Verification Requirements at MC RD and CIC

Clients are NOT initially required to provide supporting verification of information reported on the MC RD forms when it is returned for MAGI MC only cases.

The EW must use the following available electronic data systems to verify a client’s eligibility before requesting verifications from the client:

  • CalHEERS Business Rules Engine (BRE)
  • Income Eligibility Verification System (IEVS)
  • Payment Verification System (PVS)
  • Systematic Alien Verification of Eligibility (SAVE)
  • MEDS

These systems can be used to verify information such as:

  • Income,
  • Unemployment benefits/Disability payments from the Employment Development Department,
  • Social Security benefits from the Social Security Administration,
  • Social Security Number,
  • Earned interest on an account from a financial institution,
  • Immigration status, and
  • Assets (Bank Account, Real Property, Watercraft, Aircraft).

Non-MAGI MC Verification Requirements

The following must be completed/verified at RD for Non-MAGI MC:

  • Income
  • Legal responsibility for a child applying alone.

    • NOTE: The parent must be contacted, but is not required to apply.

  • Status and value of nonexempt property.

 

Non-MAGI Asset Waiver

 

Beginning March 1, 2023 through December 31, 2023 the Non-MAGI Asset Test is temporarily waived at renewal or during a reported change in circumstance. The property determination must be completed without requesting additional asset verification and disregard a report of new assets . Asset Verification Program (AVP) requirements still apply. Refer to [MCHB Chapter 16, Sub section Property Verification] for additional information and examples regarding the Non-MAGI Asset Waiver.

 

Asset Verification Program Requirement for Non-MAGI ABD and LTC Cases

The Asset Verification Program (AVP) is a process to generate reports with enhanced financial information on Non-MAGI Medi-Cal applicants and recipients of the Age, Blind and Disabled (ABD) and the Long Term Care (LTC) programs. AVP assists EWs in identifying unreported assets.

Important: Effective 1/1/2024, the use of AVP is required by federal law ONLY to determine whether ABD applicants or members seeking coverage for LTC made asset transfers for less than the fair market value during the mandated lookback period.

Requesting Asset Verification 

Starting January 3, 2022, Eligibility Workers (EWs) must request asset reports at application, reported changes in circumstances, and special case (responsible relative) for all Non-MAGI ABD and LTC individuals. AVP reports are uploaded into CalSAWS and MEDS by the third week from the date of request. AVP reports provide asset information with a 90-day look-back for non-LTC ABD and 60-month look-back for LTC applicants and recipients. The lookback period is determined by the date the weekly batch file is submitted to the vendor, not the application date or the date the request was initiated.

AVP Reports Received After Medi-Cal Approval

When eligibility is approved prior to receipt of an asset report, the EW must evaluate the contents of the report once received and take appropriate action as needed

Important: No negative actions are to be acted upon during the Public Health Emergency. If an asset report reveals negative information about a case, thorough case comments must be documented.

For individuals who have a SSN, but did not provide it during the early stages of the application process, the EW must request the asset report once the SSN has been verified by the SSA. EWs must then submit the EW10/MB10 and subsequently remove any pseudo SSN before adding the verified SSN to MEDS.

Annual Redetermination

The State Department of Health Care Services (DHCS) will be providing the counties with AVP reports for ABD and LTC recipients approximately 60 days prior to the RRR date. The report is viewable in the IEVS screen in MEDS.

Change in Circumstance (CIC) Redetermination

EWs must request asset reports at reported changes in circumstance for all Non-MAGI LTC and non-LTC ABD individuals. Renewal dates must be reset pending the receipt of the AVP report, and eligibility should not be denied or delayed due to non-receipt of such report. EWs must follow the normal CIC redetermination procedure, beginning with the completion of an ex parte review. If the result of the ex parte review is inconclusive, then the EW must contact the recipient by sending a “Medi-Cal Request for Information” form (MC 355) to verify the new information and allowing 30 days for their response.

Special Case (Responsible Relative) Searches

Federal and state law require EWs to obtain the financial records of “any other person” whose resources are required by law to be disclosed to determine the eligibility of a Medi-Cal applicant or recipient, or to determine the amount or extent of medical assistance. The relative responsible for contributing to the cost of health care services of a Medi-Cal applicant or beneficiary is limited to spouse for spouse and parent for child.

