Change in Circumstance

A Change in Circumstance (CIC) occurs whenever a report is received that prompts a change in a data element that requires a redetermination of eligibility; this allows the MC RD due date to be reset for a new 12-month period. The report of new information can be received from different entities including but not limited to, a client report, IEVS, PARIS report etc. The CIC and the new 12-month period begins the month after the change was reported.

These types of changes include, but are not limited to:

• Income (Earned, unearned, employment, rental, etc.)
• Expenses (Child care, self-employment, etc.)
• Household (Add-a-person, removing a person, MFBU, Tax Filing Household, etc.)
• Tax Filing Status (Single, Married Filing Jointly, etc.)
• Immigration Status
• Property (Cases with Non-MAGI MC)

EWs need to determine MC eligibility for the future month and provide an adequate and timely 10-day NOA. When resetting the RD due date, the EW must mail an MC 219 and document in the Journal Detail page.

There are some data elements that would NOT require the EW to reset the RD due date based on the CIC. These types of changes include, but are not limited to:

• Address
• Phone number
• Rent

Guidelines for Resetting the RD

The RD date cannot be reset unless all of the above eligibility data elements are verified.

• If ALL income and property is verified, the EW must update the case and reset the MC RD due date for another 12 months.
• If the client provides verification of the information that changed, but the household has other income (and property for Non-MAGI/Mixed cases), it must be verified to reset the RD. The EW can call and explain the process of resetting the RD and ask if they would like to provide verification. If the client does not wish to reset the RD or does not provide paper verifications for something that they DID NOT report changed, the verified change is updated and the MC RD due date is not reset.

  • Note: The case should not be discontinued if the client does not provide verification for something they did not report changed. The case should only be discontinued for failure to provide verification of the reported change.

• If the client did not provide verification for the change that was reported (and it was not E-Verified), then the EW must mail an MC 355 requesting paper verifications, allowing 30 days for the client to respond. The MC RD date must not be reset until all eligibility data elements are verified.
• If the client does NOT provide the required paper verification of the reported change within 30 days and it was not E-Verified, the EW must discontinue the case for failure to provide verification with a timely 10-day NOA.
• If the change in circumstance results in an individual being placed on Consumer Protection Program (CPP), the RD date must not be reset.

Examples

Example 1 - MAGI MC Client - Income VerifiedExample 1 - MAGI MC Client - Income VerifiedGraham is a MAGI MC client and reports an increase in income. He provides pay stubs as verification and all other eligibility data elements have been E-Verified. The EW updates the change in CalSAWS and resets the RD date.

Example 2 -Mixed MC Household Example 2 -Mixed MC Household Harley and Kendra are in a mixed MC household. Harley is eligible for MAGI MC and has income. Kendra is eligible for Non-MAGI MC and has income and property. Harley reports a change in income and provides paystubs as verification. The EW enters the reported change in CalSAWS and contacts Harley and offers to reset the RD if Kendra’s income and property verifications are provided. The client agrees and the EW mails an SCD 50 requesting verification. The client fails to provide Kendra’s verification. The RD will not be reset, but the case will not be discontinued. 

Example 3 - MAGI MC Client - Income Not Verified  Example 3 - MAGI MC Client - Income Not Verified  Lana is a MAGI MC client and reports a change in income, but does not provide verification and the income is not E-Verified. The EW sends an MC 355 requesting verification, which the client fails to provide by the due date. The EW discontinues the case with appropriate 10-Day Notice. The client later provides the verification within the 90-Day Cure Period. The EW rescinds the case and the RD date is reset from the day the verification is provided. 

CIC During a CEC or TMC Period

When a CIC is reported during a CEC or TMC period:

• The RD may be reset if the CIC places the individual into a more advantageous program.
• The RD must not be reset if the CIC would have no impact, or negatively change the individual’s eligibility.

