Medi-Cal Handbook Intercounty Transfer (ICT) 15 ...Intercounty Transfer (ICT) 15. Intercounty Transfer (ICT) 15.1 General Requirements [50136-50138, 50185] An Intercounty Transfer

Medi-Cal Handbook page 15-1Intercounty Transfer (ICT)

15. Intercounty Transfer (ICT)

15.1 General Requirements [50136-50138, 50185]

An Intercounty Transfer (ICT) is to be initiated when a Medi-Cal client becomes the responsibility of a new county. A statewide electronic ICT (eICT) process must be followed by ALL counties in California to ensure that there is no interruption or overlapping of Medi-Cal benefits when a client moves from one county to another.

15.1.1 Definitions

Sending County

The county where the client moved from (former county of residence) is referred to as the Sending County.

Receiving County

The county where the client moved (new county of residence) is referred to as the Receiving County.

15.1.2 ICT Application Requirements

There are NO application requirements. The information in the eICT file must be used to continue the client’s Medi-Cal benefits. Clients are NOT required to:

• Fill out any Medi-Cal application forms, or

• Reapply for Medi-Cal benefits, or

• Complete any redetermination of eligibility in the Receiving County during the ICT period.

Note:The Receiving County will complete the annual redetermination (RD) if is due during the ICT period.

Update # 2016-46 Revised: 12/19/16

page 15-2 Medi-Cal HandbookIntercounty Transfer (ICT)

15.1.3 Three (3) Main Components of eICT

1. System Data Transfer (SDT): The SDT sends the case and client data in CalWIN to initiate an ICT to the Receiving County.

2. Imaged Document Transfer (IDT): The IDT refers to the actual verifications (i.e. birth certificates, bank statements, court orders etc.) that were photocopied and mailed to the new county in the past. Digital copies of these documents are now collected as a group and sent to the Receiving County. The eICT process supports a one-time document file transfer. All subsequent documentation is sent manually (mail/fax) and requires a CW215/MC360 and/or eICT reference number to link the additional documents to the initial eICT. Imaged documents received from other counties will be downloaded and saved to our Image Document Manager (IDM).

3. eICT Requests: The eICT Request process requires the new county of residence (Receiving County) to send an eICT Request via CalWIN to the county the client is currently active in (Sending County) when the Sending County is not notified that the client moved. (This is currently a clerical function.)

15.1.4 Continuation of Medi-Cal Benefits

Medi-Cal cases must remain active throughout the ICT period with no interruption in benefits. The Sending County must not terminate a client’s Medi-Cal benefits until an effective ICT pick-up date is confirmed with the Receiving County.

15.1.5 Redetermination of Medi-Cal Eligibility

A full eligibility review is NOT required until the next annual redetermination (RD) based on the last RD date established by the Sending County. It is assumed that no other change occurred UNLESS one is reported by the client that affects MC eligibility.

[Refer to “Client Reports Other Changes” on page 15-16 for more information.]

Revised: 12/19/16 Update # 2016-46


15.1.6 Temporary vs. Permanent Change of County Residence

A change of county residence is considered:

TEMPORARY PERMANENT

When a client reports a change in county address due to seasonal employment, attending college, medical care, or other personal reasons.

When a client intends to reside and maintain a primary home or live in the new county for an indefinite period.

The county where the client’s primary home is located is responsible for maintaining the client’s Medi-Cal record and does not initiate an eICT. However, the MEDS record must be updated to show the temporary residence county address and residence county code to ensure continued access to medical services in the temporary residence county. Change the individual’s home address in CalWIN to the new address. The mailing address and residency county in CalWIN can be changed but will not impact eligibility or initiate an ICT.

The former county must initiate an eICT to the client’s new county of residence.

15.1.7 Address Change and Cancellations

Occasionally the anticipated move does not occur or the client/family may move to another county other than the one intended. When this occurs, the EW will “cancel” the eICT action.

• Cancellation of an eICT is triggered by the Sending County updating the client’s address to another county. When a cancellation occurs, new processing time frames begin based on when the new address information is entered and the eICT Send is triggered.

• The Receiving County’s “Request for eICT” cannot be electronically cancelled. Only the Sending County has the ability to cancel the initiated eICT process electronically.

• In the event that the Receiving County has completed the eICT process and the client has returned to the Sending County, a new eICT must be initiated back to the Sending County.

Update # 2016-46 Revised: 12/19/16


15.1.8 ICT Time Frames

The ICT time frames are as follows:

Sending (former) County Receiving (new) County

The Sending County must initiate an electronic-ICT (eICT) within seven (7) calendar days to the Receiving County from the date the client reports:

• A permanent change of county residence, or

• That he/she is living in another county for an indefinite period.

Example: A client reports a new county residence on June 10th. An eICT must be initiated and sent to the Receiving County by June 17th.The 30-day transfer period ends on July 16th and the end of the transfer period is July 31st.

The Receiving County must complete the eICT no later than the first of the month after the 30-day eICT notification from the Sending County (by mail or via an electronic interface).

