Continuous Eligibility for Children (CEC)

CEC ensures that all children under age 19 who are determined eligible for zero SOC MC maintain eligibility until the next annual redetermination or the child turns 19, whichever occurs first. All adverse changes in financial eligibility income, property, including a change in maintenance need levels, are disregarded until the CEC period ends.

CEC Program Eligibility Rules

The following eligibility rules apply to the CEC program:

• The CEC period begins at the first month of MC eligibility for all categories of zero SOC MC, including cash-based categories.
• Any changes in family income, assets or other circumstances reported by the family during the CEC period, which would otherwise move a child under age 19 from:
  • Zero SOC category (including MAGI aid codes) to a SOC category
  • Zero SOC category (including MAGI aid codes) to a Premium aid code,
  • Zero SOC eligibility (including MAGI aid codes) to ineligibility.
• The CEC period continues for up to 12-months, and ends the last day of the month in which the annual redetermination (RD) is due, or when the child turns age 19, whichever occurs first.
• Independent minors living on their own, away from parents (under age 19) are entitled to CEC.

CEC Exceptions

CEC does not apply in the following circumstances:

• A child receiving Minor Consent services
• A child becomes incarcerated
• In the event of death
• The family/child moves out of state.
• A break in aid of more than one month.

The 12 Month CEC Period

The CEC period is always twelve months. The CEC period begins with the first month of an initial zero SOC (or MAGI) eligibility determination or the first month impacted by an annual redetermination, and ends with the last month covered by that determination, or the child’s 19th birthday, whichever occurs first. The month impacted by the annual redetermination is the month following the month in which the annual redetermination is completed. CEC can begin at any time during the CEC period after the first zero SOC month.

ExampleExample

Guaranteed CEC Period

The CEC guaranteed period is within the CEC period, but must begin with a zero SOC month. CEC can only be triggered following a change from zero SOC MC to either a SOC or ineligibility. The months from the time of the zero SOC determination until the next annual redetermination are referred to as the CEC guaranteed period.

If the initial eligibility determination or the annual redetermination results in coverage for zero SOC Medi-Cal, the CEC period and the CEC guaranteed period start at the same time. The CEC period and the CEC guaranteed period always end at the time of the next annual redetermination.

During the CEC guaranteed period, any change in family income, assets, or other circumstances resulting in a SOC or ineligibility is disregarded for the child but not for the adult family members. The child is place into CEC and continues to receive zero SOC MC for the remainder of the 12 month CEC eligibility period.

The zero SOC determination is not limited to determinations at initial eligibility or at annual redetermination, however, it can begin no earlier than the first month impacted by an initial eligibility determination or an annual redetermination.

CEC Aid Codes

Most children on Non-MAGI aid codes will remain on the same aid code throughout the CEC period, however, there are some instances where a child can no longer stay on that aid code and the CEC aid codes must be utilized (ex: TMC). The Non-MAGI CEC zero SOC Aid Codes are as follows:

CEC Aid Codes

Aid Code	Description
7J	Full Scope coverage to qualified children under age 19 (Citizen/Legal Immigrant)
7K	Restricted coverage to qualified children under 19 without satisfactory immigration status.

 

There is not a specific CEC aid code for MAGI individuals. Due to system limitations, MAGI children eligible for CEC must remain on Soft Pause through the end of their CEC period.

CEC Individuals on Soft Pause who Age Out of their Aid Code

When a MAGI child is on Soft Pause and reaches the age limit for their current aid code, system functionality does not allow the aid code to be changed and remain on Soft Pause. A Burman Hold will be placed on these individuals in MEDS, however, this should not cause an issue with access to care. If the client indicates that they were denied services, check the MOPI screen in MEDS for the specific service month. If no eligibility appears in MOPI but there is eligibility on the INQM (Q1, Q2, etc.) screen, review the case and create a GadWIN ticket if necessary. The Burman Hold must not be lifted.

Changes Reported During The CEC Period

MC recipients are still required to report information which may affect the determination of eligibility (i.e., change in family/tax household composition, income or property) within ten calendar days following the date the change occurred. This requirement has not changed. However, any changes reported must not be used to adversely affect a child’s eligibility during the CEC period.

Note: If the change in family circumstances causes the child to be moved to a different zero SOC MC category, the EW must authorize the change. The child would continue to be protected by CEC under the new category until redetermination. 

Decrease in Income Reported in SOC Month Prior to Annual RD

If the family reports a decrease in income for any month prior to the annual RD that results in the child’s eligibility for a zero SOC program, then the guaranteed CEC period based on that report is triggered and continues through the next annual RD.

Annual Redetermination Following a Period of CEC

EWs must take appropriate action based on the information gathered during the redetermination process.

 

If the redetermination results in...	Then...
The family income level permits the child to continue to be eligible for a zero SOC (or MAGI) MC program,	The child is placed into that program, and a new CEC period begins.
The family income level gives the child a SOC,	A new CEC period does not begin until the child is determined eligible for a zero SOC program.
Total ineligibility for all MC programs,	The child must be discontinued.

CEC Retroactive Eligibility

Applicants and recipients have up to one year to apply for retroactive MC coverage, and must be evaluated for any or all months within the 3-month retroactive period when requested. If a child is determined eligible for a zero SOC MC (or MAGI MC) program in one of the three retroactive months, then CEC applies beginning the first day of the month in which the child is determined eligible.

SOC in Month of Application and Zero SOC in Retroactive Month

When it is determined there is a SOC in the month of application, but there is eligibility for zero SOC (or MAGI) in a retroactive month, the guaranteed CEC period is based on the retroactive zero SOC month, and runs for a period of 12-months.

