MC RD Rescissions

If the MC RD forms are not logged into CalSAWS as Received by NCO, CalSAWS will auto-generate the MC discontinuance NOA and set the MC program to discontinue at the end of the month in which the RD is due.

 

Rescission Between NCO and the End of the Discontinuance Month

When clients provide the MC RD information or forms after NCO to prevent the auto-discontinuance for failure to comply with the MC RD process the following steps must be followed:

 

Incomplete MC RD forms

If clients return Incomplete MC RD forms and/or verifications after the requested due date, but before the discontinuance date:

• EWs must rescind MC at the same benefit level,
• Send rescission NOA, and
• Obtain any missing information through the ex parte review and/or by sending an MC 355 to request missing information and allow 30 days.

NOTE: If verifications are missing, set the verification status to Pending when updating data collection pages and generate the MC 355. [Refer to Job Aid (JA): Verifications-Manage or JA MC 355 List, MC 355 Detail and MC 355 Verification Detail Pages.]

For CalSAWS system entries when an MC RD Packet is received as Incomplete [Refer to Job Aid (JA): Medi-Cal Renewal Packets].

Example Example MAGI MC is discontinued on 10/31/2016 for failure to return the MC 216 and missing income verification for the 10/2016 MC RD. The client returns the MC 216 on 10/29/2016 before the MC discontinuance date (10/31/2016). MAGI MC must be rescinded effective 11/1/2016. The EW must send an MC 355 to request the income verification and allow 30 days for the client to respond. 

 

Ineligibility for MAGI MC

If clients return the MC RD forms and/or verifications before the discontinuance date and they are not eligible for MAGI MC, but eligible for APTC/CSR:

• EWs must first rescind MAGI MC at the same benefit level before the discontinuance date and authorize the case.
• The EW must determine if the client is potentially eligible for Non-MAGI MC and mail the Non-MAGI MC Screening Packet allowing 30 days for the client to return the forms or provide the necessary information.
• If the client does not provide any information after 30 days,
• The EW updates the change, discontinues MAGI MC with a timely 10-day MC discontinuance NOA, and approves APTC/CSR.

Example Example MAGI MC is discontinued on 10/31/2016 for failure to return the MC 216 and income verification for the 10/2016 MC RD. The client returns the MC 216 and a paystub on 10/29/2016 before the MC discontinuance date (10/31/2016). The income is over MAGI MC limits and the client is eligible for APTC/CSR. First, the EW must rescind MAGI MC benefit effective 11/1/2016 and authorize the case. Second, the EW must determine If the client is potentially eligible for Non-MAGI MC and mail the Non-MAGI MC Screening Packet allowing 30 days for the client to return the forms or provide the necessary information. If the client does not provide any information after 30 days, then update the new income, authorize case to fail MAGI MC, send 10-day MC discontinuance NOA, and approve APTC/CSR in CalHEERS. 

Rescissions After the End of Discontinuance Month

After the discontinuance month, clients must provide ALL MC RD information and/or verifications (within 90 days from the discontinuance date) to rescind discontinuance for failure to comply with the MC RD.

For CalSAWS entries to Rescind [Refer to CATS CB 2023-23: How to rescind a program.]

Note: When clients partially return the MC RD forms and/or verifications after the discontinuance date but within the 90-Day Cure Period, their MC benefits will remain discontinued. EWs will send an SCD 50 to request missing information. If the verification is received by the due date, EWs will restore the same level of benefits back to the date of discontinuance. 

Example Example MAGI MC is discontinued 8/31/2016 for failure to return the MC 216 and income verification for the 8/2016 MC RD. The client returns only the MC 216 on 11/5/2016 (90-Day Cure Period ends on 11/30/2016). The case is NOT rescinded and the EW sends an SCD 50 to request the income verification. The client returns a paystub on 11/15/2016. Therefore, MAGI MC is restored effective 9/1/2016. 

 

Verifications and 90-Day Cure Period

If clients partially return the MC RD forms and/or verifications after the discontinuance date but within the 90-Day Cure Period, their MC benefits will remain discontinued.

• EWs will send an SCD 50 to the client request missing information.
• If the verification is received by the due date, EWs will restore the same level of benefits back to the date of discontinuance. 

For CalSAWS entries to Rescind [Refer to CATS CB 2023-23: How to rescind a program.]

 

If clients return ALL the requested forms and/or verifications after the discontinuance date but within the 90-Day Cure Period, and the EW determines the client will not be eligible for MAGI MC with changes reported:

• The EW will rescind to the same level of benefits before the discontinuance date and authorize the case.
• Then, the EW must determine if the client is potentially eligible for Non-MAGI MC and mail the Non-MAGI MC Screening Packet allowing 30 days for the client to return the forms or provide the necessary information.
• If the client does not provide any information after 30 days, the EW updates the change, discontinues MAGI MC with a timely 10-day MC discontinuance NOA, and approves APTC/CSR. 

ExampleExample

Related Topics

Redeterminations

MC RD is NOT Returned

MC RD Forms