Single Point of Entry Applications

The Single Point of Entry (SPE), in Sacramento, was established by the state to coordinate application activities for MC. SPE receives applications from clients who have been assisted by Certified Application Assistors (CAAs) located in medical clinics. Individuals may also pick up the SSApp from other community organizations and mail their application directly to SPE.

One-e-App

“One-e-App” is an automated internet-based application for MC used in our county by the CAAs located at medical clinics that are part of Santa Clara Valley Health and Hospital Systems.

Application Process

The CAA interviews the applicant at the clinic and enters the information directly online into One-e-App.
When all necessary paper verifications are provided, the CAA electronically forwards the application to SPE. In addition, the CAA faxes the paper verifications and a copy of the signature page to SPE.
When the CAA submits the completed application, the client receives the following information from SPE:
- A real-time preliminary screening.
- An electronic confirmation of receipt.
- A unique application number.

SPE Actions

SPE screens the application for completeness and forwards the application to SSA to determine eligibility for MC. Hard copies of the MC applications and all related documentation are currently delivered to the Assistance Application Center (AAC), including:

A “One-e-App Application Summary” printout.
A transmittal form.
Copies of verifications submitted by the applicant.
A signature page with a photocopy of the original signature.

The “One-e-App Application Summary” is an official application for MC. The same procedures apply when processing this application form.

Application Date

The date of application is the date that the “One-e-App” is electronically submitted to SPE. The date is on the transmittal form, as well as on the MEDS [INQP] screen.

Clerical Role

Follow current district office procedures for completing file clearance, registering, and assigning procedures. In addition, the MEDS [INQM], [INQ1], and [INQP] screens are needed for these applications.

Application Tracking System

The application tracking system allows client information to be shared between SPE, MEDS, and the individual counties. Sharing of information is accomplished through the Client Index Number (CIN). This process is intended to provide:

Better service to clients.
A more efficient data collection process.
Fraud prevention.

Applications are also received electronically from the MAXIMUS SPE system providing an electronic method of transferring data and images for new applications from MAXIMUS to the county.

SPE Screening Process

All applications for children ages 6 - 18 years old processed at SPE are screened for potential eligibility for MC. The forms include:

One-e-App
Online Covered California Application

SPE has four (4) business days to complete the screening process. During the screening process, SPE:

Completes the File Clearance process to see if a child is already known to MEDS.
Identifies ownership of income, family relationships, and income disregards (i.e., income from disability, self-employment, education, pension or retirement).
Screens for potential MC eligibility.
Reviews for CW client status during the prior four months.
Reviews infants under 1 year old for Deemed Eligibility (DE).
Contacts the applicant for missing or additional information.
Establishes Accelerated Enrollment (AE) eligibility on MEDS if applicable. Generates the mailing of a BIC for individuals enrolled in AE, if one was not previously issued.
An Integrated Voice Response system automatically generates a call to the client when an application is forwarded for a MC determination or is determined to be receiving full-scope, no-cost MC benefits.

CIN Assignment

SPE completes the file clearance and assigns a CIN to all individuals who are included on form submitted to SPE.

If the client is on the Statewide Client Index (SCI), then SCI and SPE will find and use the existing CIN.
- Note: If the client is known to CalSAWS and also has a prior MEDS record, the person completing the file clearance MUST confirm that the CIN on the transmittal form belongs to the MEDS record associated with the county ID.
If the application does not contain adequate information and the SPE staff is unable to obtain the information within 4 days, a CIN is not assigned to that individual.

SPE Accelerated Enrollment Process

When an individual appears to be eligible for a zero SOC MC program based on the income screening performed at SPE, they will be placed on aid code 8E. The SPE forwards the case to the residence county for a MC determination. MC eligibility under aid code 8E continues until a determination for MC eligibility is completed.

Individuals in AE will appear on the monthly Exception Eligibles Report (EER) in aid code 8E. Once an MC eligibility determination is completed and reported to MEDS, the 8E record will be cleared and MEDS will accept the MC eligibility as long as the information entered into CalSAWS EXACTLY matches MEDS. The AE program eligibility continues under aid code 8E until this takes place. The EER can also be used as:

An informational tool for determining MC eligibility.
A useful way to track missing documentation from SPE.

Note: The 8E records on the EER must be cleared as soon as possible. Staff must make sure that aid code 8E is terminated once the MC application is approved or denied.

