOA is issued to deny benefits for failure to provide verification(s) at application, then the NOA will list the name of the applicant(s), and the specific verifications that were requested from the applicant(s).
If the NOA is issued to discontinue benefits for failure to comply with the RE process, then the NOA will list the name of the specific beneficiary(ies) and the specific verifications that were requested from the beneficiary(ies).
If the NOA is issued to discontinue benefits for failure to provide verification(s) at RE, then the NOA will list the name of the specific beneficiary(ies) and the specific verifications that were requested from the beneficiary(ies).
If the NOA is issued to discontinue benefits for failure to provide verification(s) due to a reported change in circumstances, then the NOA will list the name of the specific beneficiary(ies) and the specific verifications that were requested from the beneficiary(ies).

How to Read MAGI NOA Content for Verifications Not Provided

Case Composition: 2 person household (John Doe and John Doe Jr.)

Section 1: Displays the name of each individual household member. (Refer to the sample below for all three sections)

Section 2: Provides the following information:

Effective date of discontinuance.
The reason benefits are being discontinued.

Section 3: Lists all of the verifications requested that the household failed to provide:

If there is no name next to a verification, that means the verification was requested for the individual listed in Section 1.
If there is a name next to a verification, that means the verification was requested from another household member, which affects the eligibility determination for the individual listed in Section 1.

Sample

Section 1:

John Doe

Section 2:

Your Medi-Cal will end the last day of 12/2015 because:

You Did not complete the redetermination process. In order to complete our review of your annual redetermination or change in circumstance, we needed the following information from you:

Section 3:

You failed to give us the required proof for

Income - Salary, Wages
Property - Checking Account
Income - Cash Gifts - (John Doe Jr)

Section 1:

John Doe Jr.

Section 2:

Your Medi-Cal will end the last day of 12/2015 because:

You did not complete the redetermination process. In order to complete our review of your annual redetermination or change in circumstance, we needed the following information from you:

Section 3:

You failed to give us the required proof for:

Income - Cash Gifts
Income - Salary, Wages - (John Doe)
Property - Checking Account - (John Doe)

How to Read Non-MAGI NOA Content for Verifications Not Provided

Case Composition: 4 person household (John Doe, Jane Doe, John Doe Jr., and Luis Doe)

Section 1: Provides the following information: (Refer to the sample below for all three sections)

Effective date of discontinuance.
The reason benefits are being discontinued.

Section 2: Lists all of the verifications requested that the household failed to provide. Each verification will list the name of the household member that the verification was requested for.

Section 3: Displays the name of all household members that are being discontinued.

Sample

Section 1:

Your Medi-Cal will end 12/31/2015 because:

You did not complete the redetermination process. In order to complete our review of your annual redetermination or change in circumstance, we needed the following information from you.

Section 2:

You failed to give us the required proof for:

Income - Salary, Wages - (John Doe)
Property - Checking Account - (John Doe)
Income - Cash Gifts - (John Doe Jr.)

Section 3:

Medi-Cal Benefits will be discontinued for:

John Doe
Jane Doe
John Doe Jr.
Luis Doe

The 90-day cure period language (for specific discontinuance NOAs only). This language informs the beneficiary that they have up to 90 days after benefits have been terminated to provide the requested verification(s), and have their benefits reinstated, without having to reapply. Refer to the sample below.

This language will be included in the following NOAs:
- Failure to comply with the annual RE process
- Failure to provide verification(s) at RE
- Failure to provide verifications as a result of a change in circumstance(s)
  
  Note: Denial NOAs do not include information about the 90-day cure period.
Medi-Cal California Code of Regulations that supports the eligibility determination.

For cases that contain more than one individual, all the information listed above will repeat for each individual in the case. As a result, MAGI NOAs will print on the front and back of a page.

Sample

We asked you for that information, but we have not received it and it is needed to complete your annual redetermination or process your change in circumstance.

You have 90 days from the date you are discontinued to provide the needed information. If we do not get the information by 03/31/2016, you must re-apply for Medi-Cal. If you return or otherwise provide the information requested above before 03/31/2016 and the information establishes continued eligibility, your eligibility will go back to the date you were discontinued as though you returned the form or otherwise provided the needed information timely.

We used the information you gave us and our records to make our decision. If you have any questions or think we made a mistake, or if you have more information to give us, call or write to your worker right away.

California Code of Regulations Title 22 Section 50175, 50189 and 14005.37(i) is the regulation or law we relied on for this decision.

Hearing Rights and Other Information

Information regarding the applicant/beneficiary’s right to request a hearing and other related information (known as the NA BACK 9) will always be on page 2, regardless of the number of pages the NOA may contain. Refer to the sample below.

Note: The mailing address located on the NA Back 9 to request a fair hearing is not the same for MAGI and Non-MAGI.

Sample

Your Hearing Rights

You have the right to ask for a hearing if you disagree with any county actions. You have only 90 days to ask for a hearing. The 90 days started the day after the county gave or mailed you this notice. If you have good cause as to why you were not able to file for a hearing within the 90 days, you may still file for a hearing. If you provide good cause, a hearing may still be scheduled.

To Ask for a Hearing:

Fill out this page,
Make a copy of the front and back of this page for your records. If you ask, your worker will get you a copy of this page.
1-855-795-0634 toll free, 1-800-952-8349 TDD, 1-916-651-2789 Fax

Mail to:
California Department of Social Services
State Hearings Division, ACAB
744 P Street, MS 9-17-98
Sacramento, CA 95814

To Get Help: You can ask about your hearing rights or for a legal aid referral at the toll-free state phone numbers listed above. You may get free legal help at your local legal aid or welfare rights office.

Local Legal Aid Office: 800-399-4529 ext. 3901
State Welfare Rights Organization: 310-603-3341
California Coalition of Welfare Rights Organization: 916-736-0616

If you do not want to go to the hearing alone, you can bring a friend or someone with you.

Non-MAGI Notice of Action

The same content found in MAGI NOAs will be displayed in Non-MAGI NOAs; however, Non-MAGI NOAs will not include the following: (Refer to the sample below)

Covered California or Medi-Cal logos
CalHEERS Case Number in the header

Non-MAGI NOAs display the content in a different format, and will also print on the front and back of a page when the NOA contains multiple pages.

Sample

Threshold Languages

LRS will send MAGI and Non-MAGI NOAs in the applicant/beneficiary’s designated threshold language. If the NOA is not available in the preferred language, LRS will send the NOA in English, along with the GEN 1365 (Multilingual Notice of Language Services) to comply with policy.

Verification Docs

N/A

Attachments

N/A

DPSS ePolicy

NAVIGATION