Changes Reported for Other Programs

CalFresh and/or General Assistance

If the MC client is also receiving other public assistance (CalFresh (CF) and/or General Assistance (GA)), and the client reports a change in a data element for those programs that requires a MC redetermination of eligibility, the client must have his/her MC eligibility redetermined and the MC RD due date reset for a new 12-month period.

CalWORKs, Foster Care, Adoption Assistance Program, and Kinship Guardian Assistance Payment Program

If the case has MC and a cash-linked program (CW, FC, AAP, or KinGAP), the MC and cash-linked annual redetermination dates will NOT be impacted by this change. Do not reset the MC RD due date.

Example 1 - CF/MC Combo CaseExample 1 - CF/MC Combo Case

Example 2 - Applicant Approved for both CF and MC Example 2 - Applicant Approved for both CF and MC  

Change in Circumstance Examples

This section provides various examples of what may or may not be considered a CIC.

• Example 1Example 1

  Figaro is a MAGI MC client and he reports a new job (Pasta My Heart) on September 3rd. The EW updates the income in CalSAWS and calls the BRE to determine eligibility. The new income is E-Verified. Figaro continues to be MC eligible and his new 12-month period begins in October. This type of change (income) is considered a CIC and all information has been E-Verified, the MC RD due date must be reset to September 2017.

  

• Example 2Example 2

  Clarabelle reports a change in her home address within Santa Clara County. This is not a change to a MC eligibility data element that would trigger a CIC. This type of change (address within CA) would not be considered a CIC; therefore, an eligibility redetermination would not occur and the MC RD due date should not be reset.

  Note: As long as the client is still a California resident, the EW has no reason to make a new eligibility determination because a home address change would not change MC eligibility (unless out of state).

• Example 3Example 3 

  Sylvester reports that his rent increased from $500 to $1750. This type of change (rent) would not be considered a CIC and the MC RD due date should not be reset.

• Example 4Example 4 

  Alice Bluebonnet has been working at The Hat Shack and receiving $300 weekly for the last 2 years. She submits her SAR 7 for CalFresh and reports $300 weekly from her current employment at The Hat Shack. Since there is no change to her income or employer, this is not considered a CIC. The MC RD due date should not be reset for her case.

• Example 5Example 5

  Babbs McBunny has been working at the Elmer's Petting Zoo and receiving $520 bi-weekly for the last 4 years. She submits her SAR 7 for CF and reports $520 bi-weekly from her new employment at Sweet Carrots Restaurant and that her employment at Elmer’s Patting Zoo has ended. Babbs provides verification that her previous employment ended but does no provide verification for Sweet Carrots Restaurant. Following a successful BRE hit the income at Sweet Carrots is E-Verified. Although there is no actual change in income amount, there is a change in employer which requires multiple MC eligibility data element changes and entries in CalSAWS. This is a CIC and all information has been verified/e-verified; the MC RD due date must be reset for another 12 months.

  Note: Refer to the CalFresh Handbook for more information on CF income verification requirements.

• Example 6Example 6 

  Daisy Hobbin calls on August 19, 2016 to report that she is 7 months pregnant. Since there is a change in household size, this type of change (pregnancy) would be considered a CIC and self-attestation for pregnancy is a sufficient form of verification; therefore, the MC RD due date must be reset to August 2017.

• Example 7Example 7

  Daisy Hobbin calls on November 4, 2016 to report her newborn child, Laurie Hobbin. Although there is no change in household size because she previously reported her pregnancy, end dating the pregnancy and the addition of Laurie requires MC eligibility data element entries which make this type of change a CIC. Therefore, the MC RD due date must be reset to November 2017.

• Example 8Example 8 

  Massimo Pesto has been working at Le Pizzeria for 1 year and earns $798 monthly. He drives over to Social Services Agency on September 10, 2016 to report an income change from $798 monthly to $799 monthly and hand delivers the income verification. This type of change (income) would be considered a CIC and paper verification was submitted satisfying the verification requirement; therefore, the MC RD due date must be reset to September 2017.

  Note: Even if Massimo had reported a change of one (1) cent to Social Services Agency, it would be considered a CIC and the MC RD would be reset to a new 12-month period as long as the amount was verified.