Note: The eICT period may be extended or shortened as long as both the Sending and the Receiving Counties mutually agree on the date of termination and ICT pick up date to ensure that there is no interruption in Medi-Cal benefits.

The Sending County must ensure that the electronic data file with verifications and documentations supporting the client’s Medi-Cal eligibility are sent promptly to the Receiving County.

The Receiving County must NOT delay the processing of the ICT while waiting for additional information/verification from the Sending County. The client’s continuous receipt of Medi-Cal benefits is not contingent upon the transfer of case documents from one county to another.

If the Sending County is unable to locate required documents/verifications, then the Sending County must indicate the missing documents/verifications on the “Notification of Medi-Cal Intercounty Transfer” (MC 360) so that the Receiving County may follow up with the client at the next annual RD.

The Receiving County must make every effort to contact the Sending County, and not the client, for needed information/verification.

Note: When the client is currently active in another county and applies for aid in the new county, the Receiving (new) County has three (3) working days to request an eICT from the Sending County. If the Receiving County has not received an eICT data file for a specific case within 10 working days of the request, the Receiving County ICT Coordinator will promptly contact the Sending County ICT Coordinator by telephone/email to resolve any issues responding to the request, to ensure the timely processing of the ICT.

Revised: 12/19/16 Update # 2016-46


15.1.9 Discontinuance Date

MC disposition is automatic process by the interface between Sending/Receiving systems and CalHEERS. When a case is authorized in the Receiving County, a disposition batch transaction is sent to auto-discontinue the case in the Sending County. If the transaction fails, the Sending County must NOT terminate a client’s Medi-Cal benefits until an effective ICT pick-up date is confirmed with the Receiving County.

The discontinuance date is either:

• The last day of the month in which the 30th day falls after the ICT packet was sent to the Receiving County,

Example:Mr. & Mrs. Johnston report that they have moved to Monterey County. An eICT is initiated and sent to the Receiving County on 4/15. The date of discontinuance is 05/31.

OR

• An earlier/later discontinuance date agreed upon by both counties.

Example:Santa Clara County initiates an eICT to Alameda County on 4/8. The date of discontinuance is normally 05/31. However, both Santa Clara County and Alameda County agree that Alameda County will pick up the ICT MEDS record effective 05/01. Santa Clara County should discontinue the case on 04/30. No ten-day ICT discontinuance Notice of Action is required as long as the client’s MEDS record for the month of May already shows County “01” (Alameda).

15.1.10 Completion of an ICT

An ICT is completed when the Receiving County has the case active in its county system with the correct county address and residence county code on MEDS. The annual RD due date is the same date established by the Sending County.

Update # 2016-46 Revised: 12/19/16


15.1.11 Only Part of Family Moved (Partial ICT)

If only one or some household members has moved to the new county, the Sending County must manually complete ICT process by updating the new county address and residence in CalWIN and sending the required ICT document, verifications, and MC 360 form for those household members to the new county.

The current system functionality does not support eICT process for a partial household transfer.

Example:A child was on Medi-Cal with a parent/caretaker and moved out of county due to a change in custodial parent/caretaker. The Sending County shall initiate an ICT for the child. If the new custodial parent applies for Medi-Cal in the child’s new county of residence (Receiving County), the Receiving County should contact the Sending County to initiate an ICT for the child.

15.1.12 eICT Processing During a System Outage

If there is a system outage lasting one day or less, the EW Supervisor will determine whether to wait for system availability to complete the automated eICT process, or to complete a manual ICT process.

For any system outage lasting more than one work day, EWs must use the manual ICT process. For files not processed manually, CalWIN will process the files in order of date received once the system outages are resolved. When the need for a manual process is determined, it is the responsibility of that county initiating the ICT to communicate to the other county.

When CalWIN or the other county SAWS anticipate a planned outage, all counties will be notified one week in advance of the planned outage.

15.1.13 Request for Retroactive Medi-Cal

If the client requests Retroactive Medi-Cal during the eICT period, the Sending County must process the retroactive request since the case is still open in the Sending County.

If the client requests retro Medi-Cal after the ICT has been completed, then:

Revised: 12/19/16 Update # 2016-46


• The Sending County shall process the request for those months that the client was on Medi-Cal in the Sending County as a budget recalculation may be necessary. The Receiving County shall contact the Sending County’s ICT Coordinator regarding the retroactive request.

• The Receiving County is responsible for the months prior to the application month if the client was not on Medi-Cal for those months in the Sending County.

15.1.14 Craig v. Bonta

When a Craig individual moves to another county, the Sending County shall notify the Receiving County with a “Notification of Intercounty Transfer” (MC 360). A MEDS printout or an eICT packet is not necessary because the Sending County has no actual case file for the individual. The Sending County must completeEW 12 online transaction to change the new county address and residence code so that the individual will be removed from the Sending County’s “Exception Eligibles” report. On the following month, the individual will show up on the Receiving County’s report. The Receiving County is responsible for completing the review following Craig v. Bonta procedures.

