Non-MAGI Application Supplemental Packet

MEDI-CAL

Non-MAGI Application Supplemental Packet

Release Date

06/30/2020

Section Heading

Purpose

To convert existing policy to the new webpage - No content changes
To revise existing policy and/or form(s)

What changed?

The Department of Health Care Services (DHCS) released policy requiring the use of supplemental forms for Non-Modified Adjusted Gross Income (MAGI) Medi-Cal (MC) eligibility determinations;
The MC 604 IPS, Additional Income and Property Information Needed for MC form is also used for Non-MAGI eligibility determination at application; and
The required supplemental forms include a Non-MAGI cover letter and brochure.

Policy

Applicants determined not eligible for MAGI MC must be evaluated for Non-MAGI MC, if they meet any of the following criteria:

Aged, Blind, or Disabled (ABD);
Seeking Long Term Care (LTC);
Seeking services under Home and Community Based Services Waiver;
Potentially eligible as Medically Needy; or
Applicant requested a Non-MAGI or full eligibility determination.

Background

As required by Welfare and Institutions Code, Section 15926 and 42 Code of Federal Regulations Section 435.911(c)(3), a Non-MAGI MC eligibility determination must be performed when an applicant requests Non-MAGI, a full eligibility determination, or when the individual is:

Not eligible to MAGI MC and potentially eligible to Non-MAGI;
Income eligible for Advanced Premium Tax Credits (APTC) or Cost Sharing Reduction (CSR), or
Not income eligible for MAGI MC and indicated on the Single Streamline Application they want to be evaluated for all MC programs.

Definitions

Terms and Descriptions

MAGI MC

Income based MC program that utilizes the MAGI methodology to determine eligibility for MC.

Non-MAGI MC

Income and property-based MC program that existed prior to the implementation of the Affordable Care Act, and continues to provide MC coverage under the following programs:

ABD;
LTC;
Medicare Savings Programs (MSP);
Medically Needy;
250% Working Disabled Program;
Pickle;
Sneede vs. Kizer; or
Minor Consent.

APTC/CSR

Income based programs that provide subsidies in the form of tax credits or help in paying out-of-pocket expenses like deductibles and co-payments. Qualified individuals who are not eligible to MAGI MC or eligible to Non-MAGI MC with a Share of Cost can buy health insurance and receive APTC/CSR through Covered California (CoCA).

Note: APTC/CSR cases without MC eligible members are administered by CoCA.

Ex-Parte

The process of reviewing all information available to the county that is relevant to determine MC eligibility without having to contact the applicant/beneficiary or request verifications. Sources include the LEADER Replacement System (LRS), Medi-Cal Eligibility Data System (MEDS), Income and Eligibility Verification System (IEVS) abstracts, and Systematic Alien Verification for Entitlement (SAVE).

Two-Contact Process

The process of contacting the applicant (verbally or in writing) two times to request additional information and/or verification prior to taking negative action (denial). The process must include:

First contact:
Requesting information and/or verification from the applicant and allow at least a ten-calendar due date to submit.
Second contact:
If the applicant fails to provide or provides incomplete information and/or verification by the due date, then a second request must be given to the applicant with an additional ten-calendar due date to submit the information and/or verification.

Note: When requesting additional information and/or verification during the application process, eligibility staff must use the CW 2200.

Requirements

To conduct a Non-MAGI MC eligibility determination when the applicant is not eligible to MAGI MC and they meet the criteria under the Policy section in this document, additional information and verification related to Non-MAGI must be collected by completing an ex-parte review.

If eligibility to Non-MAGI MC cannot be established through an ex-parte review, the Non-MAGI Application Supplemental Packet must be provided to the applicant. The following supplemental forms must be included in the packet:

Form/Letter/Brochure and Descriptions

Non-MAGI Cover Letter

This letter:

Informs the applicant of their request for an evaluation for all MC programs including:
1. MAGI MC;
2. Non-MAGI; and
3. CoCA.
Requests that the applicant provides a completed MC 604 IPS and verification(s) by a specific due date.
Informs the applicant of differences between Non-MAGI and MAGI MC.
Informs the applicant of Minimum Essential Coverage (MEC).
Provides an overview of Non-MAGI MC and APTC/CSR.

MC 604 IPS - Additional Income and Property Information Needed for Medi-Cal

This form captures the required property/assets, income, and expense information to evaluate the beneficiary for Non-MAGI MC.

MC 007 - Medi-Cal General Property Limitations

This form provides a general overview of the MC property requirements for Non-MAGI individuals.

DHCS 7077 - Notice Regarding Standards for Medi-Cal Eligibility

This form provides a brief summary of the MC property requirements for unmarried/married individuals who reside in or are entering a LTC facility.

DHCS 7077A - Notice Regarding Transfer of a Home for Both a Married and an Unmarried Applicant/Beneficiary

This form provides a brief summary of the MC eligibility rules related to the transfer of a home for unmarried/married individuals who reside in or are entering a LTC facility.

PUB 10 - Non-MAGI Medi-Cal

This brochure provides detailed information regarding the Non-MAGI MC program requirements.

With the release of this policy, the MC 604 IPS replaces the MC 210 PS and MC 322 when requesting additional income and property information for a Non-MAGI eligibility determination at application.

Verification Docs

N/A

DPSS ePolicy

NAVIGATION