ExampleExample

Eligibility Established Prior to Retroactive Request

A late retroactive request and subsequent CEC eligibility changes the eligibility previously determined in the months already established.

CEC Begins in a Retro Month/CEC Guaranteed Period Ends Prior to RD

When CEC is based on a zero SOC month in the 3-month retroactive period prior to the month of application, the CEC guaranteed period will end before the annual RD 12 months from the date of the application. In this situation, the CEC guaranteed period extends to the annual RD. When the retroactive CEC guaranteed period ends, the guaranteed CEC period based on the month of application is still in effect. The child will have been covered by CEC from the applicable retroactive month to the annual RD.

ExampleExample

Note: When the guaranteed CEC period is based on a retroactive zero SOC month, and the family reports a decrease in income for any month prior to the annual RD that results in a child’s eligibility for a zero SOC program, then the child’s guaranteed CEC period based on that report is triggered and lasts until the annual redetermination. The child has CEC until the annual RD, even though the retroactive CEC period has ended.

CEC for Infants Under Age One

Currently, infants under age one who are born to MC eligible mothers are deemed eligible for full-scope, zero SOC MC without an application, and remain MC eligible under the DE program for one year, regardless of any family income or resource changes during that period. DE takes precedence over the CEC program.

Infants whose DE ends because they are no longer living with the MC eligible mother are eligible for CEC.

Children Discontinued from CalWORKs

When a child is terminated from CalWORKs and there is no longer eligibility for cash-based MC, EWs must first determine if the child qualifies under any other zero SOC MC program, including TMC, and place the child in that appropriate Aid Code.

• If the child is not eligible for any other zero share-of-cost Medi-Cal program, he/she must be placed in a CEC Aid Code.
• CEC begins with the first month of initial eligibility or the first month impacted by an annual redetermination of eligibility, whichever is later.
• CEC ends 12-months from the initial CalWORKs application or annual RD.

Children Losing Foster Care Eligibility

A child receiving Foster Care (FC) and/or Kin-GAP is eligible to receive MC benefits under CEC if he/she is not eligible for any other zero SOC MC Program.

Note: The FFY Program takes priority over CEC. Children who were in FC on their 18th birthday are eligible to receive zero SOC MC until their 26th birthday. These children must be transferred into the FFY Program.

CEC applies whenever a child under 19 loses Foster Care eligibility and does not qualify for the Extended MC Eligibility for Former Foster Youth (FFY) program. The child is entitled to CEC until the next annual redetermination, which is 12 months from the last Foster Care RV. The Foster Care EW will transition the child to the CEC program after being discontinued from Foster Care without requiring a new application. An MC-only case must be established for each CEC child until the end of the CEC period, unless the child moves out of state or requests discontinuance.

Children Losing SSI Cash-Based Medi-Cal

Children losing SSI cash-based benefits continue to receive zero SOC MC (or MAGI) benefits under the Craig vs. Bontá lawsuit until an eligibility determination for ongoing MC is completed.

CEC Procedures

When CEC is triggered, children must either remain on a current zero SOC (or MAGI) program, if applicable, or transferred to the appropriate CEC Aid Code.
 
EW staff must take the following action for all children under age 19:

CEC Procedures

If...	And...	Then...
A child is on an FPL program,	A change in family income results in a SOC,	Transfer the child to the CEC Program, using the appropriate Aid Code, through either the end of the redetermination period, or the child(ren) turns 19, whichever occurs first.
The child(ren) are receiving TMC,	Changes result in financial ineligibility, or TMC eligibility stops for any other reason,	The child(ren) must be evaluated to determine if he/she is still within the CEC period. If so, transfer the child(ren) into the appropriate CEC Aid Code until the CEC period ends, or the child(ren) turns 19, whichever occurs first. NOTE: If the child(ren) is not within the CEC period, follow the normal procedures for TMC ineligibility and review for eligibility under another MC program.
There are child(ren) eligible for CEC,	They are in an MFBU with other family members,	The EW must ensure that any reported changes are acted upon appropriately for the other family members.

 

Redeterminations Not Completed Timely

When a MC redetermination is not processed timely, and a child is determined to have a SOC, the EW is responsible for reviewing the information for the month the RD was due, and for each month until the RD was actually completed to determine if CEC is applicable.

ICTs

CEC cases are treated the same way current procedures are followed for ICTs. The CEC child continues to receive zero SOC (or MAGI) MC in the receiving county for the remainder of the CEC period. EWs must:

• Review information contained in the case record prior to transfer,
• Ensure that the child(ren)’s zero SOC MC continues during the ICT period, and
• not discontinue the child(ren)’s zero SOC MC benefits until the receiving county has placed the child in CEC or another zero SOC MC Aid Code.

CEC When a Child Leaves the Home

CEC applies when a child under 19 leaves the home as CEC follows the child. The child must be continued in his/her new home (as long as it is in California), regardless of family income and/or living arrangements, as long as the child is still in the CEC period.

In addition, CEC also applies when the CEC guaranteed period is established on a parent’s case and the minor moves out, establishing his/her own case.

Confidentiality rules do not apply to the parents or caretaker relatives of the child as long as the child is a minor and under the care of the person they are living with. The custodian of the child may be contacted.

Note: Changes in custody should be reported to the Department of Child Support Services (DCSS).

Whereabouts Unknown

Children on CEC may not be discontinued for Whereabouts Unknown.

Note: Other members in the household must be discontinued as appropriate.

Request for CEC Discontinuance

The parent(s) of an eligible CEC child may request discontinuance of his/her child’s MC benefits. If a request is made for discontinuance, the EW must discontinue benefits as requested.

Related Topics

Extended Medi-Cal Eligibility for Former Foster Youth (FFY) 18 to 26 Years of Age