Discontinuance at MC RD or CIC

MC RD Discontinuance Due to Non-compliance

When a client fails to comply with the MC RD process, MC will be discontinued for failure to complete the RD or failure to provide information or verifications. The client must be informed of the reason for the discontinuance with a timely 10-day NOA.

For Non-MAGI MC cases, if the client reports a change, regardless of the change reported, the income and property both need to be verified BEFORE a CIC can be completed to reset the MC RD due date for another 12 months. The case should not be discontinued if the client only provides the verification of the reported change; the MC RD due date should not be reset. However, if the client does NOT provide the required paper verification of the reported change within 30 days, the EW must discontinue the case for failure to provide verification with a timely 10-day NOA.

MC RD Discontinuance Due to Ineligibility

MAGI MC

At RD, a MAGI MC client may be determined ineligible for MAGI MC. The EW must complete an ex-parte review (all income and property verification must be within 90 days) and/or send out the Non-MAGI MC Screening Packet. An eligibility determination for a Covered CA healthcare program will happen automatically at the same time in CalSAWS. In addition, the client may or may not be placed into Soft Pause.

Non-MAGI MC

At RD, a Non-MAGI MC client may be:

Determined ineligible due to loss of linkage, at which point an eligibility determination for any other healthcare program should be evaluated.
Ineligible for zero SOC MC, the client can choose whether they want MC with SOC only (which is not MEC), MC with SOC and a Covered CA healthcare program, a Covered CA healthcare program only, or any other healthcare coverage programs they qualify for including CCHIP, MCAP, etc.

Mixed MC (MAGI MC & Non-MAGI MC) Discontinuance

All determinations are individually based; the Non-MAGI MC rules cannot be applied to MAGI MC clients and vice versa.

There are some case scenarios where MAGI MC clients or Non-MAGI MC clients may have to be discontinued without discontinuing the other MAGI MC or Non-MAGI MC client. For Mixed MC cases, when the automated renewal BRE occurs and e-verifies all the information for the MAGI MC client, the Non-MAGI MC client must still provide paper verification of income and/or property (as applicable) to complete the MC RD. If paper verification is not received for income and/or property for the Non-MAGI MC client, the EW must mail an MC 355 allowing 30 days for the client to respond. If the client does not respond, then only the Non-MAGI MC client must be discontinued with a timely 10-day NOA.