15.1.15 In-Home Supportive Services (IHSS)

When a Medi-Cal recipient, who is also receiving IHSS benefits, reports a change of address outside of the county, the EW must inform the IHSS worker of the address change in addition to initiating an eICT for the Medi-Cal case. This is to ensure that the client will receive uninterrupted benefits and services in both programs in the new residence county. IHSS information can be viewed in MEDS from the Special Program screen (INQ1/INQ2) with Aid Codes 2K, 2L, 2M, or 2N.

When a Medi-Cal recipient, who also receives IHSS, moves to our county, the eICT must be picked up in our county within the allotted 30 days to prevent a hardship on the client with continuing IHSS. [Refer to “Inter-County Transfer (ICT)” on page 48-6.]

15.1.16 Exceptions

The eICT procedures in the following case situations have different or additional requirements.

• If the Sending County determines that the person or family is no longer eligible, NO eICT shall be initiated. Instead, the Sending County shall discontinue the person/family with an appropriate NOA. Some examples are:

Update # 2016-46 Revised: 12/19/16


• Loss of California residency• Client requests to discontinue Medi-Cal benefits• Client is incarcerated• Client is deceased.• Client, who is an incompetent long-term care (LTC) to handle his/her affairs,

has a family member/representative acting on his/her behalf and residing in the County to request the case not be transferred when the LTC client moves out of the county.

• If a client reports a change in county of residence during the RD, the Sending County must initiate an eICT within seven (7) calendar days.

If the... Then the...

Sending County cannot complete an eligibility determination after the ex parte review,

Sending County may contact the client and request the needed information/verification.

Client does not provide the requested information/verification,

• Sending County may discontinue client’s Medi-Cal benefits.Note: The client has the responsibility to cooperate during a redetermination of his/her Medi-Cal eligibility.

• Sending County must inform the Receiving County of the Medi-Cal termination date and reason.

Client provides the requested information/verification to the Receiving County,

Receiving County must determine client’s ongoing Medi-Cal eligibility.

15.1.17 CalWORKs ICT Discontinued Cases

The Medi-Cal Program does not have the same ICT rules as CalWORKs Program. Therefore, when the CalWORKs ICT is not picked up in the Receiving County, a Medi-Cal ICT must still be processed. The client’s failure to complete the CalWORKs ICT requirements does not result in the termination of the client’s Medi-Cal benefits.

The Receiving County must make an eICT request to the Sending County to obtain necessary documentation to process the Medi-Cal ICT. The Sending County must provide the requested information to the Receiving County within ten calendar days. The Receiving County must not delay processing the Medi-Cal ICT while waiting for additional information from the Sending County because the receipt of benefits is not contingent upon the transfer of case documents from one county to another.

Revised: 12/19/16 Update # 2016-46


If there are missing documents or verifications, the Sending County must annotate the missing document or verification on the MC 360 for the Receiving County to follow-up with the client at the next annual RD. The annual RD due date for Medi-Cal is the same date established under CalWORKs before the case was discontinued.

Example:Mrs. Smith and her child moved to Santa Clara County. San Mateo County initiated a CalWORKs ICT. Under the CalWORKs ICT requirements, Mrs. Smith must apply for cash aid in Santa Clara County. If Mrs. Smith fails to apply for cash aid, her CalWORKs case will be discontinued after the 30-day ICT period. The EW must continue Mrs. Smith and her child’s Medi-Cal benefits under an appropriate MC program after her CalWORKs case is discontinued. There must be no interruption of their Medi-Cal benefits.

15.2 ICT Problems/Issues

It is important that both the Sending and the Receiving County communicate and expedite the eICT process. EWs must provide information or verifications requested by the Receiving County whenever possible. Counties must work together to streamline the eICT process and not delay the processing of the ICT pending additional case documentation.

The Receiving County may not reject an eICT based on an incomplete ICT packet or incorrect paperwork from the Sending County. The Receiving County must not delay processing the eICT, but instead work with the Sending County to complete the eICT.

In the best interest of the Medi-Cal clients, the overriding principle is to issue benefits promptly and ensure that access to health care coverage is not delayed.

If there are problems/issues during the eICT process, the EW and EW Supervisor must first try to resolve these issues with their counterparts in the other county. eICT problems that cannot be resolved by the EW and EW Supervisor with the other county are to be referred to the Medi-Cal Program Coordinator through the office Medi-Cal liaison.

Update # 2016-46 Revised: 12/19/16


15.2.1 CalHEERS County of Responsibility

When an address change is made in CalHEERS, the new address is used to determine which county the unsolicited DER is sent to. CalWIN is programmed to reroute the DERs to the appropriate county when both counties use CalWIN, but cannot reroute DERs to other consortia (C-IV or LRS).

Address Changes Between Two CalWIN Counties

If the county with the outdated address (original county) has an open case, the DER will be received in that county through External Change. An eICT should be initiated by the original county. If the original county has a closed case, the DER will be received in that county through External Referral. The case should be reopened, benefits approved (if all other eligibility criteria are met) and an eICT sent to the new county.

