Medi-Cal (not Medicare or medical)
Annual Redetermination form

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 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.

Non MAGI Income qualifiers like Aged & Disabled would use MC 210 RV (Rev 5/11)  which is in the process of being updated.

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 .

Medi-Cal & County contact information

 

If you’ve found more information on redetermination, please put a link in the comments below.

Medi-Cal Handbook

Blog Post – Insure Me Kevin.com  11.9.2016

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Learn More:  

LA Care – FAQ’s

FAQ for Enrollers assisting Medi Cal Enrollment  

Kaiser Instructions

End of Medi-Cal Expansion under Donald Care – American Health Care Act * §112    * Sec. 116. Providing incentives for increased frequency of eligibility redeterminations.

Contact Information for your Local Medi-Cal Office

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.

Four Page Summary on How to Enroll, Shop & Compare Covered CA  for 2016

 terrible renewal form  california health line.org – confusing forms   california health  line.org how state will handle renewals   california healthline.org Lawsuit filed against Medi-Cal for making it hard to renew coverage california health line.org/ Redeterminations of Medicaid Eligibility

FAQ’s and ask a Question 

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)

Call Blue Cross Direct - They don't pay me to help you with Medi-Cal
Call Blue Cross Direct - They don't pay me to help you with Medi-Cal Call Blue Cross Direct - Medi-Cal's Website - Contact Page, including secure email to ask a question

Direct Phone # 866.613.3777
Direct Phone # 866.613.3777

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Medi Cal - County Office Lookup

County Offices

iii. Redetermination of Eligibility

The county must determine a beneficiary’s ongoing eligibility upon learning of a change potentially affecting eligibility 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.7  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 – 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.8 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.9

• 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.10

° 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.11 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.12 If eligible, the county should assist the individual with enrollment into Covered California and, if requested, with Covered California plan selection.13 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.14 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.15 Beneficiaries found eligible for Share of Cost Medi-Cal must also be evaluated for Covered California financial assistance.16 Beneficiaries eligible for Covered California have the choice of having just Share of
Cost Medi-Cal, Covered California, or both.17 

° 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.18 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.19   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.20

° 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.21 Note that the “good cause” rule regarding submitting information even beyond the 90 days applies.22 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.23 

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.24

Copied from Western Poverty Guide  * 

 

 

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We can’t afford to do Covered CA’s and Medi-Cal’s work to answer your questions.  Please use our contact page and talk to someone who is getting a great salary and benefits to help you. Try their Facebook page  https://www.facebook.com/CoveredCA/

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48 comments on “Redetermination? Renewals?

  1. I didn’t fill out my annual redetermination forms and got disenrolled. When I went to the County Office, they said that since I got a job and didn’t inform them, that I was banished from getting Medi-Cal.

    What do I do?

      • OK, it looks to me like you simply “pissed off” the Social Workers at your county office.

        Maybe they think you are lying, even if your income change, didn’t make a change in benefits!

        What is an Intentional Program Violation?

        An Intentional Program Violation (IPV) is the Department of Social Services’ way of saying someone lied in order to obtain benefits. DSS may claim that a person has committed an IPV if he or she failed to report information, made a false or misleading statement, or engaged in conduct which violated DSS rules.

        There are many reasons for IPVs. However, two of the most common situations involve a public assistance recipient’s failure to report earned income from a job and a recipient’s failure to report a change in household composition, such as when a spouse or parent has returned to the household. Under both these circumstances, the unreported information could result in the recipient receiving more public assistance than he or she is eligible to receive.

        What are the possible penalties for committing an Intentional Program Violation?

        The penalties for committing an IPV can be severe. If DSS chooses to sanction a recipient administratively, the sanction may be for six months for the commission of a first public assistance-IPV or for twelve months if it is the second IPV or if the recipient wrongfully received benefits in the amount of $1,000 to $3,900. A third IPV, or an IPV resulting in the wrongful receipt of benefits in an amount over $3,900 may result in a sanction of eighteen months, and a fourth or subsequent IPV may result in a sanction of five years.

        What should a recipient who is charged with welfare fraud do?

        It is always important to remember that welfare fraud can result in criminal prosecution, and ultimately time in jail or prison. Consequently, the recipient must be very careful when speaking with DSS, its investigators, and the District Attorney. The recipient has the right to remain silent, and the right to an attorney. If criminal charges are brought, the recipient may be eligible for a court appointed criminal defense lawyer.

        If criminal charges are not brought, the recipient should have the opportunity to try to “negotiate” a settlement. The recipient can agree to pay back an overpayment without admitting to fraud. If a deal can be worked out without criminal charges being brought, the recipient should make sure that DSS and the DA promise, in writing, not to prosecute. If this agreement cannot be reached, the recipient should consult with an attorney. https://www.lasnny.org/lifelines/ipv-welfare-fraud/

        ******

        Q: I received a notice in the mail to re-determine my eligibility for Medicaid.

        Do I have to respond?

        A: Yes, you must respond to every notice asking you for more information related to your eligibility for State programs, even if none of your information has changed. If you do not respond, your coverage will end.

        Q: My application for health coverage through Medicaid was denied for failure to provide
        requested information
        or verification documents, what should I do now?