SPE Transmittal Forms

The following transmittal forms are used with applications received from SPE:

Summary Transmittal
1. This form lists all applications referred to the county in the batch. This listing is for inventory control and contains specific information on individual family members.
2. When received, appointed office staff must cross-check the Summary Transmittal from SPE with the applications referred in the batch. If the Summary Transmittal contains applications not included in the batch, or, if applications included in the batch are not listed on the Transmittal, the SPE Liaison must be contacted immediately by phone at (916) 673 - 4602 or e-mail at SPELiaisons@maximus.com.
SPE Transmittal Form
1. Each application form forwarded to SSA from SPE is attached to a Transmittal form. The transmittal is a summary of each application sent and informs the EW how each person was screened, the family composition, and income used.
2. The transmittal form lists each child on the application, and indicates:
  1. Family income,
  2. What programs the children were screened for,
  3. If Retroactive MC is requested,
  4. If additional family members are requesting MC, and
  5. The CIN assigned to each child.

Processing SPE Applications

Missing Information

SPE keeps copies of all applications and verifications received and forwarded to counties for a MC determination. If an application is received from SPE with missing information (i.e. verifications, a signature page, etc.), the EW will need to request the information. The request for verifications is limited to only those that are required. For example, the EW does not need to contact SPE for property verifications, as SPE does not collect property information.

For requests for missing information or for questions regarding SPE screening, or transmittals, contact the SPE County Liaison by:

Phone: (916) 673-4602, or
E-mail: SPEliaisons@maximus.com

When requesting information from SPE (by phone or e-mail), the following information must be provided:

Case Control Number
Child's Name
Child's Date of Birth
Child's SSN or Pseudo Number, if available
Date of Application

Note: Staff must use the secure email function when communicating with SPE.

Required Forms

The following forms are required to be provided to the family:

CHDP Brochure
MC 003
MC 219
SCD 115

Additional Forms

Medical Support forms
- “Support Questionnaire” (CW 2.1 (Q))
- “Notice and Agreement for Child, Spousal, and Medical Support” (CW 2.1 Notice and Agreement)
MC 322 (as applicable)
MC 210 A (“Supplement to Statement of Facts for Retroactive Coverage/Restoration”)
MC 371

Adding Adults

When adults are requesting MC, the EW will need to contact the client for additional information. SPE only screens MC eligibility for the children. The EW may need to obtain the MC 322 and the MC 371 to Add a Person.
Applications originating at SPE are processed as follows:

Clerical:
1. Reviews Transmittal Form to make sure all applications listed are received.
2. Performs File Clearance and prints the INQM and INQ1 screens for each individual on the applications.
3. Checks the MEDS INQP screen for the date of application.
4. Registers the application in CalSAWS if no active case is found.
5. Forwards the application with paper verifications to the Continuing EW if the case is active.
EW:
1. If SPE indicates Retroactive MC Only is requested, sends MC 210 A to the applicant for completion and signature.
2. Processes the MC Application and if:
  1. MC is approved
    1. Completes CalSAWS entries to establish eligibility on MEDS.
    2. Reviews MEDS to make sure that the AE record is terminated.
  2. Child on AE is denied,
    1. Makes sure that the denial is correctly reported to MEDS and the AE MEDS record is terminated.

SPE File Clearance Procedures

Special File Clearance procedures for processing SPE applications are as follows:

Clerk and EW Sup:
1. Checks the MEDS record for the transmittal CIN and the date of application. If SPE erroneously linked to a MEDS record belonging to a different individual, and the individual on the transmittal is
  1. Known to SCI/MEDS,
    1. Request MEDS coordinator to call the ITSD help hotline immediately to restore the erroneously chosen individual’s record to what it was prior to the SPE update.
    2. Once the record is restored to its condition prior to the erroneous update, the prior BIC, if any, will be valid.
  2. NOT known to SCI/MEDS,
    1. Request MEDS coordinator to call the ITSD help hotline immediately to restore the erroneously chosen individual’s record to what it was prior to the SPE update.
    2. Once the record is restored to its condition prior to the erroneous update, the prior BIC, if any, will be valid.
    3. Submit an AP18/AP20 for the individual and check MEDS the following day to determine the CIN assigned during the MEDS batch update process.
EW:
1. Checks for multiple MEDS records.
2. If the File Clearance identifies more than one MEDS record for the individual on the transmittal, completes an SCD 1296 to request the MTO to complete one or more EW 11 transactions as needed to merge the MEDS records.