Example:A client with an open case in Santa Clara County reports a new address in CalHEERS within Fresno County. The DER will be rerouted to Santa Clara County. An EW will receive the change of address through External Change and should initiate an eICT.

Example:A client with a closed case in Santa Clara County reports a new address in CalHEERS within San Diego County. The DER will be rerouted to Santa Clara County as an application in External Referral. The External Referral must be processed by designated intake staff, and sent as an eICT to San Diego County.

Address Changes Between C-IV or LRS and CalWIN

When a client from a C-IV or LRS county changes their address in CalHEERS to a CalWIN county, the DER cannot be rerouted to the original county and the information will not be sent to either county. If a client contacts an EW in regards to this issue, the EW should have their Supervisor email the ICT Coordinator who will contact the other county.

If the other county’s case is closed, the ICT Coordinator will request that the case be reopened and sent as an eICT. If the other county is unwilling to reopen their case, a new CalHEERS case will need to be created for the client since the original CalHEERS case will remain linked to the other county’s case. [Refer to Medi-Cal Update 2016-37: Closing Duplicate or Multiple CalHEERS Cases]

Revised: 12/19/16 Update # 2016-46

https://ssaconnect.sccgov.org/ssa_departments/debs_program/Documents/handbooks/medical/updates2016/mc16-37.upd.pdf



If the other county’s case is open, follow normal eICT procedures. [Refer to “Client Applies in the Receiving County While the Case is Active in the Sending County,” page 15-14]

15.3 Medi-Cal Managed Care Health Plans (MMCHPs)

A client who is currently enrolled in a MCHP in the Sending County will only be able to access emergency care, family planning and Sexually Transmitted Disease (STD) services in the Receiving County.

If the client needs non-emergency medical care, mental health services, routine pregnancy care, or prescription refills in the Receiving County before the effective date of disenrollment from his/her Sending County’s managed care plan, the EW advises the client to contact the Managed Care Ombudsman Office for emergency disenrollment at 1-888-425-8609 or email to [email protected].

When either the Sending or Receiving County becomes aware that the client has an urgent medical need, that county must immediately complete the Request For Change - Online Fillable Form on the MMCD (Medi-Cal Managed Care Division) Office of the State Ombudsman web page to request disenrollment of the current Sending County’s MMCHP and enrollment of the Receiving County’s managed care plan once a new residence county code is reflected in MEDS. If the need is for future months, MEDS will update the beneficiary’s record during the monthly MEDS renewal process. The client may also contact Health Care Options (HCO) at 1-800-430-4263 to request a plan change once the new county address is updated in MEDS.

If the MMCD Office of the Ombudsman can verify the client’s new residence county address on MEDS or verify with the Sending County that the Receiving County has been notified of the client’s new county address, the Office of the Ombudsman will initiate a disenrollment from the existing managed care plan on MEDS. The client may access fee-for-service Medi-Cal on the day after the Office of the Ombudsman has completed the disenrollment action.

[Refer to MC Update 2015-9 MC Managed Care Ombudsman for urgent reasons.]

If the client has complex medical condition or complicated pregnancy and needs to be exempt from managed care enrollment, he/she can directly contact HCO to request a medical exemption form or complete it online and return it to HCO for evaluation of fee-for-service benefit in the new county of residence.

Update # 2016-46 Revised: 12/19/16

http://www.dhcs.ca.gov/services/medi-cal/Pages/MMCDOfficeoftheOmbudsman.aspx

http://www.dhcs.ca.gov/services/medi-cal/Pages/MMCDOfficeoftheOmbudsman.aspx



[Refer to “Exemptions from Mandatory Enrollment/Voluntary Enrollment” on page 14-4 for more information.]

[Refer to a complete list of MMCHPs available for all counties and their contact information.]

15.3.1 Managed Care Transition During ICT

Medi-Cal MCHPs are different in each county. It is crucial that the EW from the Sending County ensure that the client’s MEDS record correctly reflects the client’s current address and the new residence county code. The chart below summarizes the managed care plan enrollment/disenrollment process:

If the Sending County is...

And the Receiving County is...

Then...

Fee-for-Service (FFS)Two-Plan Model (2-Plan)Geographic Managed Care (GMC)County Organized Health System (COHS)

NOTE: Santa Clara County has the Two-Plan Model.

COHS MEDS will automatically enroll the client into the COHS health plan effective the first of the month AFTER the MEDS update (i.e., residence address and new residence county code).

FFS2-PlanGMCCOHS

2-PlanGMC

• MEDS will automatically disenroll the client from the Sending County health plan effective the first of the month AFTER the MEDS update (i.e., residence address and new residence county code), and

• The client will be on fee-for-service (FFS) Medi-Cal, and

• The client will receive new enrollment information within two weeks of the MEDS update. Mandatory clients must select a plan to prevent being defaulted into one.

FFS2-PlanGMCCOHS

FFS Client will receive fee-for-service (FFS) Medi-Cal.

NOTE: If the Sending County submits an address and residence county code change to MEDS after MEDS renewal, the beneficiary will retain the same benefits that he/she had in the Sending County for an additional month.

