MC Eligibility Determination for Refugees

Program Determination

When determining MC for refugees, each member of the family must be determined ineligible for the public assistance programs listed below before RMA benefits can be granted:

California Work Opportunity and Responsibility to Kids (CalWORKs)
Cash-linked MC
MAGI MC
Non-MAGI MCx

Specific Considerations

Refugees and Entrants who apply under the RMA/EMA ONLY programs must first have their eligibility determined according to MC eligibility rules. The following are specific requirements under RMA:

Each family member must be determined ineligible for public assistance programs before RMA can be granted.

MC or RMA

If...	Then...
Any refugee is eligible for a MC program	Approve MC and not RMA.
A refugee is ineligible for MC because there is no linkage,	Place the refugee on RMA, if all other requirements are met, since linkage is not a requirement.

Financial Requirements

Refugees must meet the MC financial eligibility requirements at the time of application. All Refugee cash assistance received from a Voluntary Agency (VOLAG), including a Resettlement Grant and Match Grant are NOT counted when determining eligibility for RMA.

In those cases where a refugee does not meet the income maintenance need level for zero share-of-cost (SOC) MC, the client may be placed in RMA.

Note: In the hierarchy Non-MAGI MC must be evaluated before RMA can be explored.

Exempt Income and Property

In meeting the financial eligibility requirements for RMA, the following income must be considered exempt:

Public cash assistance (i.e., RCA, ECA, resettlement and match grants)

Income and property from the agency sponsor (VOLAG),

Income in-kind,
Income earned after the date of application,
Any income and/or property remaining in the refugee’s country of origin, which are not available.

Reminder: Refugee applicants who do not meet the property eligibility requirements for RMA must be allowed to “spend down” in the same manner as in other MC programs.

Income for RMA

If the Refugee’s Family Income is...	Then the Refugee...
At or below the 200% of the FPL and is not eligible for zero SOC MC,	May be placed on RMA with zero SOC for the twelve month eligibility period.
Above the 200% of the FPL,	May receive RMA with a SOC for the twelve month eligibility period.

The following is an example of a refugee with increased earnings:

Example of Income for RMA

If the Refugee is...	And...	Then the EW must...
Currently receiving MC (no RMA/EMA),	Receives increased earnings from employment, and loses zero SOC MC coverage,	Transfer the Refugee to RMA until the end of the twelve month eligibility period.
Eligible for Transitional Medi-Cal (TMC),	The initial TMC period is longer than the time remaining on RMA,	Place the Refugee on TMC. Refugees must be placed in a program which has a longest period of eligibility.

Clarifications

Clarifications below apply to any individuals being evaluated for the RMA program; regardless of their refugee categories. The following charts provide clarifications to assist staff in establishing eligibility determination.

If income is received AFTER the date of application, the following rules apply:

Income Received After Date of Application

Medi-Cal	RMA Program
Count all income received or expected to be received in the month.	No RMA evaluation until client is found ineligible for no SOC MC.
If adult(s)/child(ren) are eligible for no SOC MC, no RMA evaluation is necessary as it does NOT apply. NOTE: If the family is eligible for TMC after CalWORKs or MAGI MC due to increase earnings, set up TMC if the six-month TMC is longer than the remaining 8-month RMA period.	RMA does not apply.
If an ADULT is ineligible for MAGI MC due to income or Non-MAGI MC due to no linkage or excess property, then evaluate under RMA rules.	Under RMA evaluation, do NOT count any income received AFTER the date of application. Grant RMA with NO SOC.

If income is available as of the date of application, the following rules apply:

Available Income at Application

Medi-Cal	RMA Program
Count all income received or expected to be received in the application month.	No RMA evaluation until client is found ineligible for MAGI MC or zero SOC Non-MAGI MC.
If adult(s)/child(ren) are eligible for MAGI MC or zero SOC Non-MAGI MC, no RMA evaluation is necessary as it does NOT apply. NOTE: If the family is eligible for TMC after CalWORKs or MAGI MC due to increase earnings, set up TMC and the six-month TMC is longer than the remaining 8-month RMA period.	RMA does not apply.
If an ADULT is ineligible for MAGI MC or Non-MAGI MC, then evaluate under RMA rules.	Count all income received or expected to be received in the application month. Grant RMA with NO SOC if income is under 200% FPL limit. Grant RMA with SOC if income is over 200% FPL limit. Note: Any increase in earnings/income are not counted in the future months.
If a child is ineligible for OTLIC,	Grant RMA with SOC if income is over 266% FPL limit. Note: Any increase in earnings/income are not counted in the future months.
If a child is ineligible for OTLIC,	Reminder: Refer the child to the Healthy Kids program if income is between 267% -300% FPL.

Refugee Cash Assistance (RCA) Entrant Cash Assistance (ECA)

Refugees in receipt of RCA/ECA are automatically eligible for RMA until the end of the twelve-month eligibility period. RCA can be cash assistance from the Social Services Agency, monies from a voluntary settlement agency, receipt of match grant funds (four months only), or can be a cash grant from the Federal Department of State or Department of Justice Reception and Placement programs.

Receipt of RCA/ECA is not necessary for refugees to be eligible for RMA. Refugees may apply for RMA benefits without receiving RCA/ECA.
Loss of RCA/ECA does not mean loss of RMA. If a refugee loses or is terminated from RCA, RMA must be continued without redetermination or change in benefits until the end of the twelve month eligibility period.

Exception: Clients receiving RCA with the TCVAP aid code 1V are entitled to MC, but the MC is not included in the aid code. The client must be granted a MC aid code separately for MC following the TCVAP process.