• Example 9Example 9 

  Dmitry Pavlov is a non-citizen who has been in the United States for 8 years and works as a biomedical consultant. On May 5, 2016, he mails a letter stating that his immigration status has changed from non-citizen to Legal Permanent Resident (LPR). There are no other changes reported by Dmitry. This type of change (immigration status) would be considered a CIC; therefore, the MC RD due date must be reset to May 2017.

• Example 10Example 10

  On February 18, 2016, Annelise calls to report that she is now disabled and there are no other changes. This type of change (disability) would be considered a CIC; therefore, the MC RD due date must be reset to February 2017. EWs must also send a DDSD referral.

• Example 11Example 11

  Vesna currently has a MC only case. She walks into our Intake office on October 20th, 2016 and completes the CF 285 to add CF to her existing case. After reviewing the CF application, the Intake EW discovers that the information on the application is exactly the same as the information that already exists in her current case in CalSAWS. Since there is no new information, this is not considered a CIC. The MC RD due date should not be reset for her case.

• Example 12Example 12

  Zuzka currently has a MC only case. She walks into our Intake office on October 20th, 2016 and completes the CF 285 to add CF to her existing case. After reviewing the CF application, the Intake EW discovers that the only change is the social security number reported for Zuzka's one year old (Anbessa) on the application. This type of change (SSN) would be considered a CIC. The MC RD due date must be reset to October 2017.

• Example 13Example 13

  Yohannes currently has a CF/MC case. He walks into our GA Intake office on June 12th, 2016 and completes a GA application. After reviewing the GA application, the Intake EW discovers that the only change is his home address. This type of change (address) would not be considered a CIC. The MC RD due date should not be reset.

• Example 14Example 14

  Jacques Le’Orange is receiving Non-MAGI MC, his wife receives MAGI MC, and he reports a new bank account. The EW sends an MC 355 requesting verification of the new bank account and income because he is receiving Non-MAGI MC. If the clients would like to reset their RD due date, then they must provide these verifications. Jacques does not provide the verification of either property or income. This type of change (property) would be considered a CIC; however, property does not affect the MAGI MC client. Jacques is discontinued but his wife continues to receive MAGI MC.

  Note: If Jacques provided property verification but not income verification, then he would continue to receive Non-MAGI MC but the MC RD due date would not be reset.

• Example 15Example 15

  Waleed is receiving Non-MAGI MC, he reports a new savings account with Sunshine Bank. However, he does not submit verification of the new account. The EW completes the ex parte review and contacts the client by phone but there is no response. The EW then sends the MC 355 requesting verification allowing 30 days for Waleed to respond. Waleed still does not respond. The EW discontinues MC for failure to provide verification.

• Example 16Example 16

  Amihan Santos is receiving Non-MAGI MC, she is a tattoo artist at the Once Upon A Tattooshop. She has been earning $250 per week consistently for 3 years. She calls to report a new IRA account with Liwayway Bank in February 2016. The EW requests verification of the new bank account and her income because she is receiving Non-MAGI MC. Amihan provides the verification of both the IRA and her income. This type of change (property) would be considered a CIC and Amihan provided income verification; therefore, the MC RD due date must be reset to February 2017.

  Note: If Amihan did not provide income verification, she would not be discontinued because it was not a reported change. However, her MC RD should not be reset without income verification.

• Example 17Example 17

  Aayush Chaudhary is receiving MAGI MC. He is a licensed Sky Diving instructor at The Sky is Falling Academy earning $300/bi-weekly. He called to report that his immigration status changed from T-Visa to Legal Permanent Resident. The EW makes the changes in CalWIN and then runs EDBC to call the BRE. The Federal Hub verifies immigration status but comes back incompatible for the income. The EW completes the ex parte review and contacts the client by phone but there is no response. The EW sends the MC 355 requesting verification allowing 30 days for Aayush to respond. Aayush sends in verification of income. This type of change (immigration status) would be considered a CIC; therefore, the MC RD due date must be reset.

