DPSS ePolicy

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Whenever Modified Adjusted Gross Income (MAGI) or Non-MAGI Medi-Cal (MC) beneficiaries report a change in circumstances that requires a redetermination of eligibility, and results in ongoing MC benefits, their annual Renewal (RE) date must be reset for a new 12-month period.

The annual RE date is reset only when the reported change in circumstances is a change to an eligibility data element that requires a redetermination of eligibility (i.e. changes in income, household composition, or countable property).

Welfare and Institutions Code, Section 14005.37(n), specifies that a MC beneficiary can have their annual RE date reset for a new 12-month period whenever the beneficiary reports a change in circumstances that triggers an eligibility redetermination.

Change In Circumstances

A change in an eligibility data element that requires a redetermination of eligibility is considered a change in circumstances.  If the redetermination results in ongoing MC eligibility, the annual RE date must be reset.  This is referred to as a “Rolling Renewal.”  Eligibility data elements include, but are not limited to the following:

• Age (for example, individual turning 65 years old)
• Citizenship/Immigration status
• Employment
• Household composition
• Income
• Other health coverage (such as, Medicare)
• Property/Resources (for Non-MAGI)

The redetermination of eligibility does not have to result in a change of MC benefits in order to reset the annual RE date.  For example:

• If a beneficiary is receiving MAGI MC and reports a change in income, if the beneficiary is still MAGI eligible after redetermining eligibility, the annual RE date must still be reset.

Not all reported changes in circumstances require a redetermination of eligibility.  If a reported change does not require a system run to redetermine MC eligibility, the annual RE date does not need to be reset.  Examples of these changes include:

• Change of Address (Residence/Mailing/Other)
• Change of Phone Number (Home/Cell/Message/Other)

Consumer Protection Programs

If due to a reported change in circumstance(s), the MC beneficiary is determined eligible for a Consumer Protection Program (CPP), the beneficiary would not have his/her annual redetermination date reset.  Instead the beneficiary would be enrolled in the appropriate CPP.  Examples of a CPP include:

• Continuous Eligibility for Children (CEC)
• Transitional MC (TMC)
• Continuous Eligibility for Pregnant Women

Resetting The Annual Renewal Date

When determining MC eligibility based on a reported change in circumstances that requires a system run, staff must redetermine MC eligibility for the future month following the reported change.  For example:

The new RE date reflected in the example above is based on the following criteria:

• The reported change in circumstance(s) required a new eligibility redetermination (system run); and
• The eligibility redetermination resulted in ongoing MC eligibility.

Changes Reported To Other Programs

If a MC beneficiary is also receiving benefits under another public assistance program(s), and the beneficiary reports a change in circumstances that would require a redetermination of MC eligibility, the beneficiary must also have their MC eligibility redetermined.  Other public assistance programs include, but are not limited to:

• CalWORKs (CW)
• CalFresh (CF)
• General Relief (GR)

For example, if a MC beneficiary who is also receiving CF benefits reports an income change on their SAR 7 (Eligibility Status Report), the reported change in income must also be updated in the MC case.  Based on the reported change, MC benefits must be redetermined for ongoing MC eligibility.

If the redetermination of MC benefits results in ongoing MC eligibility, the MC annual RE date must be reset with a new 12-month period of eligibility.

Under no circumstances shall eligibility staff attempt to align the MC RE date with the redetermination/recertification date for another program.  The 12-month period of MC eligibility should never be shortened or extended to align with other benefit programs.

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