[Refer to Medi-Cal Managed Care models for 58 counties.]

Revised: 12/19/16 Update # 2016-46

http://www.dhcs.ca.gov/individuals/Pages/MMCDHealthPlanDir.aspx

http://www.dhcs.ca.gov/individuals/Pages/MMCDHealthPlanDir.aspx

http://www.dhcs.ca.gov/provgovpart/Documents/MMCDModelFactSheet.pdf


15.3.2 Managed Care and Temporary County Change

If the client is residing in the new county temporarily due to seasonal employment, attending school, medical care, and other personal reasons and is on aid under a mandatory aid code, the client may be required to enroll in one of the MMCHP offered in the new county of residence. MEDS, at renewal, reads the change as a new address and is unable to determine whether the address change is temporary or permanent. However, the Sending County’s MMCHP can request a temporary exemption for 60 days based on the client’s moving to a new location.

If the client is residing temporarily in another county that is NOT a managed care county, MEDS will disenroll the client based on the address change at MEDS renewal and the client will be placed into fee-for-service Medi-Cal. If the client returns to the home county within two months, the client will be automatically reenrolled in the old plan by MEDS at the next Renewal.

15.4 Recipient Responsibility

Recipients who have moved from one county of residence to another have the responsibility to notify either the Sending County or the Receiving County so that an eICT can be initiated.

15.4.1 Client Contacts the Sending County and/or Requests Discontinuance of Medi-Cal Benefits

Sometimes, clients are not aware that their Medi-Cal records can be transferred to their new county of residence. Therefore, if a client requests discontinuance of Medi-Cal benefits due to a change of county residence, the EW must inform the client of the ICT process, initiate an eICT, and continue the client’s Medi-Cal benefits.

If the client’s Medi-Cal is discontinued per request and the Sending County subsequently receives information within 90 days from the date of discontinuance that the client moved to another county and wants to continue his/her Medi-Cal benefits, then the Sending County EW must restore the client’s Medi-Cal benefits, initiate an eICT, and ensure that there is no interruption of benefits.

Update # 2016-46 Revised: 12/19/16


15.4.2 Client Applies in the Receiving County While the Case is Active in the Sending County

When a client applies in the (new) Receiving County while he/she already has an active case in the Sending County, the Receiving County must check MEDS to confirm that he/she is indeed active in the other county. The Receiving County must:

• Send an eICT Request to the Sending County to initiate an eICT. Do not ask the client to complete a new application.

• Explain the ICT process to the client and instruct the client to contact the Sending County if there are other changes (aside from the change in county residence) so that those changes can be documented in the eICT by the Sending County.

[Refer to Common Place Handbook “Creating an eICT Request in CalWIN” on page 46-9 for detail instruction.]

Note:If the client’s first contact (in person or by phone) is with a clerical staff and the client has an open case in the Sending County, then he/she must refer the client to the designated staff to submit an eICT request to the Sending County.

15.4.3 Client Requests Medi-Cal After Case Has Been Discontinued Due to Loss of Contact

When a client moves to another county and contacts either the Sending or Receiving County after his/her Medi-Cal case has been discontinued due to whereabouts unknown or loss of contact, the following rules apply:

If the Case Has Been Discontinued for...

And The Client Contacts the... Then the...

Less than 90 days,

Sending County within that time period,

• Sending County must rescind the client’s Medi-Cal benefits without any break in aid, and

• Inform the client that an ICT will be initiated to the Receiving County.

Revised: 12/19/16 Update # 2016-46


Less than 90 days,

Receiving County within that time period,

Contacted staff (whether EW or Clerical staff or Information Supervisor) from the Receiving County must check if the client was on Medi-Cal within the last 90 days by checking the MEDS termination date used by the Sending County.

Note: If the client’s first contact (in person or by phone) is with a clerical staff, then he/she must refer the client to the designated staff who will then:

• Submit an eICT request to the Sending County, and

• Request rescission of the client’s Medi-Cal benefits, and

• Advise the client to contact the Sending County to report other changes (aside from the change in county residence) so that those changes can be documented in the eICT by the Sending County.

[Refer to “Client Reports Other Changes,” page 15-16.]



Update # 2016-46 Revised: 12/19/16


15.5 Client Reports Other Changes

If a client reports a change (other than the change in county residence) which may affect eligibility and/or share of cost, the reported change may ONLY be acted upon AFTER the transfer of county responsibility is complete AND the client is already active in the Receiving County. The Receiving County shall not conduct an eligibility review based solely on a change of residence.

More than 90 days,

Sending or Receiving County

Designated staff (for Santa Clara County, it would be whoever handles inquiries for closed cases [e.g., Information Supervisor]) from the Sending and Receiving County must:

• Jointly assess the client’s current circumstances to determine if restoration in the Sending County or reapplication in the Receiving County is in the best interest of the client.

• Determine each case situation separately and be flexible in determining which county has responsibility for the restoration of the client’s Medi-Cal benefits.


