Notices of Action

A NOA informs an applicant/client in writing what information was used in their case and how it was used. The language used in the NOA should be clear and simple. For denials and discontinuances, the NOA must include the specific information or verification needed to determine eligibility and the reason(s) the action was necessary.

When to Send a Notice of Action

A NOA must be sent to the applicant/client when eligibility for MC is:

  • Approved
  • Denied
  • Discontinued
  • Changed (i.e. Share of Cost (SOC))

Informing Requirements

A NOA must:

  • Notify the applicant/client of their MC eligibility or ineligibility and of any changes made in their eligibility status or SOC.
  • Give all of the information that the applicant/client needs in order to be able to judge whether or not the action to be taken is correct.
  • Provide enough information so that the applicant/client can make an informed decision whether or not to request corrective action or file an appeal.
  • State the action to be taken.
  • Have an effective date of action.
  • List the name(s) of individual(s) affected.
  • State the reason for the action:
    • State the general regulation, and
    • Apply the applicant/client circumstances to the rule.

    • Reminder: When MC is denied/discontinued due to failure to provide, the NOA must specifically list the items requested but not provided.

  • List the regulations supporting the action.
  • Provide an explanation of the right to a State hearing. (This is on the NA Back 9, on the reverse side of the notice.)
  • Provide an explanation of the right to Aid Paid Pending. (This is on the NA back 9, on the reverse side of the notice.)

Timely Notice of Action

A timely NOA must be mailed 10 calendar days before the effective date of action whenever the action is a discontinuance, termination or other adverse action.

Note: The 10-day period does not include the date the notice is mailed nor the first day of the month the change will take effect.

Adequate Notice of Action

Timeframe

In certain situations a 10-day NOA is not required; the notice must be mailed any time before the effective date of the action.

ExampleExampleA client moved out of California on November 23. Benefits will be terminated December 1st for the client; thus, an adequate NOA must be mailed to the client's last known address by November 30.

A 10-day NOA is not required in the following situations:

  1. There is a non-adverse action affecting MC eligibility (i.e. decreased SOC).
  2. The EW has received information confirming the death of the client.
  3. The EW has received a clear written statement signed by the client stating that he/she wishes to:
    1. Withdraw an application,
    2. Discontinue MC benefits, or
    3. Waive his/her right to a 10-day NOA.

    4. Note: The written statement may be given on the “Request for Withdrawal and/or Waiver of Ten-Day Advance Notice” (MC 215), “Request for Discontinuance/Withdrawal/Waiver” (CSF 31), or client’s written statement.

  4. When the county has received returned mail and the EW has made two attempts to contact the client.
  5. The EW has received information confirming that the client has moved out of California.
  6. The client has been determined eligible in a new county, and the EW confirmed that MC has been established in the other county without a break-in-aid.
  7. MC has been granted for a specified period, and the client has been informed on the Notice of Approval that MC benefits will automatically terminate at the end of a specified period (i.e. Transitional MC).

Other Notice of Action Requirements

A NOA must also:

  1. Be written in clear, non-technical language,
  2. Be issued in the appropriate language,
  3. Be mailed no later than the effective date of the action, if the action is non-adverse, and
  4. Include the following information, if applicable:
    1. The amount of the SOC, if any,
    2. The amount of new non-exempt income used to determine the SOC,
    3. The name and telephone number of the EW, and
    4. The date the form was completed.

Long Term Care Medi-Cal Notices of Action

When issuing a NOA to an applicant/client in Long Term Care (LTC), the EW must:

  • Mail the original NOA to the applicant/client at the nursing facility.
  • Mail a copy of the NOA to the individual's representative, if another person is acting on his/her behalf.
  • Mail a copy of the NOA to the administrator of the facility, if requested by the family.
  • Verify a copy of the NOA is in CalSAWS.

