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Budgeting
Medi-Cal (MC) budgeting is determined prospectively. When entering income into CalSAWS it is important to enter the income into the correct income specific windows. Entering income into CalSAWS is not dependent on a specific program; it is dependent on the type of income. CalSAWS automatically treats income differently depending on the rules for each program and program hierarchy.
Income Frequency Entries
At initial application and in continuing, EWs must use the client’s actual pay frequency when entering income in CalSAWS. For detailed CalSAWS system entries for income [Refer to Job Aid (JA)-Income Management.]
Date Received/Expected to be Received at Application
The Date Received/Expected to Be Received used at initial application must be the first paycheck received in the application month.
Date Received/Expected to be Received
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If |
And |
Then the date received/expected to be received |
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The client will be MAGI or Non-MAGI eligible based on the new income |
The income change reported is beneficial |
Must be the first of the month in which the change was reported and verification was provided timely. |
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The change reported is not beneficial |
Must be the first of the month in which a timely NOA can be provided |
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The client will be APTC eligible or the bounce back rule applies |
N/A |
Must be the first of the month following when the change actually occurred Note: This will avoid incorrect tax credits from being granted, apply bounce back rule, and ensure the correct annual income is budgeted. |
On January 18, 2019 Quinten, active on MAGI MC, reports a decrease in income from 4C’s. His first check with a decreased amount has a pay date of January 12, 2019. Because the change is beneficial and he reported the change timely, the Date Received/Expected to Be Received must be January 1,2019.
On March 22, 2019 Janaya reports that she began working less hours and her income has decreased. Her first check with decreased income was received on November 16, 2018. The Date Received/Expected to Be Received must be March 1, 2019 because the change was not reported timely and there was no good cause.
On May 5, 2019 Rafika reported an increase in income from Target. Her first check with increased income was received on April 27, 2019. Due to the increase in income the client will lose MAGI eligibility and she will qualify for APTC. The Date Received/Expected to Be Received must be May1, 2019 to ensure the correct annual income is calculated for tax credits however, do not reevaluate the current or past months. APTC should be approved for June and on.
Note: If Rafika had remained eligible for MAGI MC with the income increase, the income would be entered for June 1, 2019 since tax credits would not be a factor.
On April 3, 2019 Ethan reported that his income from Barnes and Noble increased. His first pay check with the increased amount was received on July 29, 2018. Based on the new income Ethan will no longer be MAGI eligible. Since he will be APTC eligible the Date Received/Expected to Be Received must be August 1, 2018.
Note: If Ethan had remained MAGI MC eligible the income would be entered for May 1, 2019 since tax credits would not be a factor.
On April 15, 2019 Marcus, a Non-MAGI recipient with a SOC, reported that his income from Mark’s Hot Dogs decreased. His first pay check with the decreased amount was received on April 12, 2019. Based on the new income Marcus will no longer have a SOC. The Date Received/Expected to be Received must be April 1, 2019.
On May 25, 2019 Lynn, a Non-MAGI recipient with a SOC, reported an increase in her pension. Her first payment with the increased amount was received on February 1, 2019. Based on her new income Lynn’s SOC will increase. The Date Received/Expected to be Received must be July 1,2019 to meet the adverse action 10 day timely NOA requirement.
On February 23,2019 Gavin reported a new job at Big 5 Sporting Goods which he started in December of 2018. Based on Gavin’s new income he is still eligible for MAGI MC. The Date Received/expected to be Received must be January 1, 2019.
Note: If Gavin’s income made him eligible for APTC, the Date Received/Expected to be Received must be January 1,2019. This would ensure the CMI and PAI were budgeted correctly.
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