Sending County erroneously terminated the client’s Medi-Cal benefits or the client provided evidence of good cause,

Sending County EW must restore the client’s Medi-Cal benefits and initiate an eICT.

Sending County has correctly terminated the client’s benefits,

Client will be required to reapply for Medi-Cal benefits in the Receiving County. No eICT is required.

Client is required to reapply in the Receiving County (based on the above situation) and he/she is unable to provide verification(s) which was/were previously provided to the Sending County,

Receiving County EW may contact the Sending County to obtain the missing verification(s).

Note: Do not delay approval of client’s Medi-Cal benefits for missing verifications that are available from the Sending County.



Revised: 12/19/16 Update # 2016-46


Some examples of a change in circumstances, in addition to the move, that would justify an eligibility review after the eICT is completed are:

• Adding additional family member(s) that may result in income and/or property re-computation.

• New family composition that could result in a change of aid category, ineligibility or reduced benefits.

• New income information that could result in an increase in SOC.

• New property information that could result in discontinuance.

Reminder:The client must be given the option to spend-down after the eICT is completed.

The chart below details the needed actions:

If the Client Reports Other Changes to the...

And the Sending County...

Then the...

Sending County Has not yet initiated the eICT to the Receiving County,

Sending County must process the change and document the reported change in the eICT file.

Sending County Has already sent the eICT,

Sending County must contact and manually notify the Receiving County of the change.

Receiving County, Has not initiated or is still in the process of initiating an eICT,

Receiving County must instruct the client to contact the Sending County of the other change(s) so that those changes can be documented by the Sending County.

Update # 2016-46 Revised: 12/19/16


15.6 Annual Redetermination (RD)

Medi-Cal annual redetermination must be completed and updated in CalWIN when it is due. The change of county address does not exempt the beneficiary from complying with the RD requirements.

The Receiving County is responsible for processing the annual RD when the RD is initiated, due or overdue during the eICT transfer period. The Sending County, upon notification of the move, must promptly change the address and county code on MEDS and initiate an eICT to the Receiving County.

[Refer to Medi-Cal Handbook “Redeterminations” on page 10-1 for MC RD process.]

Receiving County Has already initiated the eICT,

Receiving County may only complete a Medi-Cal eligibility review AFTER the:

• Transfer of county responsibility is completed, AND• Client’s Medi-Cal record is active in the Receiving

County.

This means the Receiving County must activate the client’s Medi-Cal record on MEDS based on whatever eligibility status the client had from the Sending County (e.g., same Aid Code, etc.). THEREAFTER, the Receiving County may then evaluate the reported change(s).

The Receiving County must follow SB 87 procedures and redetermine eligibility through an ex-parte review. If the ex parte is not sufficient, then contact the client by phone. If unsuccessful, send a “Request for Information” (MC 355). SB 87 time frames must be followed.

Note: If the client refuses to cooperate with the Receiving County’s request for information, through phone contact or MC 355, then the client’s Medi-Cal benefits may be discontinued.

If the Client Reports Other Changes to the...

And the Sending County...

Then the...

Revised: 12/19/16 Update # 2016-46


The following rules apply:


Sending County has received the RD packet or contact from the client and all information/verification are provided,

Sending County should update the RD and then initiate an eICT to the client’s current county of residence.

Sending County has already started the RD process but the RD packet or required information/verification(s):

• Has not been returned by the client, or

• Is incomplete (e.g., missing information/ verifications)

Sending County must initiate the eICT immediately and forward the RD packet and any information reported by the client to the Receiving County when received.

Receiving County must process the eICT without delay and update the RD after the eICT is completed.

Exception: The Sending County can terminate Medi-Cal benefits and rescind the eICT if it has facts clearly demonstrating that the client is no longer eligible. The Sending County must notify the Receiving County of action(s) taken [Refer to “Exceptions,” page 15-7.]

Client applies in the new county (Receiving County) or contacts either county within 90 days after Medi-Cal is terminated for failure to complete the annual RD,

Receiving County must:

• Not require the client to complete a new application.

• Assist the client in completing required RD forms and ask the client to provide new or changed information/verification.

• Contact the Sending County for copies of verification that are already available.

• Request the Sending County to rescind the termination and initiate an eICT.

• Process the annual RD when the eICT is completed.

Client applies at or contacts the Receiving County after 90 days of termination from Medi-Cal for failure to complete the annual RD,

Receiving County may require the client to complete a new application, unless the client can provide evidence of good cause for not completing the annual RD.

If good cause exists, follow the instructions mentioned above, as if the client made a contact within 90 days from the Medi-Cal discontinuance date.

Update # 2016-46 Revised: 12/19/16


Note:The Receiving County cannot reject an ICT for an overdue RD if the individual is now residing in that county. The Receiving County can ONLY reject the transfer when the ICT packet is sent to the wrong county of responsibility.

15.7 Processing Outgoing ICT

When a client moves to another county, the EW must initiate an eICT to the other county by following the procedures below.

