Here’s the most comprehensive redetermination explanation and forms that I could find.
I checked with Medi-Cal and here is an excerpt of their response.
The majority of MAGI Income Medi-Cal renewals are now handled electronically via an ex parte [means you don’t have to appear in person] review process. Specifically if a beneficiary’s information can be electronically verified through the Federal Hub, then the beneficiary is automatically renewed for a year which does not require any paperwork or verification to be completed by the beneficiary.
As always, if the beneficiary has any change in circumstance, they must report that to the county within 10 days of the event or Medi-Cal might make a Federal Case of it!
For beneficiaries whose information cannot be electronically verified through the Federal Hub, the counties now send the beneficiary a pre-populated renewal form (MC216) only asking them to provide the information that could not be verified. Therefore this new process minimizes the paperwork necessary to complete the beneficiary’s annual renewal.
Scroll down and get more detail, where it says Redetermination of Eligibility, changes.
Reply from Medi-Cal, about their asking for the most current information:
Medi-Cal is a state program administered at the county level. DHCS is not able to make changes. Your changes need to be reported to the human services agency of your county dhcs.ca.gov/CountyOffices .
If you’ve found more information on redetermination, please put a link in the comments below.
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Western Poverty Law - Exact Legal Rules on Coverage for Low Income Californian's
Western Law Center Guide on redetermination – Page 6.227
Medi-Cal Consulting Services provides assistance to families seeking Medi-Cal benefits for loved ones. Here’s their initial assessment form. Fees for our services are based on the complexity of the issues surrounding the case.
terrible renewal form california health line.org – how state will handle renewals california healthline.org Lawsuit filed against Medi-Cal for making it hard to renew coverage Redeterminations of Medicaid Eligibility
- § 435.916 — Periodic redeterminations of Medicaid eligibility.
- § 435.919 — Timely and adequate notice concerning adverse actions.
- § 435.920 — Verification of SSNs.
DHCS FAQ’s for Social Workers 5.19.2011
If I already have Medi-Cal benefits, do I need to reapply?
No. If you already have Medi-Cal coverage, your Medi-Cal benefits will continue until your next regularly scheduled annual redetermination date. Then make sure you get the paperwork in on time and make sure Medi-Cal processes it. If you have Covered CA your subsidies depend on it! Backlog problems LA Times 12.20.2016.
If I currently receive Medi-Cal benefits, will my benefits change in 2014?
No. Medi-Cal will continue to provide the same benefits under the ACA as it provides you today. At your annual redetermination, we will determine what health insurance program you and your family are best suited for. AB 1 Perez more than you ever wanted to know…
What if I earn $10/month too much for Medi-Cal? I can’t afford to pay for coverage.
Use our FREE calculator to determine if your MAGI Modified Adjusted Gross Income allows you to get Covered CA Subsidies for Health Insurance. Your net premium might very well be under $100/month and you might get Silver 94. See also our income chart.
8. What will happen after I apply for Medi-Cal health coverage?
You will receive a letter within 45 days to tell you which program you and your family members qualify for. If you don’t hear from us, please call us at 1-800-300-1506 (TTY: 1-888-889-4500). (FAQ’s DHCS.Gov)
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Medi Cal - County Office Lookup
- Bank Statement Review
- Don’t want Medi-Cal for the kids – redetermination form?
- Household Definition – Who counts?
- MC 216 Income & Expense Definitions
- MC 262 Long-Term Care Medi-Cal Renewal
iii. Redetermination of Eligibility
The county must determine a beneficiary’s ongoing eligibility upon learning of a change potentially affecting eligibility [Medi-Cal and the law require changes be reported within 10 days] from the beneficiary or from its own review as follows:
• Determine if the change in circumstances affects eligibility. For example, a change of address may not affect eligibility for Medi-Cal, but a change in household size might. If there is no change in eligibility based on the new information, no other action is needed. Another example: If income increases $100/month, but the annual household income remains below the eligibility limit, the individual remains eligible for the same program so no further action is needed.
• If the county determines that the change in circumstances may affect eligibility, the county must attempt to gather all eligibility information using the ex parte process – [beneficiary doesn’t have to appear in person] a review of all available data resources such as the beneficiary’s CalWORKs file or the federal data services hub.
• If the ex parte process does not provide the county the information it needs to find the beneficiary still eligible, the county shall ask the beneficiary for the information it needs. To request information from a beneficiary, the county must use a pre-populated form containing the information that the county already has and that requests only the information needed from the beneficiary to renew eligibility. The beneficiary has 30 days from the date the pre-populated form is mailed to respond. The beneficiary must be allowed to provide the information requested on the pre-populated form by mail, phone, in person, or any other commonly available electronic means authorized by the county or DHCS.
• During this 30-day period, the county must try to contact the beneficiary by phone, in writing or other commonly available electronic means at least once in an effort to obtain the necessary information. If the beneficiary has identified a preferred method of contact, the county must use that method, otherwise, the county must use reasonable efforts to determine the best method of contact.
• If the beneficiary responds, the county must determine if the beneficiary remains eligible based on the information provided by the beneficiary. If they remain eligible, the county completes the redetermination and sends written notice to the beneficiary. The beneficiary’s next renewal date should be reset to 12 months from the date the county determines the beneficiary is eligible.
° In evaluating information regarding changed circumstances, the county must follow the SB 87 process described at Section A.3.a.iv below and in Welfare & Institutions Code 14005.37 subsection (d) and evaluate the beneficiary for eligibility for all Medi-Cal programs (MAGI and non-MAGI) before terminating the beneficiary from Medi-Cal. If based on the new information the beneficiary is found not eligible for any Medi-Cal program (if they are over income due to an increase in income or change in family composition, for example) the county must determine eligibility for Covered California with financial assistance. If eligible, the county should assist the individual with enrollment into Covered California and, if requested, with Covered California plan selection. After completing the beneficiary’s eligibility determination for Covered California, the county is required to send the beneficiary a ten-day Notice of Action terminating their Medi-Cal. Note that the county is supposed to take any steps necessary to ensure that a Covered California-eligible beneficiary being discontinued from MediCal can transition to Covered California without a break in coverage. Beneficiaries found eligible for Share of Cost Medi-Cal must also be evaluated for Covered California financial assistance. Beneficiaries eligible for Covered California have the choice of having just Share of Cost Medi-Cal, Covered California, or both.
° If the beneficiary does not provide the necessary information to the county within the 30-day period, the county may send the beneficiary a ten-day Notice of Action of terminating Medi-Cal. At this point in the process, the county is required to immediately evaluate the beneficiary for premium tax credits and forward the case to Covered California. At the end of the ten days, the beneficiary may be discontinued or terminated from Medi-Cal; however, if the beneficiary provides the requested information prior to the termination date, the county must rescind the termination action and conduct an eligibility evaluation and redetermination.
° If terminated, the beneficiary still has 90 days from termination to “cure” or provide the information requested and if they do so, the county must treat the information as if it was received timely. Note that the “good cause” rule regarding submitting information even beyond the 90 days applies. See also Section B.1 later in this chapter for the Medi-Cal notice and hearing rights, including the right to continue receiving MediCal pending appeal (aid paid pending).
Note that these rules generally apply to both MAGI and Non-MAGI Medi-Cal beneficiaries.
Also note that the county can terminate without doing a redetermination only when it has proof that the beneficiary cannot be eligible for Medi-Cal such as proof that the beneficiary died or moved out of state. Copied from Western Poverty Guide *
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