        A: Applicants who are denied Medicaid for failure to provide requested documents have 60 days from the date of the denial notice to submit the documents to the office that sent the denial notice. If an applicant submits the requested documents within 60 days, the case will be reopened. After 60 days, someone must reapply.

        Additionally, applicants can appeal this and any other denial. This will allow them to dispute https://www.illinois.gov/hfs/SiteCollectionDocuments/ACA_FAQApplicationforMedicalAssistance.pdf

        Again, go online and see if you can fix the problem.

        We are NOT attorney’s!!! https://boardtraining.info/links-resources/unlawful-practice-of-law/

        You might need one. We are not qualified to tell you if you need an attorney. Check out the link to attorney websites above!

  2. i would have lost my medi-cal but in california the craig vs bonta 12.6.2010 letter to county employees lawsuit stops them

    I’m wondering if im going to lose my medi-cal after the worker re-does my case??

    i also get medicare so wondering if this re-determination is something they have to do to kick me off medi-cal

    Craig vs Bonta says something about Medi-Cal cannot terminate until you do the redetermination

    so im confused i’ll ask my case worker tuesday

    i guess but wondered if you have insight

  3. Am i allowed to have gained monies from the refinance of my home? Do i need to pull that money out of my bank account prior to sending in my redetermination forms?

  4. In Section 4 Question D of Annual re-determination form MC 210 RV it is asked ” did anyone in the home get inpatient care in a nursing facility or medical institution?”.

    I was admitted to the hospital for emergency CABG ( heart bypass ) surgery, and stayed in ICU for 10 days.

    Is this considered as having got inpatient care?

    • Here is Medicare’s definition – Criteria publication # 11435

      Here’s what I find to be the most relevant part.

      If you need help understanding your hospital status, [in patient or not] speak to your doctor or someone from the hospital’s utilization or discharge planning department.

      On the Medi-Cal form where it ask which family member, you could include that you were in icu for a bypass.

  5. I need to talk to a real person!!!
    I have a single question, but the automated calls CANNOT help me!!
    I have tried calling any number I can find for Medi-Cal, but no number leads me to a real person!!
    I just need to talk to a real person!!!

    Can someone give me an actual number that will get me to a real live Medi-cal representative?!

  6. I am 29, live at home, go to USC full time. I live with my mom who is retired & on social security. I just received a redetermination packet. Do I have to put my family who lives at the house on this form with their income? They do not want medical or aid. I do not know their income & my mother feels that its no ones business what her income is since she is not applying for any type of aid. In other words for section 1 of the MC210 form what do I put for family & income.

    ***We’ve answered very similar questions on these child pages.

    • Thank u so much for ur response. I only receive SSDI, $1091/mo. However, the month before my fathers transfer was my bday & I desperately asked for cash bc my HOA increased & I’ll be unable to pay my bills so I deposited every cent I had-$220 the previous month-the total amount of my bday gifts (more than usual obviously but I think my family is worried I’m going to lose my condo). So I’m worried if they ask for another bank statement from the month before it will show that huge bday money deposit. And it said u can only have $60 deposited quarterly I just read online??? I’m so scared. If I lose MediCal I don’t know what I’ll do. I have so many health problems I’m fighting. If my redetermination date is Nov; papers mailed in Oct do u know if I have Til Nov 30th? Should I wait Til my next bank statement comes out- bc I NEVER have deposits like that- this was just a one time thing& it could cost me so much. I’m so scared. Thank u so much,
      Amber. CA

  7. Under income and Expenses to renew my children’s medi-cal they also list my my children but they don’t receive any income. Would I leave it blank? They only have amounts under my name and my husbands.

    • See above

      it says annually

      but you only get a redetermination form if Medi-Cal isn’t able to verify everything through the federal hub

      When your income increases be sure to contact us so we can get you in with the regular insurance company through covered California with subsidies if applicable

  8. What address can I mail the medi-cal redetermination form to in the city of los angeles? Also can I fax it?
    Thank you

  9. My husband and I have been searching for the mc216 form that does NOT have “for informational purposes” stamped across it. Our contact person at medi-cal says they are out there but we can’t find one 🙁
    Amy suggestions??
    Thanks so much!!

    • No idea. If I had it, I would post or link to it. If you are able to find it online, please post the link here for others. How about asking your Social Worker to email it to you?

      • Thanks for your swift reply!! It has been frustrating…we don’t really have a social worker per se, but the person Bruno got thru to (after an HOUR on hold!!! grrr) was not helpful, just told him to look for it-that is is out there. We both searched and searched
        Seems they are making it intentionally difficult to get requalified???
        I guess we have to spend a day out in el Monte at the office??

        Arrrghhhh

        Thanks again, and Happy 4TH!!

  10. Is my boyfriend considered family when filling out the medi-cal redetermination form? Yes he lives with me, but he has his own expenses to worry about. I am referring to the part about job and checking account. Thank you for your help with this 😉

  11. I live with my daughter who has a job and provide me free rent and food. Is she considered a family member or only my husband is my family member? I have to fill out the annual redetermination form now. Please help.

    Thank you very much.

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