Ten Day Reporting Requirement

Medi-Cal (MC) clients are required to report certain changes within ten (10) days. A ten-day Notice of Action (NOA) is required if that change results in an adverse action. The “Important Information for Persons Requesting Medi-Cal” (MC 219) must be provided to an applicant/client during the intake process, during the redetermination process, and/or when adding a program/person. Eligibility Workers (EWs) must inform applicants/clients of the their responsibility to report changes within 10 days, including but not limited to:

  • Change of home and/or mailing address
  • Change in family composition or tax household
  • Change in marital status
  • Change in tax filing status
  • Change in income or employer
  • Change in property or resources
  • Change in immigration status
  • Change in disability status
  • Change in other health coverage
  • Change in pregnancy status

Requirements

EWs must take appropriate action on any changes they become aware of that affect MC eligibility, whether it is:

  • Reported directly by the client,
  • Reported on the SAR7 in conjunction with other public assistance programs,
  • Received through an IEVS abstract, or
  • Received from a third party (i.e. Managed Care, Workers Comp, Other Counties, etc).

Note: Only client caused errors, whether or not there is willful failure to report facts, are reportable to DHCS.

Medi-Cal Contact Update (MC 354) Form

Per Welfare and Institutions Code section 14005.36, EWs will receive contact information updates from Health Care Options (HCO) or Medi-Cal Managed Care Health Plans (MMCHP). These changes may include address changes, name changes, or telephone changes.

When the HCO or MMCHP contacts the county (by telephone, fax, or email) the EW should determine whether the representative has the client's consent.

The MC 354 form can be used by HCO or MMCHP to inform Social Services Agency when a MC client reports a change of address to the provider or to the MMCHP. EWs should review the information reported and update as necessary.

Note: The MC 354 is not an eligibility requirement. If the client refuses to sign or complete this form, it does not affect their MC eligibility.

If... Then...
The client gives consent, The EW should update the client's new information immediately.
The client did not give consent,

The EW should attempt to verify the information by:

  • Checking existing information to verify if the change had previously been reported but not updated.
  • Contacting the client to confirm the new information.

If the EW does not receive confirmation, the EW will not make the change.

Related Topics

Notices of Action

Manual NOAs

IRS Form 1095-B