Client has already completed an application in the Receiving County but during the eligibility determination process, the Receiving County discovers that the client has been terminated within 90 days for failure to complete the annual RD in the Sending County,

Receiving County must:

• Not deny the application.

• Continue to process the completed application and use it for the RD.

• Contact the Sending County, not the client, for documentation that the client has already provided to the Sending County.

• Request the Sending County to restore the case and initiate an eICT.

• Complete/update the RD after ICT is completed.

STEP EW ACTION

1 Change the client’s address and enter the new county of residence in CalWIN by following CA-330 section D “Sending MC eICT”.


Revised: 12/19/16 Update # 2016-46

https://ssaconnect.sccgov.org/ssa_departments/debs_program/Documents/calwin_searchable/calwin_announcements/ca_330.pdf


Note:Do NOT initiate the ICT process for (not transitioned) Pre-ACA or LIHP cases prior to evaluating the cases under MAGI rules.

2 Prepare required eICT documents prior to uploading the imaged documents

The following is a list of documents the Sending County must include in the ICT packet:

• Current Statement of Facts and appropriate Supplemental forms (e.g., MC 322, MC 604-IPS, RFTHI, MC 0216, MC 210RV, MC262),

• Identifications and/or Social Security Numbers,• Proof of citizenship, alienage and immigration status,• Description of MFBU or Tax Household (RFTHI) forms (MC 01-2014; MC 01-2014

APDX-RFTHI),• Budget worksheets (e.g., non-MAGI or MAGI budget screens/pages from

CalWIN/CalHEERS),• Description of MFBU/MBU (Sneed) (e.g., the [Case Members] tabpage from the

Inquiry subsystem),• Last approval or SOC Notice(s) of Action (NOA),• Case Narrative/Summary, and• Copy of ICT Informing Notice) MC358-S) sen to a client.

The following documents may also be sent if the case includes:

• Income/property verification or e-verifications,• Pregnancy verification if available,• “Statement of Citizenship, Alienage, and Immigration Status” (MC 13),• Other Health Coverage information,• Child, Spousal and Medi-Cal Support information (CW 2.1), including any court

orders for child/spousal support,• Veterans Referral (MC 05),• Copy of Disability Determination Service Branch (DDSB) decision (MC 221) or

other verification of incapacity.• Authorized Representative form (MC 306) or letter.

3 Ensure to electronically send the uploaded documents and forms, a “Medi-Cal Intercounty Transfer Informing Notice” (MC 358 S) and a “Notification of Intercounty Transfer” (MC 360).

4 Check MEDS two days after address and residency change to see if new address and Residence County code are properly recorded. If necessary, complete SCD 1296 to request an EW 12 MEDS on-line transaction to update new address and residence county code on INQM screen.

5 Discontinue Medi-Cal benefits ONLY if an ICT effective date is confirmed with the Receiving County via MEDS alert number 9022 “County Transfer Completed - From County to County” or if the Receiving County arrange the pick-up date with the Sending County. A ten-day NOA is not required if the Receiving County has already picked up the client’s Medi-Cal record on MEDS.

STEP EW ACTION

Update # 2016-46 Revised: 12/19/16


15.7.1 Waiver Programs

When a client is active on three waiver programs administered by the County and moves to a new county, EWs must instruct the client to report a new address and residence to the designated responsible agency and initiate eICT.

Three (3) waiver programs are:

• Department of Developmental Services Home and Community-Based Services (DDS-HCBS) Waiver

• Medi-Cal In-Home Operations (IHO) Waiver

• Multipurpose Senior Service Program (MSSP) Waiver

15.8 Processing an Incoming ICT

15.8.1 Incoming ICT

All incoming eICTs are processed by designated intake clerical staff for application registration and downloading ICT documents.

[Refer to Common Place Handbook “Processing Incoming eICTs” on page 46-10 for detail information.]

15.8.2 Client Applies at District Office

Clients are NOT required to reapply for Medi-Cal benefits in the Receiving County. However, if and when a client applies in person at a District Office and indicates that he/she has recently moved here from another county, or the ID process indicates that the client is active in another county per MEDS record, the client must not be required to fill out any Medi-Cal application forms, and must be informed of the ICT process. The new county (Receiving County) must refer the client to the designated staff who will submit an eICT request to the Sending County.

[Refer to Common Place Handbook “Creating an eICT Request in CalWIN” on page 46-9 for detail information.]

Revised: 12/19/16 Update # 2016-46


15.8.3 Processing an Incoming ICT

If a client from another county moves to our county, the EW must do the following to continue client’s Medi-Cal benefits with no interruption.

STEP EW ACTION

1 Review the eICT file from the Sending County for completeness.

2 Verify the client’s current address and Medi-Cal status on MEDS.

3 Review the imaged documents and initiate actions in CalWIN to continue Medi-Cal benefits. [Refer to CA-330 Section D for Pre-ACA MC or Section C for ACA MC.]

4 Contact the Sending County caseworker listed on the MC 360 if there are questions regarding the ICT or missing documents.