Reviewing the AVP Report

When the asset verification report identifies all assets included in the recipient’s case file, and the value of those assets is under the property reserve limits, the existing information in the case file does not need to be updated in order to match the report. In addition, EWs must not request bank statements and/or property valuation reports, unless the asset report:

  • Reveals previously undisclosed assets;
  • Reveals a previously disclosed asset with a value exceeding the property reserve limit; or
  • Does not detect an asset already disclosed by the recipient.

Note: AVP is only applicable for ABD and LTC cases, therefore the use of AVP reports as verification in the ex-parte process, only applies to these cases.

Reminder: The outcome of the AVP report must be documented in CalSAWS.

Beginning July 1, 2022, eligibility must be granted if the self-attested property on the Renewal is below the property limit for the household without receipt of the AVP report and all other Medi -Cal eligibility criteria are met. If the AVP report is received and the property listed on the report is under the property limit, no additional verification is required. If the AVP report is received and the property limit listed is more than the household's property limit, verification must be requested.  

Income Verification for Individuals without a SSN or Individual Taxpayer Identification Number

Individuals who do not have a valid SSN or Individual Taxpayer Identification Number (ITIN) are required to provide verification of their income only AFTER the Federal Hub has provided results of Not-Verified, Failed or Pending.

Required Verifications

When information cannot be verified through electronic data systems (MEDS, Federal Hub, etc.), the EW must request the required verification from the client allowing 30 days for the client to provide.
Required verifications must be provided, if they are not provided within 30 days then the case must be discontinued with a timely 10-day NOA. If the client provides partial information or otherwise attempts to comply with the request, the EW must continue to allow time for the client to provide the missing information without being discontinued, as long as the client continues to make a good faith effort.

The CalSAWS MAGI Person Detail page reflects verified information.

These verification fields include:

 

  • “SAWS Verification” means the county received paper verification from the client.

 

  • "State Verification” means a Covered California employee or the Federal Hub verified the information and the CalSAWS Verification field was updated automatically.

 

  • “Reasonably Compatible Verification” means a Covered California employee (Service Center Rep) or the Federal Hub verified the information.

For detailed guidance on accessing the CalSAWS MAGI Person Detail page [Refer to Job Aid (JA): Medi-Cal CalHEERS-MAGI Verifications]

 

If something is verified by the Federal Hub or Covered California employee (Service Center Rep), the EW must not update the other Verification field unless there is paper verification listed in Imaging. If the MAGI MC eligibility is not functioning properly, create a GADWIN ticket. All Non-MAGI MC cases should have paper verifications in Imaging. This ensures that CalHEERS does not erroneously list the income as SAWS verified and the correct source of verification is displayed in both CalHEERS and CalSAWS.

Printed Verification for Imaging

EWs must print certain screenshots from each system (CalSAWS, CalHEERS and MEDS) and send those screen prints to Imaging as verification. These print outs include:

  • CalHEERS Personal Verification page (i.e. FedHUB verifications) for each eligible individual. Refer to the Finding Information in CalHEERS (FInCH) document.
  • Print CalSAWS, CalHEERS, and MEDS screens that display the exact same information for each eligible individual.
  • For CalSAWS, print the Case Summary page.
  • For CalHEERS, print Program Eligiblity Summary by Person page.
  • For MEDS, print [INQM] screen and, if applicable, [INQ1], [INQ2], and [INQ3].

CalSAWS Screenshot to Print

Print the Case Summary page in the Medi-Cal program block for each active household member.

 To print do the following:

  1. Go to the CalSAWS Home Page, enter a case number in the Case Number field and click Submit; or Go to the Person Search page and enter the search criteria; or Enter a case number in the Case Number field on the Task navigation bar and click Go.
  2. Click the caret next to the individual(s) name to expand, the aid code(s) will appear.
  3. Print the Case Summary page. Make sure all information is visible on the printed page(s). (This may require printing more than one page.)

MEDS Screenshot to Print

Print the individuals [INQMINQM] MEDS screen for each active household member. Depending on the case/individual the EW may also need to print screens [INQ1], [INQ2] and/or [INQ3] to capture all eligibility.

CalHEERS Screenshots to Print

Each household members’ eligibility appears together on the [Program Eligibility by PersonProgram Eligibility by Person] screen CalHEERS. The following steps will reduce the number of unnecessary pages printed from CalHEERS.

CalHEERS1

CalHEERS2

  1. Select Print Preview.
  2. Change Custom setting to 60%.
  3. Select page range to print only the pages with content.

Related Topics

Redeterminations