Medi-Cal Access Program

If...

Then...

The application is incomplete (does not include all information required to process the application for eligibility and enroll the client),

• The client is notified that she has 17 calendar days to submit all required information, after which MCAP has 3 days to process and enroll.
• Do not forward the packet back to the provider.
• Contact the applicant to obtain any needed information or verification that is missing from the MCAP application packet.

The application is complete (includes all information required to process the application for eligibility and enroll the client),

• MCAP has 3 calendar days to process and enroll the applicant plus another 10 calendar days to notify the client's health plan.
• The client will receive a notice that she is enrolled in MCAP. The letter will provide the date health coverage starts. Coverage starts 10 calendar days after the date the application is approved.
• Once enrolled the client will receive an Evidence of Coverage (EOC) booklet and an insurance card from the health plan.

Income verification submitted is last year’s income tax records,

It may be used if the client states that his/her income remains the same; otherwise, request more recent information.

Updated information is not available,

Document in the case file, but do not take any negative action or deny the application.

Updated information reflects an increase in the eligible pregnant woman’s income during her pregnancy or postpartum period, or a change in family status which would otherwise give the woman a SOC MC,

Do not take any negative action. The applicant is protected under Continued Eligibility (CE). The information may be compared against future income information obtained as part of the redetermination.

Updated information reflects a decrease in income from that shown on the previous year’s tax return,

No immediate action needs to be taken to calculate the woman’s income eligibility, as she already has no SOC.

The MCAP application is received incomplete,

• Do not forward the packet back to the provider.
• Contact the applicant to obtain any needed information or verification that is missing from the MCAP application packet.

The applicant is found ineligible for no SOC MC due to excess income,

• Make a note on the denial NOA that the application will be sent back to MCAP.
• Include a copy of the denial NOA with the reason why the applicant was determined ineligible for no SOC pregnancy-related MC with the referral to MCAP.