9062 - Positive OHC Reported - County Aid Reevaluation Needed - Urgent

This alert is generated when other health coverage (OHC) is established on an aid code 77 record. Individuals who have OHC that covers anti-rejection medications are not eligible for State-only restricted aid code 77.

Action Required

The EW must contact the client to find out if the OHC covers anti-rejection medication. If the client states that the medication is not covered, verification must be provided. Refer to MC HB Chapter 4: Application, Section Organ Transplant Anti-Rejection Medication Program for a detailed information.
If the anti-rejection medication is covered by the OHC, the EW must review the client’s case for Medi-Cal eligibility per SB87 requirements and take the following actions:
If the client is eligible for another Medi-Cal program,
- Complete Data Collection pages with the current information, run EDBC and authorize the case.
- Submit an SCD 1296 requesting termination of aid code 77 if client’s OHC covers anti-rejection medication.
- Issue “Discontinuance For Organ Transplant Anti-Rejection Medication Program” (MC 379).
If the client is determined not eligible for another Medi-Cal program,
- Issue a proper 10-day discontinuance NOA explaining the reason for termination of aid code 77 and the right to request a fair hearing.

9062 - Positive OHC Reported - County Aid Reevaluation Needed - Urgent

Action Required

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