Redetermination Due to Loss of TMC Eligibility

Complete an ex parte process to determine if the tax household information is available. If the information is available, If the information is not available, then mail the following forms to the client:

  • “Request for Tax Household Information” (SCD 2350) if the tax filer information cannot be collected over the phone.
  • The “Important Information for Persons Requesting Medi-Cal” (MC 219).

Additional forms must be sent as appropriate such as:

  • “Statement of Citizenship, Alienage, and Immigration Status” (MC 13)

 

Reminder: Completion of an MC 13 is not required for U.S. citizens/nationals. An MC 13 must be sent only if there is a change in citizenship/immigration status.

 

Note: Other health coverage may be available through the employer and the client may qualify for the Health Insurance Premium Payment Program (HIPP).

Processing the Redetermination Packet

If the...

Then...

Client does not provide the information on the SCD 2350 within 30 calendar days,
  • For Initial TMC, discontinue the case at the end of the initial 6-month period with a 10-day NOA.
  • For Additional TMC, discontinue the case as soon as a 10-day NOA can be issued.

SCD 2350 is incomplete within the 30-day timeframe,
  • Attempt to contact the client by phone or by sending an MC 355.
  • Allow an additional 30 calendar days for the client to provide the requested information/verification.
  • For Initial TMC, discontinue the case at the end of the initial 6-month period with a 10-day NOA.
  • For Additional TMC, discontinue the case as soon as a 10-day NOA can be issued.

Requested information is received AFTER the case is discontinued, but within 90 days from the discontinuance date,

The EW must evaluate continued MC eligibility using the information received and rescind the discontinuance action if eligibility exists.

Information is available or the client provides the information, and the client is determined to be eligible for MAGI MC,

Transfer the individuals to the appropriate aid code(s), and send the appropriate NOA to inform the client of the new MC program.

Client is NOT eligible for MAGI MC,
  • If linkage exists, send the Non-MAGI MC Screening Packet.
  • If linkage does not exist, approve other healthcare coverage programs.

Client provides information and is determined to be eligible for MC with a SOC,
  • A 10-day NOA is required.
  • I f there is no time for a 10-day NOA, allow aid code 38 for one month and then transfer to SOC MC.

Note: Aid code 38 for one month is not appropriate if the client provides information early enough to send a 10-day SOC NOA.

  • Refer children to the Healthy Kids program as appropriate.

Related Topics

Overview

Aid Code after TMC Discontinuance

Termination of TMC