Automated Discontinuances for Medi-Cal Redeterminations March 15, 2018

Below is the list of action items from the initial discussion at PSC on February 15, 2018 What reports are available in the C-IV System to assist counties with processing MC REs? What are the common User errors that prevent MC REs from going through the automated RE process? Are there existing MC RE job aids or C-IV functional presentations (CFP) available to Users? How is the MC caseload impacted if auto discontinuance functionality is implemented? Current volume of delinquent REs, and RE Dates advanced without running EDBC.

What reports are available in the C-IV System to assist counties with processing MC REs? The table below lists the reports available in the C-IV System by Report Name, Description, Schedule, Available Date and Navigation. This information will be included in a CIT with complete RE Batch. process information. Report Name Description Schedule Available Date Navigation Batch MAGI Skipped Report Provides information on cases whose request for MAGI determination are skipped by the monthly batch processes. Twice a month On C-IV Project’s 5th business day and 11th calendar day of every month G:Reports L:Scheduled  T:Administrative MAGI Discontinuance Report Provides information on cases that are skipped from the batch EDBC processes due to an ineligible or discontinued determination. L:Scheduled  T:Case Activity MAGI Error Report Provides information on cases which received an error transaction response from an EDR that was sent by the monthly batch processes. G:Reports L:Scheduled  T:Case Activity Outstanding Eligibility Determination Request Report Provides a listing of Eligibility Determination Requests by benefit month that do not have an associated Determination of Eligibility Response. Daily Monday through Saturday Batch RE Mixed Household Exception Report Provides information on cases with mixed household status that were not run through batch EDBC. Monthly On C-IV Project’s 5th business day of every month

What are the common User errors that prevent MC REs from going through the automated RE process? The Skip Reasons listed below prevent the EDRs from being sent to CalHEERS. There can be multiple skip reasons per case. Users must address the skipped reason and re-ping the Federal Data Services Hub (FDSH). Skip Reason Feb-18 Mar-18 Latest Determination is not Reviewed. 1259 1149 More than one Active Medi-Cal program exists on the case 566 550 Missing Verification Consent 416 406 Missing Tax Household information 359 404 Missing Primary Tax Filer 301 298 Missing relationship between any case person to every other case person 264 285 Program Case has a Pending Individual 256 249 Primary Contact has not been identity proofed 89 95 Deceased person has Tax Household record. 88 78 Missing Marital Status 70 84 Medi-Cal Primary Applicant does not match MAGI DER Primary Applicant. 59 62 Deceased Primary Applicant. 23 22 The Primary Applicant is marked as Duplicate or Hidden. 20 18 The address is missing. 15 The CIN is missing. 12 4 Medi-Cal requested type of FC/AAP/Out of State 2 3 More than 1 person has the same SSN. MAGI Determination has been skipped for Requested Type No worker assigned 1 Missing Primary Applicant

Are there existing MC RE job aids or C-IV functional presentations available to Users? To assist Users in preventing cases from failing the automated RE process, the following job aids include information on some of the skip reasons: Medi-Cal - CalHEERS - Insurance Affordability Programs (IAP) Identity Proofing Tax Household Information Verification Consent Maintain Verifications Medi-Cal - CalHEERS - Tax Household At this time, there are no CFPs available assist with the automated RE process. Note: The Batch RE Process and the need for additional job aids will be discussed with the Medi-Cal Committee at their meeting on April 4th.

RE Batch Processing Statistics The following are the cumulative statistics for the March 2018 RE Batch Process for May 2018 REs for all counties: Total cases submitted through the automated RE process = 90,845 87,804 (EDRs sent) + 3,041 (skipped cases) Cases that did not receive a DER due to being skipped = 3% RE DERs received back from CalHEERS = 85,932 DERs received with Pending Eligible status (packet auto generated) = 31,771 (37% of the total RE DERS received) Eligible DERs ran through EDBC (Ex-parte RE) = 43,182 (48% of the total RE DERS received) Note: Happy Path REs are correctly known as ex-parte REs.

Pending Eligible DER Status When a DER returns with one or more persons in a Pending Eligible status, a MAGI RE packet is automatically sent to the Customer. A Pending Eligible status means the person would be eligible for the program, but is not due to one of the following exceptions: Reported income is not reasonably compatible. Note: Incompatible income is the most common reason for a Pending Eligible status. Not a state resident. Verification returned as incarcerated. Verification returned as deceased and a date of death was not received.

How is the MC caseload impacted if auto discontinuance functionality is implemented? The proposed automated RE discontinuance process will include MC cases with an RE packet sent to the Customer but not received. The proposed automated RE discontinuance process will not be impacted by the following: Delinquent REs Cases where the User updated the RE Due Month but did not run EDBC

RE Batch Process Job Aid The RE Batch Process Job Aid, which will include the following is currently under development and will be made available to the counties upon completion: RE Batch Process flow Available RE Batch Process reports RE Batch Process skip reasons