9526 - Infant/Child Elig Terminated - Check for Exception Elig - Action

This MEDS Renewal message is issued at the beginning of the month in which the infant/child reaches the maximum age allowed for that Aid Code (e.g., 1st birthday for Aid Codes P9, 6th birthdate for Aid Codes P7).

Since MEDS has not received a termination transaction from the county for the end of the current MEDS month, the MEDS Renewal process terminated the recipient’s MEDS record effective the end of the current MEDS month. In addition, the system posted a ‘PP’ in the TERM-REAS field. The alert displays the infant/child’s age in number of months (e.g., 00013 = 13 months).

Additionally, the record is placed into a Hold status until corrective action is taken by the EW.

Action Required

• If the child is no longer eligible for the Special Percentage Program:
  • Discontinue eligibility for the special program in CalSAWS/CalHEERS and ensure proper NOA(s) has been sent.
  • Transfer the child’s Medi-Cal eligibility to the appropriate Aid Code if eligible. (REMINDER: Explore CEC rules).
• If the infant/child remains eligible as he/she is in continuing inpatient care:
  • Complete an SCD 1296 requesting online action by the MTO to reestablish eligibility on MEDS for future months.
  • The EW must indicate on the SCD 1296 that this is ‘EXCEPTION ELIGIBILITY’ for the special program and whether the Add (EW20) or Modify (EW30) transaction is for an ‘ongoing period’ or ‘closed period’. Without this vital information, the MTO cannot generate the appropriate transaction.
  • This notation will alert the MTO as to the appropriate ‘exception eligibility ESAC’ to use in the online transaction. Failure to use an ‘exception eligibility’ ESAC will cause the transaction to reject.

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