Long Term Care Medi-Cal Applications

The following business process applies when processing Long Term Care Medi-Cal applications:

Step Who Action
1 Application Support/ Application Registration
  • Receives LTC application.
  • Performs full file clearance and Application Registration (Refer to Clerical handbook, section 8.2)
    • Selects LTC from the Type field’s drop down list on the Collect Applicant Information window in CalWIN.
    • Assigns case to the LTC case load DMAA in CalWIN.
  • Creates TMT Request
    • Clicks the Request Category link
    • Selects Intake.MC.LTC.language
    • Updates status to Pending
    • Changes Priority from Standard to Urgent
    • Enters in the Notes field:
      • Application Type (LTC)
      • Application Date
      • Language (if other than English, Spanish or Vietnamese)
      • Comment “LTC packet enroute” along with date sent and initials of sending AS.
      • Clicks the Group link.
  • Assigns to designated Intake EW.
2 Intake EW
  • Receives TMT request assignment under “My Request.”

    • Note: LTC TMT requests are assigned as Urgent requests and must be processed as such.

  • Reviews hard copy Application packet, CalWIN Data Collection, case comments, IDM, MEDS, IEVS, etc.
  • Enters information into CalWIN from verifications/forms provided.
If... Then...
Verification forms are complete,
  • Runs EDBC and authorizes the case.
  • Reviews client correspondence and processes as appropriate.
  • Reviews and resolves CalWIN and MEDS alerts.
  • Documents in the Maintain Case Comments window.    
Verifications are not received or not complete,
  • Completes SCD 1121 and mails to the client and Authorized Representative (AR), if applicable, with a ten day due date.
  • Includes a prepaid return envelope self-addressed with EW’s # written on the envelope.
  • Documents in the Maintain Case Comments window.
  • Submits all application documents and MEDS screens with Fasteners to be scanned into IDM.
  • If the client submits the missing verifications and complete application, processes the MC application and approves benefits.
  • OR
  • Follows up on the due date the verifications are due, if the client does not submit the missing verifications or application by the due date, and sends the “Final” SCD 1121 with another 10-day due date (and sends a copy to the AR, if applicable).
    • If by the 10-day due date the client has still not submitted the missing verifications or application, sends the appropriate denial NOA(s).    
  • If Medi-Cal is approved:
    • Updates TMT Status to Authorization Completed.
    • Reviews MEDS after two business days to verify eligibility.
    • Submits all Application documents and MEDS screens to be scanned into IDM.
    • Updates TMT Request Status to Task Clearance Finalized.
  • TMT Request automatically transfers to EWS Scoreboard for review.
3 EW Supervisor EWS
  • Receives the TMT Request assignment under “My Request.”
  • Selects and reviews applications for accuracy and completeness as per policy.
  • If Application Processing is:
    • Accurate and complete:  
      • Updates TMT Request Status to Transfer Pending.    
    • Not accurate or complete:   
      • Returns case to EW for corrections.
      • Updates TMT Request Status to Returned.

Related Topics

Medi-Cal Business Processes Overview