• Example 18Example 18

  Anastasia Watson is receiving Non-MAGI MC and her child Alastair Watson is receiving MAGI MC. Anastasia calls to report child support in the amount of $455 per month. The EW completes the ex parte review and contacts the client by phone but there is no response. The EW sends the MC 355 requesting verification allowing 30 days for Anastasia to respond. Anastasia does not respond. Due to Anastasia’s failure to provide verifications this CIC will not reset the RD due date. Furthermore, the Non-MAGI client (Anastasia) must be discontinued while the MAGI MC individual (Alastair) continues to receive MAGI MC.

• Example 19Example 19

  Sadiki Azikiwe updates his income in CalHEERS. The Change DER is sent to CalSAWS. The EW will verify the MAGI Referral Data in CalSAWS and imports the changes. The information is not E-Verified. The EW completes the ex parte review and contacts the client by phone but there is no response. The EW sends the MC 355 requesting verification allowing 30 days for Sadiki to respond. Sadiki sends in verification of income. This type of change (income) would be considered a CIC and paper verification was submitted satisfying the verification requirement; therefore, the MC RD due date must be reset.

• Example 20Example 20

  Henrik Greene is a Non-MAGI MC client currently receiving RSDI and a pension from Global Associate Creators LLC. He did not send any paper verifications.The EW completes the ex parte review and verifies the RSDI through MEDS. The EW contacts the client by phone for verification of the pension but there is no response. The EW sends the MC 355 requesting verification allowing 30 days for Henrik to respond. Henrik sends paper verification. This type of change (income) would be considered a CIC and paper verification was submitted satisfying the verification requirement; therefore, the MC RD due date must be reset.

• Example 21Example 21

  Gertrude Kovács is 75 years old, receiving Non-MAGI MC.Gertrude works at the Floral Gymnastics Center earning $150 weekly. Her grandchild Edward was recently abandoned by his parents. Gertrude calls to report that she is now in care and control of Edward and needs to add him to her MC case. While on the phone with the client, the EW collects Gertrude's tax filing information, along with all necessary information to add Edward. There are no changes in income. The EW runs the case through the BRE, all information is e-verified. This type of change (tax filing status and household) would be considered a CIC and all information is verified; therefore, the MC RD due date must be reset. Gertrude is now MAGI MC eligible under the parent/caretaker relative group.

• Example 22Example 22

  Sameen is receiving Non-MAGI MC and she has an existing bank account. She reports a change in income. The EW asks the client if she would like to reset her RD due date by sending her current bank statement. The EW sends an MC 355 requesting the income and property verifications. Sameen sends income verifications but does not provide the property verification. This type of change (income) would be considered a CIC; however, she did not provide property verification so her MC eligibility continues but the MC RD due date is not reset.

  Note: If Sameen provides the property verification after 60 days and the income verification is still within 90 days, a new verification of income is not required. This type of change (property) is considered a CIC. The MC RD due date would be reset.

• Example 23Example 23

  Imari and Sherri Weisman are both receiving Non-MAGI MC and they have income and a joint bank account. They call to report the birth of their newborn, Clarisse. The EW first evaluates everyone (Imari, Sherri, and Clarisse) for MAGI MC because Imari and Sherri may be eligible for the MAGI MC Parent/Caretaker coverage group.

  If Imari and Sherri are not eligible for the MAGI MC Parent/Caretaker coverage group, then the EW can inform the Weismans to submit verification of income and property to reset their MC RD due date because they are still Non-MAGI MC clients. If the Weismans decide not to submit any additional paperwork. Even though this type of change (birth of a child) is considered a CIC, all income and property must be verified for Non-MAGI MC to reset the RD due date. Therefore, the MC RD due date must not be reset.

Change in Circumstance for  Pre-ACA Cases

When a CIC occurs on a Pre-ACA case, the case must be transitioned before the MC RD due date can be reset for a new 12-month period. 

ExampleExample

Related Topics

Redeterminations