1. Automated Discontinuances for Medi-Cal Redeterminations March 15, 2018

2. 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.

3. 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

4. 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

5. 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.

6. 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.

7. 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.

8. 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

9. 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