DHCS ACWDL 14-11: Pre-ACA Medi-Cal Annual Redetermination Process

This letter, in conjunction with DHCS ACL 14-03, provides instructions on Medi-Cal annual redeterminations to convert pre-ACA Medi-Cal to MAGI Medi-Cal during 2014.  Read the full letter with example timelines here.

For renewals normally scheduled January through June, the original month of renewal will remain the same for 2015 regardless of when the county processed the 2014 renewal.

For the 2014 annual redetermination, the county will send beneficiaries the Request for Tax Household Information (RFTHI) redetermination packet.  Beneficiaries will have 60 days to complete and return the packet (via mail, phone, fax, in person, or any other available means) and will not need to submit paper verifications for information in the federal/state data hub unless requested.  The County should follow up during the 60 days, give 10 days for the beneficiary to submit the packet, and send a 10-day termination notice depending on beneficiary response.  When the county receives the packet, SAWS will use CalHEERS rules to determine continued Medi-Cal eligibility.

When a beneficiary fails to return the redetermination packet, the Medi-Cal case is discontinued for lack of cooperation.  When an application is missing information or when there is incompatible information based on available sources, the county will request this information from the beneficiary.  Failure to submit the information will result in termination.  Beneficiaries will have a 90-day cure period; if found eligible, the county will restore benefits back to the date of discontinuance.  In non-foster youth cases, if the county is unable to contact the beneficiary after attempting by any means available to the county, the case is discontinued.

Former foster youth up to the age of 26 will receive a simplified annual renewal packet and not the RFTHI packet.  Former foster youth will not be discontinued due to loss of contact; instead, they will be placed in fee-for-service Medi-Cal.