Medi-Cal Update 2023-09

Removal of Soft Pause Indicator For OTLICP Beneficiaries

Date	References	Clerical	Handbook(s) Revised
10/16/2023	ACWDL 23-04	No	MC HB CH 2 CoveredCA-  Transitions- Soft Pause

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Background

When a Medi-Cal beneficiary's circumstances change, the Soft Pause functionality in CalHEERS protects certain populations from losing their MAGI MC eligibility while the county evaluates for other Medi-Cal programs, such as Non-MAGI MC or other Consumer Protection Programs (CPP). Previously, some beneficiaries eligible under the Optional Targeted Low Income Children's Program (OTLICP) were required to pay a monthly premium to remain in the program. A change between the programs was considered a negative action since the beneficiary was required to pay a premium and soft pause protection was applied.

Changes

Senate Bill (SB) 184 reduced monthly premiums to zero dollars for all OTLICP beneficiaries. CalHEERS will no longer apply soft pause protection for individuals moving from a MAGI MC non-premium aid code to a zero dollar premium aid code. 

 

MC HB Chapter 2 CoveredCA, Transitions, Soft Pause has been updated to reflect this information.

Implementation

This change is effective immediately.

 

Other Programs

This change only affects the Medi-Cal program.

Supervisors

Supervisors, please review this information with your staff.

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Angela Shing, Director

Department of Employment & Benefits Services

 

Contact person: Megan Turney, SSA BPIS 408-755-7540