Unwinding Period Flexibilities

The following flexibilities have been approved by the Department of Health Care Services and are to be used for Medi-Cal determinations during the CCU period. Any flexibility applied must be clearly documented in the case journal. 

Important: On May 9, 2024, Centers for Medicare and Medicaid Services (CMS) approved extending the continued use of all unwinding waivers and flexibilities past the end of the unwinding period and through June 30, 2025.

Income Affidavits

As a last resort to obtain a verification of income, staff may accept an affidavit signed under penalty of perjury from the individual as verification of income. Refer to MAGI/Non-MAGI Income Verification topics.

Verification of Income at or Below 100% FPL, or Zero Income

When a client reports income at or below 100% FPL, or zero income at Redetermination, and the income is not E-Verified, the sworn statement on the Redetermination forms is sufficient verification if no conflicting information exists.

 

A previously verified income at or below 100% FPL, or zero income determination is acceptable if no conflicting information in CalSAWS or the case file exists. This previous report can be accepted as far back as March 1, 2019.  

 

The zero income waiver and 100% FPL waiver does not allow the Medi-Cal Renewal packet to be disregarded. Once a renewal packet is sent, the packet must be returned through any of the available means; however, no additional verification is required if the beneficiary continues to report zero income and the county has not received conflicting income information.

 

Exception: If the client reports zero income but there is an open employment record in CalSAWS for that individual, or there is conflicting information in the case file, the EW must request verification and resolve the conflicting information.

Suspension of the Requirement to Apply for Unconditionally Available Income

Beginning August 1, 2023, the requirement to apply for unconditionally available income at application or renewal is suspended until further notice.

Unconditionally available income includes but is not limited to the following:

  1. Unemployment,
  2. Disability, 
  3. Veterans benefits. 

Stable Income Waiver

Beginning August 1, 2023, individuals with stable income and a Medi-Cal renewal due must have their income determination completed without a verification of the stable income.

Stable income is any income that meets the following conditions:

  • Income that is expected to continue indefinitely,
  • Does not have a known end date,
  • Is not tied to active employment,
  • Generally does not fluctuate aside from cost of living adjustments (COLA). 

The Stable income must also meet the following procedural conditions:

  • Previously verified no earlier than March 2019 (12 months prior to the COVID-19 Public Health Emergency),
  • The stable income is the only source of income in the household,
  • No contradictory information on the stable income is on file.

 

If there is contradictory information in the case file or the household has a non-stable income that is countable in the income determination, staff shall follow the normal business process and request a reasonable explanation or administrative/electronic income verification to resolve the discrepancy. 

 

Examples of stable income include but are not limited to:

  • Title II Social Security,
  • Pension income,
  • Retirement income (annuities, deferred compensation),
  • Disability payments,
  • Alimony or Child Support

 

All other Medi-Cal eligibility must be met and during the income determination, staff should review for additional waiver provisions listed in this Unwinding Period Flexibility guidance.   

Non-MAGI Asset Waiver

Beginning March 1, 2023, through December 31,2023 the Non-MAGI Asset Test is temporarily waived at renewal or during a reported change in circumstance. The property determination must be completed without requesting additional asset verification and disregard a report of new assets. Asset Verification Program (AVP) requirements still apply. Refer to [MC HB Chapter 16, Sub section Property Verification] for additional information and examples regarding the Non-MAGI Asset Waiver. Refer to Medi-Cal Update 2023-5

Asset Verification Program at Renewal

Beginning July 1, 2022, no additional verification is required if the AVP report is received and the property listed on the report is under the property limit. If the AVP report is received and the property limit listed exceeds the household's property limit, a verification must be requested. Refer to the Medi-Cal Redeterminations topic. 

Reasonable Explanation 

The method of reasonable explanation is now included as part of the Medi-Cal eligibility verification process as the state has adopted the ability for counties to request and accept a reasonable explanation to resolve income discrepancies only for MAGI and Non-MAGI Medi-Cal at initial application or annual renewal.  Refer to Medi-Cal Update 22-12

Redetermination of Medi-Cal Eligibility When Contact is Made With Hard-to-Reach Populations

This waiver allows counties to complete a change in circumstance determination and establish a new 12-month period of eligibility (prior to a normally scheduled unwinding renewal date) anytime a client who is considered a part of the vulnerable or hard-to-reach population makes contact with the county. Hard-to-reach populations include individuals where any kind of barrier exists making it difficult for them to make contact with the County, or for us to successfully reach them. Hard-to-reach populations can include but are not limited to:

  • Unsheltered Medi-Cal members or those without a fixed address,

  • Aged, Blind, or Disabled individuals, 

  • Victims of Natural Disaster,

  • Medi-Cal members who live in remote areas,

  • Incarcerated Medi-Cal member,

  • Migrant workers,

  • Foster Care individuals,

  • Or any individuals expressing hardship in contacting the county or submitting forms/verifications.

This strategy is intended to minimize discontinuances for vulnerable populations. This waiver is only intended to be used when eligibility results are positive or neutral. Refer to Revised MC Update 23-07.

Suspension of the Requirement of the Receipt of a Signed Medi-Cal Renewal Packet During an Ex-Parte Review

Effective immediately, all Medi-Cal beneficiaries who are in their renewal period and have a packet in sent status, may have their eligibility determined during an ex-parte review if the determination results in a neutral or positive change for all household members, without the receipt of a signed Medi-Cal renewal packet. If the ex-parte review results in an incomplete determination (missing information/verification in which a waiver does not apply) the individual may comply with the missing information in the 90-day cure period and have a complete renewal determination made without the receipt of a signed Medi-Cal renewal packet. 

Suspension of the Requirement to Comply with Medical Support Enforcement

Effective immediately, individuals who are required to comply with medical support enforcement (MSE) as defined in the Common Place handbook topic Child/Medical Support Overview, are not required to comply with MSE throughout the remainder of the CCU period. For MC eligibility, workers are not required to screen for medical support enforcement, send the CW 2.1 at application, or follow up on compliance with the form after benefit approval. In addition, individuals previously determined as required to comply with MSE during the CCU period and have not cooperated, must not be discontinued as a result of the MSE requirements.