Loss of Contact

When mail is returned as undeliverable, EWs must document in case comments, complete an ex parte review, mail an MC 355 (if applicable), and mail a discontinuance NOA if the MC 355 is undeliverable or not returned by the client.

Loss of contact, including mail returned as undeliverable, is not a basis for discontinuing benefits for the following programs/individuals:

Former Foster Youth (FFY)
Continuous Eligibility for Children (CEC)
Supplemental Security Income/State Supplementary Payment (SSI/SSP)
KinGAP
Adoption Assistance
Deemed Eligible Infants (under 1 year)
Beneficiaries who are pregnant or in their 365-day postpartum period

If a client provides updated address information and all other information that was requested within 90 days of the discontinuance date, EWs must immediately redetermine eligibility. If the client is found MC eligible, the discontinuance must be rescinded as if the information was submitted in a timely manner.

Ex Parte Review

An EW must complete an ex parte review before contacting the client when there is undeliverable mail. This includes the client’s case, electronic databases or verification services (i.e. MEDS), and CalWORKs (CW) and CalFresh (CF) cases of the client’s immediate family members which are open or were closed within the last 90 days.

If the EW locates a more recent address, the EW must update the Medi-Cal (MC) case with the new address, document in the Journal Detail page, and attempt to send the previously undeliverable mail to the client at the new address.

Undeliverable mail envelopes reporting an in-state forwarding address by the United States Postal Service (USPS) are considered reliable and valid forwarding addresses and can be used to update case records. When updated contact information is provided from USPS, National Change of Address (NCOA) database, Managed Care Plans (MCPs), or Program of All-Inclusive Care for the Elderly (PACE), no additional contact needs to be made to the client to verify the new address before updating the case record.

Immediate Family Members

For purposes of obtaining a new address, DHCS defines “immediate family members” as any of the individuals who make up the MC household of the applicant/client for purposes of an MC eligibility determination. The address must be more recent than the address on the MC case if provided for an immediate family member. The most recent information available to the EW must indicate that the immediate family member lives with the applicant/client.

Confidentiality

Due to confidentially of client information, EWs must make sure that an address that is identified in a CW or CF case is more recent than the address on the client’s MC case. EWs must not use a forwarding address provided by the Post Office or hand written on the envelope unless the address has been confirmed by the client.

EWs must [Refer to Common Place Handbook: “Safe at Home Confidential Post Office (P.O.) Box Process”] for instructions on the Safe at Home program, which helps victims or survivors of domestic violence or stalking to remain safe from an abusive situation.

MC 355

When an EW is unable to locate a more recent address through an ex parte review, the EW must send the MC 355 requesting only the current address and any other information that is necessary to redetermine eligibility and allowing 30 days for the client to respond. The MC 355 must be sent to the client’s last known address.

During the 30-day period after the MC 355 was sent, the EW must attempt to contact the client by telephone, in writing, or by other commonly available electronic means, to request the necessary information if the client has not responded to the request for additional information or has provided incomplete information.

Reminder: If there is a child-only CEC case, the EW must not send the child an MC 355 because of undeliverable mail. If the CEC child has other family members on his/her case that are not CEC eligible, then the EW should send the MC 355 to request the current address.

Notice of Action

If an MC 355 is returned as undeliverable, the EW must discontinue with a NOA that includes the 90-day cure period language. The discontinuance NOA must list the missing information that is needed to determine eligibility, including that the address is not current. The NOA is not required to be mailed at least 10 days before the date of discontinuance. The EW must also document actions in the Journal Detail page.

If an MC 355 is not returned and the missing information is not provided within 30 days, the EW must discontinue with a timely 10-day NOA that lists the missing information that is needed to determine eligibility and includes 90-day cure period language. The EW must also document actions in the CalSAWS Journal Detail page.

Case Documentation

Document the following information in the Journal Detail page:

Mail was returned as undeliverable,
The date the mail was sent,
The date it was returned as undeliverable,
The form, letter, or notice mailed to the client that was returned, and
What address was used.

Note: The mail that was returned as undeliverable, including both the envelope and its contents, must be sent to Imaging.

Ex Parte Process

Senate Bill 87 (Ex Parte Process) requires a Medi-Cal (MC) case review and potentially client contact when:

• A CalWORKs case discontinues,

• A Refugee Cash Assistance case discontinues,

• An SSI/SSP individual is discontinued from SSI (Craig v. Bonta),

• An MC client is no longer eligible for their current aid code, or

• In Home Support Services (IHSS) discontinuance.

• An individual is placed into aid code 38.

• An individual is placed into Soft Pause.

Note: Aid Code 38 and Soft Pause provide temporary eligibility for individuals while determining their ongoing MC eligibility under SB 87 regulations.

The Ex Parte Process requires three steps:

1. Case Review:

Ex Parte Review, The Eligibility Worker (EW) must use information available from all sources to establish ongoing MC eligibility without client contact, including IDM, MEDS, Federal Hub, CalHEERS, companion cases open or closed within the past 45 days etc. If there is not sufficient information and verifications available, then continue to Step 2.

2. Direct Contact:

The EW must contact the client by telephone to request information/verification that is not available during the ex parte review. EWs must document the reason and attempts made on the Journal Detail page. If the client cannot be reached or there is not enough information to establish eligibility, then continue to Step 3.

3. Medi-Cal Request for Information:

The EW must send a request for information (MC 355, SCD 50, etc) to the client to request needed information/verification if the ex parte review and the telephone contact have been unsuccessful. Update the MC 355 due date to allow 30 days. After 30 days, if there is not enough information or verifications provided to continue eligibility, then take appropriate action. Note: The MC 355 Due Date will need to be updated to allow for the 30 day time limit. For MC 355 system entries [Refer to Job Aid: Verifications-Manage or JA MC 355 List, MC 355 Detail and MC 355 Verification Detail Pages.]

No Ex Parte Process Required

The Ex Parte Process is not required when an individual is discontinued from CalWORKs or MC for the following reasons:

• Death

• Recipient’s written request to discontinue Medi-Cal benefits

• Loss of California Residency

• The individual is being transferred to another Public Assistance program that provides Medi-Cal benefits.

Note: Other family members in the case must be reviewed for ongoing Medi-Cal eligibility.

Transitioning from CalWORKs to Medi-Cal

Individuals discontinued from CalWORKs must be evaluated for ongoing MC eligibility by following the "Ex Parte Process”.

Eligibility Determination Procedures

Follow the procedures below for evaluating discontinued cases (CalWORKs or Medi-Cal Only) for ongoing Medi-Cal eligibility:

Reason for Discontinuance	Required Action
Failure to complete the annual CalWORKs RRR,	Send the appropriate MC RD packet to request the necessary information. Note: If the CalWORKs RRR packet was returned but the RRR process was not complete, the information on the RRR packet can be used for MC, a new packet is not required.
Incomplete MC RD,	Follow the Ex Parte process to obtain missing information/verification and complete the eligibility review.
Income exceeds CalWORKs standards,	Evaluate for MAGI MC, TMC, etc.
Ineligibility for current aid code,	Follow the Ex Parte process to determine ongoing eligibility.

CalWORKs Denials

If a CalWORKs application is denied, ongoing MC must be explored.

If...	Then...
The applicant is not eligible for CalWORKs,	Follow the Ex Parte process to determine MC eligibility.
The applicant fails to comply with the application process or provide information or verifications,	Follow the Ex Parte process to obtain missing information/verification and complete the eligibility review.
The applicant fails to complete the SAWS 2 PLUS,	Follow the Ex Parte process to determine MC eligibility.