WCER at Application

When determining an applicant's compliance with WCER, the SSBS must first review whether the individual qualifies for an exemption. If the individual does not qualify for an exemption, the SSBS must review if the individual has met the WCER through one or more qualifying activities during the look-back month.

Look-Back Month

The look-back month for applicants is the month before the application submission month.

ExampleExample: For applications submitted anytime during the month of January 2027, the look-back month is December 2026. :

WCER Beginning Date of Aid (BDA)

Meeting an Exemption at Application

Individuals meeting the exemption criteria at any time, and all other Medi-Cal eligibility criteria are met, will have a BDA on the first of the application month.

Meeting a Qualifying Activity in the Look-Back Month

If the individual has met compliance with WCER in the look-back month, and all other Medi-Cal eligibility criteria are met, the individual's BDA is the first day of the application month.

ExampleExample : An applicant applies for Medi-Cal on June 10th, 2027. The SSBS reviews the application and confirms the individual worked in the look-back month (May 2027), earning $600 in monthly gross income. The individual met the WCER in the look-back month, all other Medi-Cal eligibility criteria are met, and the BDA is June 1st, 2027. :

Meeting a Qualifying Activity in the Application Month

If the individual has not met WCER in the look-back month, but shows compliance in the application month, then the BDA is established in the following month.

ExampleExample: An applicant applies for Medi-Cal on June 10th, 2027. The SSBS reviews the application and finds the individual did not meet WCER in the look-back month, but provided information that they started attending school full-time on June 8th, 2027. The individual's BDA is the first day of the following month, July 1st, 2027. :

Not Meeting WCER at Application

If the individual is not exempt and has not met WCER during the application processing, the SSBS must issue a Notice of Non-Compliance (NNC) and allow the individual 30 days to provide information showing they are either exempt from or are meeting WCER.

If the individual provides information within the 30-days showing they meet the WCER requirement, the BDA is the first day of the month after they have met WCER. Any month prior to the BDA, the individual is ineligible for Medi-Cal and must be denied for those months.

Example:Example: An individual applies for Medi-Cal on June 10th, 2027. The SSBS reviews the application and finds the individual did not meet WCER in the look-back and is not meeting an exemption or a qualifying activity in the application month. The SSBS issues an NNC to request proof of compliance with WCER through an exemption or qualifying activity. On July 19th, 2027, the individual contacted the SSBS and provided verification showing they have been working 40 hours a week since July 1st, 2027. The individual became compliant for WCER in July 2027, and all other Medi-Cal eligibility criteria are met. The SSBS must approve Medi-Cal eligibility with a BDA of August 1st, 2027; all previous months (June and July) are denied for WCER non-compliance. e

ExampleExample: An individual applies for Medi-Cal on June 10th, 2027. The SSBS reviews the application and finds the individual did not meet WCER in the look-back and is not meeting an exemption or a qualifying activity in the application month. The SSBS issues an NNC to request proof of compliance with WCER through an exemption or qualifying activity. On July 19th, 2027, the individual contacted the SSBS and provided verification showing they have been working 40 hours a week since July 1st, 2027. The individual became compliant for WCER in July 2027, and all other Medi-Cal eligibility criteria are met. The SSBS must approve Medi-Cal eligibility with a BDA of August 1st, 2027; all previous months (June and July) are denied for WCER non-compliance. :

Exemptions can be met at any time during the application process; if an individual later responds to the NNC and provides information that they are exempt, their BDA is the first day of the application month.

Example:Example: An individual applies for Medi-Cal on June 10th, 2027. The SSBS reviews the application and finds the individual is not meeting WCER and is not exempt. The SSBS issues an NNC to request proof of compliance with WCER through an exemption or qualifying activity. The individual responds to the NNC on June 30th, 2027, and verifies being a caretaker relative for a disabled child since April 4th, 2027. The individual is exempt from WCER, and all other Medi-Cal eligibility criteria are met. The individual's BDA is the first day of the application month, June 1st, 2027.

Important: Applicants must not be denied for non-compliance until after the 30-day due date of the NNC.

Retroactive Medi-Cal Under WCER

To qualify for retroactive coverage under the work and community engagement requirements, the individual must have either met the requirements or qualified for an exemption during that retroactive month.