Clients’ Right to be Evaluated for Non-MAGI

Although the MC Hierarchy shows that MAGI must be granted before Non-MAGI, clients do have a right to request a Non-MAGI evaluation.

MAGI Eligible Client Request Non-MAGI Evaluation at Intake

If a MAGI eligible client requests a Non-MAGI evaluation at intake (verbally or on an application) then:

Approve MAGI per normal business process.
Review the case for potential linkage and send a Medi-Cal request for information (MC 355) if additional information is needed.
Transfer the case to Continuing.

If the client...	Then...
Provides partial information,	Request the missing information, allowing an additional 10 days. If the client still does not provide the missing verification, they will remain on the MAGI aid code.
Provides all information and the client is determined to be Non-MAGI eligible,	Contact the client to inform them of their new eligibility. Mail appropriate NOA if there is a Share of Cost (SOC). Check MEDS in two business days. Make sure CalSAWS, CalHEERS, and MEDS match. Document actions in the Journal Detail page.
Provides all information and the client is determined not to be Non-MAGI eligible,	Contact the client to inform them they are ineligible to Non-MAGI and will remain eligible for the MAGI aid code.
Does not provide any information or attempt to contact the county,	The client will remain eligible for the MAGI aid code.

If a continuing MAGI eligible client requests a Non-MAGI evaluation:

Review the case for potential linkage and send a Medi-Cal request for information (MC 355) if additional information is needed.
Allow 30 days for the client to provide.

If the client...	Then...
Provides partial information,	Request the missing information, allowing an additional 10 days. If the client still does not provide the missing verification, they will remain on the MAGI aid code.
Provides all information and the client is determined to be Non-MAGI eligible,	Contact the client to inform them of their new eligibility. Mail appropriate NOA if there is a SOC. Check MEDS in two business days. Make sure CalSAWS, CalHEERS, and MEDS match. Document actions in the CalSAWS Journal Detail page.
Provides all information and the client is determined not to be Non-MAGI eligible,	Contact the client to inform them they are ineligible to Non-MAGI and will remain eligible for the MAGI aid code.
Does not provide any information or attempt to contact the county,	The client will remain eligible for the MAGI aid code.

If a client who previously chose Non-MAGI is now requesting MAGI, then evaluate the client’s eligibility for MAGI.

If the client...	Then...
Is no longer eligible for MAGI,	Inform the client that they are only eligible for the Non-MAGI aid code.
Is eligible for MAGI,	Approve the MAGI aid code. Contact the client to inform them of their new eligibility. Check MEDS in two business days. Make sure CalSAWS, CalHEERS, and MEDS match. Document actions in the CalSAWS Journal Detail page.