Medi-Cal Cases/Calendar Month Holding Period

A “Calendar Month Holding Period” is defined as a calendar month beginning the 1st day following the month after CalWORKs (cash aid), CalFresh or TCF, Foster Care (cash aid) has discontinued/ended.

The following procedure must occur when a continuing office is transferring a case that was converted to Medi-Cal only after the cash aid and/or CalFresh has been discontinued for one month or longer:

Who Action
Eligibility Work Supervisor (EWS)
  • Receives the "Active Medi-Cal Only Case (TCF excluded)" report via Info View on the 1st and 11th of each month.
  • Reviews and assigns task with instructions or other pertinent comments.
EW
  • Receives task and reviews “Active Medi-Cal Only Case (TCF excluded),” ensuring Medi-Cal is the only “approved” active program.
  • Reviews the reason for discontinuance, (e.g., failure to provide Periodic Report, incomplete Periodic Report, RE, etc.).
  • Prints a copy of the Inquire on Case Information with the [Programs] tab selected showing the Medi-Cal program status as approved (all other programs will be discontinued, denied or other).
  • Reviews the Medi-Cal Program RE due date in CalSAWS.
If the Medi-Cal RE is... Then the EW must...
Overdue, 
  • Retain the case to research and process the RE.
  • Review and ensure that a RE Medi-Cal packet is sent to the client with a 20 day due date.
  • Make a determination if the RE overdue status is due to the client or EW’s failure to act.

  • Note: If the overdue status is client caused and all timely and appropriate NOAs have been sent, discontinue the Medi-Cal, document in CalSAWS Journal Detail page and transfer to closed case control number.
Due in the same month of discontinuance, 
  • Retain the case to process the Medi-Cal RE and document all actions taken in CalSAWS Journal Detail page.
  • Send a Medi-Cal RE mail-in packet to the client.

  • Note: The case will remain in the EW’s caseload number during this time period.

  • Upon completion of the RE, the case will be placed in control and must be assigned to the Medi-Cal control number until the remainder of the calendar “holding” period has been completed.
  • Example Example (The Medi-Cal RE is due in the same month of discontinuance) CalWORKs discontinues at the end of March. The Medi-Cal RRR is due March. The Medi-Cal RE mail-in packet is either sent late February or early March. If the Medi-Cal RE mail-in packet is returned within the same month of discontinuance (March) it would be processed by the EW of record. 
Due in the future month,
  • Mail the Medi-Cal RE packet and document actions taken in CalSAWS Journal Detail page.

  • Note: If the Medi-Cal RE mail-in packet is returned WITHIN the “calendar month holding period,” the case will be assigned to a generic continuing caseload for RE completion.

  • The EW will receive one (1) case credit for the assignment and actions required in the case which will be manually added to the monthly caseload balance.
  • Upon completion of the RE, the case will be transferred to the Medi-Cal control number for the remainder of the “Calendar month holding period.”
  • EXAMPLE EXAMPLE (The Medi-Cal RE is due in the future month after discontinuance) CalFresh is discontinued at the end of March. The Medi-Cal RRR is due in April. The calendar month holding period is the entire month of April. The Medi-Cal RE packet is sent in March and received on April 12th. The case will be assigned to an available EW to process the RRR. 
  • Verify in MEDS that all persons are active on Medi-Cal with the correct aid code and SOC.
  • Submit a copy of the Inquire on Case Information screen with the following notations: RE due date information; Medi-Cal RE packet mail date (if applicable); language to Supervisor for review for potential transfer.

 
EWS
  • Reviews the cases provided by each worker for case transfer appropriateness to BSC, e.g., discontinuance reasons, NOAs, budgets in CalSAWS, etc.
  • Re-reviews the Active-Medi-Cal Only Report and compares it to the cases submitted by the worker. If the case is:
    • Complete, then the EWS:   
      • Ensures the case is transferred to the district office’s control caseload number.
    • NOT complete, then the EWS:   
      • Returns case(s) to the worker for correction and completion.

        • Note: Afterwards, the case is re-submitted to the EWS for review.
Continuing Office Control Clerk
  • Transfers cases to the appropriate Medi-Cal only case control number.

  • Note: All cases in the MC control number shall remain in the continuing office for a "holding" period of a calendar month beginning on the 1st day following the month after CalWORKs (cash aid), CalFresh or TCF has discontinued/ended.

  • Example Example CalWORKs, CalFresh or TCF discontinues at the end of February and Medi-Cal is continued. The Medi-Cal case is transferred to BSC on April 1st. 
  • Reviews the Medi-Cal Only (Discontinued) -> 30 Days Report for all cases under the M/C control number.
  • Transfers all cases to BSC.

Reminder: Existing procedures for REs take precedence and must be adhered to at all times. In addition, when an RE is due in the following month, cases cannot be transferred unless the RE is processed. As such, if the RE is due in the month immediately following the calendar month holding period, the case must be held and the RE processed prior to transfer.

CalWORKs or CalFresh Restoration Required Within the “Calendar Month Holding Period”

If the case warrants restoration of either cash aid or CalFresh benefits during the holding period, the case will be assigned to ANY available worker per regular case assignment procedures.

Medi-Cal Related Inquiry and/or Urgent Actions Needed Within the “Calendar Month Holding Period”

If Medi-Cal only actions are needed, as determined by the Information Supervisor or others, WITHIN the hold period (one calendar month) the case will be assigned to an available EW within the district office. Staff will use CalSAWS Journal Detail page to document the needed actions and any pertinent information when a client is serviced by an Information Supervisor or another individual.

The EW shall receive one (1) case credit for the assignment and actions required in the case, which will be manually added to the monthly caseload balance.

Note: The length of time or the complexity of the actions required is NOT a criterion to receive extra case credit.

Supervisors shall inform the Control Clerk, who along with the EWS, will maintain case credit hand-counts of all cases assigned to workers of this type to ensure caseload standard compliance.

The following procedures shall apply:

Who Action
Information Supervisor (Other)
  • Receives a telephone call and/or drop-in client.
  • Determines action needed.
  • Documents in CalSAWS Journal Detail page to assign the case to an available EW as an “urgent” case.
  • Transfers the case to the Control caseload.
Continuing Office Control Clerk
  • Receives the newly transferred case with notations to assign the case to an available EW as an “urgent” case.
  • Verifies Medi-Cal is the only program active.
  • Sends an e-mail to the Unit Supervisor as a notification of a M/C only urgent case assignment of one of their workers. The e-mail will be completed as follows:
    • Enters on Subject Line: “M/C Urgent Case Assignment - Case Name and Number, date.”
  • Performs normal CalSAWS case transfer process to an EW.

Related Topics

Case Responsibility, Transfers, & Closed Cases Overview