APTC and MAGI MC NOA (NOD01)

Informs and explains the renewal eligibility determination for clients. It is automatically generated in CalHEERS and it contains information for APTC approval or denial and MAGI MC denial on the same notice. An individual who is approved for APTC but denied MAGI MC due to income over the MAGI MC income limit would receive a NOD01. In addition, an individual who is ineligible for APTC and denied MAGI MC due to income over the MAGI MC income limit would also receive a NOD01. The notice includes:

  • Case number,
  • Final APTC calculation amount, and
  • Final program specific eligibility determination for each client.

Note: The NOD01 cannot be manual generated from CalSAWS since it is a Covered CA notice.

When Multiple Notices of Action May Be Necessary

In some situations, a single NOA may not provide adequate notification and an additional NOA must be provided. Examples of specific situations when multiple NOAs are necessary are as follows:
Example

At application, an individual is determined to be ineligible for MAGI and a Non-MAGI determination is completed. The individual is found to be ineligible to Non-MAGI due to no linkage. In this case, the individual must be notified of both determinations:

  1. Denial of MAGI
  2. Denial of Non-MAGI for No Linkage

Example

An individual is determined to be ineligible for full-scope MC as a result of excess property; however, it is determined that the individual is eligible for an MSP under different property rules. In this case, the individual must be notified of both determinations:

  1. Denial/discontinuance for full-scope benefits due to excess property.
  2. Approval for MSP.

Example

An individual requests to have eligibility determined for the MSPs and is determined to be ineligible for all of the MSPs. The individual must be notified of the denial for each separate MSP because they have separate eligibility requirements and provide different types of benefits. As a result, multiple NOAs may be sent to these individuals. If the individual is approved for one MSP, then only the approval NOA for that MSP needs to be sent.

“Conditional” Notices

A conditional notice (MC 355, SCD 50, etc.) is not a substitute and does not meet the requirements of a NOA.

ExampleExampleThe EW sends an MC 355 requesting income verifications and informs the client that they may be discontinued if they do not provide the information by the date requested (30 calendar days). The client does not respond. The EW sends a discontinuance NOA listing why they are discontinued and specifically what they failed to provide.

A conditional notice is:

  • A notice that requires an action on the part of the client, and
  • States that discontinuance, denial or other adverse action will occur unless the action is completed by the client.

The EW should request information or cooperation from the applicant/client by:

  • Clearly advising the client of the information needed,
  • Specifying the due date to receive the information.
  • Stating that failure to complete the action(s) by the specified due date could result in discontinuance, denial, or other adverse action.

Note: The information above MUST NOT be used on a NOA. A discontinuance, denial, or other adverse NOA may be sent only after the client fails to cooperate or provide information as requested in the informal written notice by the date specified.

Notices of Action and Authorized Representatives

An applicant/client may designate another person or organization to act as his/her authorized representative (AR). The AR, however, is not automatically entitled to receive a copy of all NOAs issued to the applicant/client. The AR may only be issued a copy of a NOA which the applicant/client specifically requested be sent to the AR.

Note: If the county has received notification from the applicant/client that the AR is authorized to represent him/her in a hearing, the county is required to provide copies to the AR of all NOAs or other correspondence that the county has sent to an applicant/client relating to a hearing request or hearing issue(s).

Discontinuance Notice of Action for Non-Receipt of MC 216

The MC 239 A Discontinuance NOA for cases discontinued due to failure to return the MC 216 must only list the missing information that was requested but not provided on the MC 216 (limited to death, income, and/or incarceration as applicable). This NOA must also list the names of the individual(s) with the missing information.
CalSAWS has a functionality which will automatically exclude or include significant information based on what was requested on the MC 216. The MC 239 A NOA can also be manually generated and an EW can exclude information by typing ‘NA’ into the [Body Text Variables] fields.

Manual Printing

When manually triggering the MC 239 A Discontinuance NOA using reason codes MAN215 and NM0668, EWs must enter ‘NA’ (if applicable) in the deceased, incarcerated, or income fields under the [Body Text Variables] tab to remove information for the individual from the correspondence. If multiple names are entered for either the deceased, incarcerated or income [Body Text Variables] fields, the names will not display in a list format. When entering the names manually, EWs must use a comma between each name listed.

Related Topics

Ten Day Reporting Requirement

Manual NOAs

IRS Form 1095-B