Santa Clara County
Social Services Agency
page 1
Date:
10/06/2016
References:
None
Cross-References:
Release 46B- Project 36625,
Chapter 19
Clerical:
Yes
Handbook Revision:
Yes
Update 2016-29: Medi-Cal
Carry Forward (APTC/CSR/QHP to MC)
Background
Clients who become eligible, conditionally eligible and/or pending
Medi-Cal (MC) currently lose Advanced Premium Tax Credit (APTC),
Cost Sharing Reduction (CSR) and Qualified Health Plan (QHP)
coverage at the end of the month in which the change is made or the
following month depending on the Notice of Action (NOA) requirement.
This may cause a gap in coverage if an Eligibility Worker (EW) does
not activate MC by the first of the month following the discontinuance
from APTC, CSR, or QHP.
Changes
Carry Forward allows the client to continue paying for their current
Covered California health plan until an EW takes action to evaluate
MC coverage.When an APTC-eligible individual reports a change
making them potentially eligible for MAGI MC, CalHEERS will place
the client(s) in Carry Forward Hold.
Carry Forward rules apply when a client currently receiving APTC,
CSR or QHP is determined eligible, conditionally eligible or pending for
MAGI MC. Carry Forward protects the client’s APTC, CSR, or QHP
eligibility and plan enrollment until an EW confirms MC eligibility.
Carry Forward:
• May be applied at Redetermination.
• Applies for the current benefit year for APTC/CSR/QHP or until
CalWIN sends the Eligibility Determination Request (EDR).
• May be lifted and reapplied.
• Is applied prospectively, EWs must run eligibility for the month
Carry Forward is to be lifted first; then the case can be run back for
current or past months, if necessary.
page 2
Update 2016-29: Medi-Cal
• Applications should be evaluated for MC eligibility as soon as possible
because the client is paying medical insurance premiums for Covered
California QHP even though the client is potentially eligible for MC.
Note:
Clients are not reimbursed for any medical insurance premiums
paid during the Carry Forward Hold period.
• Protection does not apply to MCAP, CCHIP or dual eligible clients.
Retroactive MC If a client requests retroactive coverage after Carry Forward has been
removed, MAGI eligibility may be evaluated back to the month the change
Following
Carry Forward was initially reported. In addition, if a client requests retroactive coverage
and attests to no changes on the MC 210 A, the EW can grant retroactive
eligibility for up to three months with the same aid code that they had in their
application month. EWs must request the retroactive coverage be added
directly to MEDS via SCD 1296 until functionality can be added to
CalHEERS.
Carry Forward
Process
EWs must take the following steps in order to process Carry Forward
changes/applications:
STAGE
ACTION
1.
Prioritize cases with individuals with Carry Forward Hold.
2.
• Receive an External Change Data TMT with a Carry Forward Change
Type,
OR
• Receive a External Referral Application with a Carry Forward application
Type,
OR
• When the client calls, comes in or provides information that initiates Carry
Forward Hold (i.e. income decrease, change in tax filing household, etc.) for
individual clients or the entire case.
3.
• Complete all data entries required for the case (i.e. income change, intake
queue, Change DER queue).
4.
In Collect Case Individual Detail:
• Select the Carry Forward client from the Name drop-down.
• Change the Effective Begin Date to today’s date.
• Click the Remove radio button in the “Carry Forward Hold” action box.
• Click save.
• Repeat for all clients in Carry Forward status.
Update 2016-29: Medi-Cal
page 3
STAGE
ACTION
5.
• Run EDBC for the future month.The Search for CalHEERS Results
window will show SENT for that future month.
• Once a DER is received in the Search for CalHEERS Results window,
Run EDBC again and authorize the case.
• If necessary, once the Carry Forward Hold is lifted, EDBC can be run back
to the month when the change was reported or retroactive months.
IMPORTANT: Lifting the Carry Forward Hold is a two step process if MC is
requested for the current or prior months. At Intake, EDBC will always need
to be run TWICE for Carry Forward applications.
CalWIN
Changes
6.
Send the appropriate NOAs.
7.
Case comment all actions taken on the case.
Several windows and fields have been updated to include Carry
Forward.
• Perform Data Collection Wrap Up – the upload button is disabled for
External Referral applications with Carry forward status, EDBC must be
run twice during Intake.
• Search for CalHEERS Results – has two new columns added; Carry
Forward Lift and Carry Forward Hold.
page 4
Update 2016-29: Medi-Cal
• Display Health Care Program – has four new columns that
include Carry Forward Hold, Carry Forward Begin Date, IAP
Transition Begin Date, IAP Transition End Date.
Note:
Insurance Affordability Programs (IAP) generally include MC,
QHP, and Medi-Cal Access Program (MCAP). However, for Carry
Forward, IAP only refers to QHP.
1. Carry Forward Hold: Indicates if an individual has been placed in
Carry Forward Hold.
2. Carry Forward Begin Date: The First day of the first Carry
Forward month, the month after the change was reported.
3. IAP Transition Begin Date: The first day of the first IAP
Transition Month, the month the change was reported.
4. IAP Transition End Date: The last day of the last IAP Transition
month. Until Carry Forward has been lifted, this date will always
be populated with the last day of the year. Once the Carry
Forward Hold has been lifted this date will be the last day of the
month
Update 2016-29: Medi-Cal
page 5
• Search for External Referral Data: The Application Type Carry Forward
value and Application type column value Carry Forward are added.
• Search for Case Updates window – A new Change Type for Carry
Forward is added.
page 6
Update 2016-29: Medi-Cal
• Display Case Change Types – A new Change Type for Carry Forward
is added.
• Collect Case Individual Detail – The “Carry Forward Hold” action box
is added with Remove and No Change radio buttons.
Update 2016-29: Medi-Cal
page 7
• Wrap Up: Six new Eligibility Evaluations reasons will display in the
CalHEERS Summary View
1. This person is MAGI Med-Cal eligible in a Carry Forward status.
2. This person is MAGI Medi-Cal conditionally eligible in a Carry
Forward status.
3. This person is pending MAGI Medi-Cal Eligibility in a Carry
Forward status.
4. Carry Forward has completed for this person and they were not
found eligible for MAGI Medi-Cal. No prior IAP Transition
Months will be evaluated for MAGI Medi-Cal eligibility.
5. Carry Forward has completed for this person and they were
found prospectively eligible for APTC/CSR/CCP. No prior IAP
Transition Months will be evaluated for MAGI Medi-cal
Eligibility.
6. Carry Forward is not completed for this person, so their prior IAP
Transition Month cannot be determined.
page 8
Update 2016-29: Medi-Cal
• External Referral Data and External Change Data Summary View
• External Referral Data and External Change Data -Print Report
Update 2016-29: Medi-Cal
page 9
CalHEERS
Changes
The CalHEERS Budget Worksheet page will include a carry forward
indicator - In Carry Forward Transition.
Notice
Clients will receive the NOD64 “Covered California Carry Forward” notice.
Implementation This change is part of CalWIN Release 46B and CalHEERS Release 16.9
effective September 26, 2016.
Other
Programs
Carry Forward only affects MC, however, income changes may affect other
programs (CalWORKs, CalFresh, General Assistance, etc).
Clerical
Applications received through the External Referral Subsystem with a
Carry Forward status should be processed first.
During Application Registration use Carry Forward for the Type.
page 10
Update 2016-29: Medi-Cal
:
DENISE BOLAND, DIRECTOR,
Department of Employment and Benefit Services
Contact Person(s): Pamela Bianchi, Application & Decision Support Specialist, 408-755-7540.