DHCS MEDIL I 14-36: Using Modified Adjusted Gross Income and Express Lane Enrollment Aid Codes for Applications in the Pending Backlog (7/8/14)

In an effort to reduce the backlog of pending Medi-Cal applications, DHCS has issued this guidance to the counties on using MAGI and Express Lane Enrollment (ELE) aid codes as a manual workaround.

These aid codes are to be used when at least one member of the household has an active Medi-Cal or CalFresh aid code in MEDS and SAWS, and only when:

  1. At least one household member has been determined eligible or contingently eligible in CalHEERS and the entire case cannot be accepted into SAWS/MEDS because others in the household are still pending.
  2. The county file clears and determines the case as MAGI eligible, and CalHEERS responds that the case is pending due to data and/or technology issues with CalHEERS.

Counties cannot use this process to manually grant Medi-Cal eligibility for non-MAGI cases, limited/restricted scope cases, cases where no household member is on an active Medi-Cal/CalFresh aid code in MEDS/SAWS, or when the only eligible case members are TLICP children.

The state will send NOAs to beneficiaries granted eligibility through ELE aid codes based on this process.  Counties will send NOAs to those granted eligibility under MAGI aid codes.  All of these beneficiaries will receive intake packets.