DPSS ePolicy

Revision of existing policy and/or form(s).

The purpose of this document is to provide updated Medi-Cal (MC) Renewal (RE) policy and procedures for Modified Adjusted Gross Income (MAGI), Non-MAGI, and Mixed MAGI/Non-MAGI Households (HHs).  The policy and procedures outlined in this document are to be followed when processing post-Continuous Coverage Unwinding (post–CCU) MC REs beginning with the June 2024 MC REs.

What changed?

1. Added the policy that requires the MC RE forms to be pre-populated;
2. Added the performance standards policy for MC RE processing;
3. Added new policy regarding a Special Enrollment Period (SEP) for discontinued MC individuals to enroll in a Covered CA (CoCA) health plan during the 90-day cure period;
4. Added the good cause policy for MC REs;
5. Added and updated terms in the Definitions section;
6. Added third-party electronic signatures (e-signatures) as an acceptable method to capture a signature for MC REs;
7. Added the MC RE flexibility waivers that can be used when processing post-CCU REs through June 30, 2025;
8. Added a section on the Batch MAGI skipped reasons;
9. Updated the property policy for Non-MAGI MC determinations:
10. Added the automated ex-parte review process for Mixed HH REs;
11. Added a section on the use of Verify Current Income Responses (VCI-R) when processing MC REs;
12. Added a section on MC REs submitted via BenefitsCal;
13. Updated the section on MC REs submitted via CoCA;
14. Added the Consumer Protection Programs (CPPs) under Soft Pause;
15. Added the requirement to screen for Spousal Impoverishment (SI) at MC RE;
16. Added new policy to issue two reminder notices during the MC RE process;
17. Added a section on MC REs not auto-discontinued;
18. Added the verification hierarchy process for incomplete MC REs;
19. Updated the verifications received or found via ex-parte review without the RE form process;
20. Updated the 90-day cure period process;
21. Updated the Undeliverable Mail process for MC REs;
22. Updated the MC RE reports section;
23. Updated the MC RE Packets and MC RE Information Notices sections in the Forms section; and
24. Added the MC RE Forms and MAGI RE Informational Packet sections in the Forms section.

Beneficiaries receiving MC benefits must have an eligibility redetermination at least once every 12 months to determine eligibility for ongoing MC benefits.

Title 42, Code of Federal Regulations (CFR), Sections 435.916(a) and 435.916(b), requires counties to redetermine MC eligibility at least once every 12 months.  CFR Section 435.907(f), and Welfare and Institutions Code (WIC) Section 14005.37(r) mandates the MC RE form signature requirements.
 
Title 42, CFR, Section 435.916, and WIC, Section 14005.37 requires that MC RE forms be pre-populated and sent to beneficiaries who do not have their MC benefits automatically renewed during the ex-parte review at least 60 days prior to their MC RE due month.

WIC Section 14154(d)(3) mandates the performance standards for MC RE processing.  To meet the MC RE performance standards, counties must ensure that:

• Ninety percent of MC REs are completed within 60 days from the last day of the MC RE due month for MC REs in which the form was received complete and returned by the beneficiary in a timely manner:
  
  • The RE form is considered to have been received complete if all required information and/or verifications to process the RE were received and the form was signed; and
  • The RE form is considered to have been received timely if the RE form was received complete by the last day of the MC RE due month.

WIC Section 14005.37(i) mandates a 90-day cure period.  This period allows a beneficiary the opportunity to provide the requested information that resulted in an MC discontinuance and have MC benefits re-instated without having to re-apply for MC.

Per Title 45, CFR Section 155.420(c)(6) and Title 10, California Code of Regulations (CCR) Section 6504(f)(6), effective January 1, 2024, individuals discontinued from MC benefits have up to 90 days to enroll in a CoCA health plan via a SEP.  This policy is intended to align the CoCA SEP with the MC 90-day cure period.  The effective start date of the CoCA health plan coverage will depend on whether the individual requests a prospective or retroactive enrollment.  The request must be made within the 90-day cure period, and individuals may be granted a CoCA health plan coverage with an effective date back to the MC effective date of discontinuance.

Title 22, CCR Section 50175(c) mandates the MC policy for good cause, which can be applied during the MC RE process when MC individuals are discontinued for not submitting the MC RE or not providing the requested information needed to complete the MC RE.      

Annual MC RE

Beneficiaries receiving MC benefits must have an eligibility redetermination at least once every 12 months to renew eligibility for ongoing MC benefits.  

MC RE Packet Submission Methods

Beneficiaries can submit MC REs via any of the following methods:

• In person;
• By mail;
• By fax;
• Online – via the BenefitsCal and CoCA online portals; and
• By telephone.

MC RE Form Signature Requirements

For the MC RE form to be considered complete, the beneficiary’s signature must be captured during the MC RE process.  The signature may be captured via any of the following methods:

• Physical handwritten signature (on MC RE form);
• Online portal electronic signature (via the BenefitsCal and CoCA online portals);
• Third-party e-signatures (from CBO and advocate agencies); or
• Telephonic signature (via audio recording and documenting on the case journal page that the signature was captured verbally over the telephone).

If the beneficiary returns the MC RE form without a signature by mail, fax, or submits it to the county in person, the MC RE can be processed without capturing a signature when the required information needed to complete the MC RE is provided by the beneficiary or is found via ex-parte review and the processing of the MC RE will not result in a negative outcome for the beneficiary.  Otherwise, the MC RE form must be signed by one of the above signature methods.

90-Day Cure Period

MC individuals discontinued for not submitting the MC RE or not providing the requested information needed to complete the MC RE have up to 90 days from the effective date of discontinuance to provide all information needed to restore eligibility.  This includes submitting the signed MC RE form and all required information and/or verifications needed to process the MC RE.  If all needed information is provided within the 90-day cure period (rescission period), the information must immediately be entered into CalSAWS to complete the rescission process.  If the MC individual is found eligible, MC benefits must be restored back to the effective date of discontinuance (without a break in aid).  A new MC application is not required during the 90-day cure period.

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