DHCS issued new guidance on the requirements for issuing Notices of Action to individuals discontinued from Medi-Cal due to being over income for MAGI programs, not being eligible for Consumer Protection Programs, and not being eligible for any non-MAGI programs. SAWS now has been programmed to automatically generate the Over Income NOA for the appropriate scenario. The NOA provides more detail related to the income, household size, and income limit for the individual losing eligibility.
All counties must ensure that timely and adequate NOAs are issued to all discontinued individuals. For those also found ineligible for non-MAGI programs, those individuals would also be issued the appropriate non-MAGI NOA. These individuals should be immediately evaluated through CalHEERS for Covered California eligiblity.
Those losing Medi-Cal are not subject to the 15-day rule to pick a plan. They may pick a Covered California plan by the end of the month in which they lose coverage and have Covered California coverage start at the beginning of the next month as long as they pay the first month’s premium on time. The county shall assist individuals in completing the enrollment process into Covered California, including helping with plan selection should an individual request such assistance. A beneficiary may have less than ten days to prevent a gap in coverage, but affected beneficiaries would still have the full 60 days to pick a plan through Covered California.
DHCS ACWDL 16-14 (June 15, 2016).