5 Ensure the Sending County is notified of the effective ICT pick-up date of Medi-Cal benefits so the Sending County can terminate the client’s Medi-Cal benefits.

6 Complete the relevant CalWIN entries to continue client’s Medi-Cal benefits effective the first of the future month or future future month if the case is approved after MEDS Renewal.

If the Sending County... Then...

Posted a termination date on MEDS,

MEDS will pick up client’s Medi-Cal benefits for the future month.

Has not posted a termination date on MEDS,

An SC 1296 must be completed to request the MTO to generate an EW 05 MEDS transaction to pick up the client’s MEDS record for the future month.

7 Send an “Intercounty Transfer Notice of Action” (MC 359 R) to the client.

Update # 2016-46 Revised: 12/19/16

https://ssaconnect.sccgov.org/ssa_departments/debs_program/Documents/calwin_searchable/calwin_announcements/ca_330.pdf


15.9 Multiple Transfers

When a recipient moves from the second county to a third or subsequent county during the transfer period, the counties involved are responsible for the ICT actions as described below:

Stage Who Action

1 First County Inform the second county, either by phone call or in writing, to cancel the ICT.

Continue the client’s Medi-Cal benefits and ensure that there is no interruption in benefits.

Change the client’s address.

Request the “MEDS Terminal Operator” (MTO) to generate an EW 12 MEDS on-line transaction via SCD 1296 to change the:

• Client’s address to the new address (if MEDS record still shows the clients old address), and/or

• Code on the Residence County field on MEDS to reflect the client’s current county of residence.

Note: Changes made by the MTO via the EW 12 on-line transaction will be seen on the MEDS INQM screen the following day. The 14-digit County ID will not change for the current month.

Send an ICT informing notice (MC 358 S) to the client’s new address.

Initiate a new transfer to the third or subsequent county, beginning a new transfer period. Send a new eICT packet to the third county.

Discontinue Medi-Cal benefits ONLY if an ICT effective date is confirmed with the third County. A ten-day NOA is not required if the Receiving County has already picked up the client’s Medi-Cal record on MEDS.

2 Second County

Discontinue all processing of the incoming ICT.

3 Third or Subsequent County

Process the ICT in the usual manner.

Revised: 12/19/16 Update # 2016-46


15.10County of Responsibility [50135]

The county in which an applicant or his/her representative applies for benefits is the county responsible for making the initial eligibility determination.

The "County of Responsibility" is the county responsible for carrying the Medi-Cal continuing case. See the charts in the sections below to determine the appropriate county of responsibility."

These charts are intended to function as guidelines when determining the county of responsibility. There will be situations other than those identified in these charts. When resolving county of responsibility issues, staff should be flexible and keep in mind the best interest of the applicant/beneficiary and/or his/her representative. Staff must consider criteria such as:

• Age of the applicant/beneficiary and his/her representative,• Physical and mental condition of the applicant/beneficiary,• Travel distance for the applicant/beneficiary and his/her representative, and• Possible delay in the processing of the application and eligibility determination

that will create undue hardship for the applicant/beneficiary and/or his/her representative.

Update # 2016-46 Revised: 12/19/16


15.10.1 Courtesy Applications

COURTESY APPLICATIONS

Situation County of Responsibility

An application from different sources (i.e. CalHEERS External Referral, mail-in etc.) made in a county other than the county of responsibility.

The county in which an applicant or his/her representative applies for Medi-Cal benefits is the county responsible for making the initial eligibility determination, even if it is not the applicant’s county of residence.

If all information needed to determine eligibility is available, the county must issue benefits then initiate eICT to the client’s county of responsibility.

Otherwise, the county must forward the application and all information collected within 15 days from the date of application to the county of responsibility for follow up and completion of the initial eligibility determination.

Example 1:

An individual lives in Santa Cruz and becomes ill in Santa Clara County. The individual is immediately admitted to VMC. The outstationed EW at the hospital receives a Medi-Cal referral from the hospital staff. The client completes the necessary application form(s), and provides sufficient information for the EW to determine initial eligibility. The EW would approve Medi-Cal, then initiate an eICT to Santa Cruz County, the client’s county of responsibility.

Example 2:

An applicant’s representative applies in Santa Clara County on behalf of an individual who resides in Alameda County. The individual is hospitalized and unable to complete and participate in the application /eligibility determination process in Alameda County. Santa Clara County must accept the Medi-Cal application from the representative. If the representative has knowledge of the applicant’s income/resources and can provide Santa Clara County with information to process the Medi-Cal application, Santa Clara County must determine initial eligibility and grant Medi-Cal benefits to the individual. Santa Clara County would then transfer the continuing eligibility case responsibility to Alameda County.

Revised: 12/19/16 Update # 2016-46


15.10.2 Person Maintains a Home

PERSON MAINTAINS A HOME


Person maintains a home and resides permanently.

The county where person lives.

Person maintains a home but works out of town seasonally.

The person is considered temporarily absent from home. The county where person maintains his/her home is the county of responsibility.

Person maintains a home but is vacationing in another county.

The person is considered temporarily absent from home. The county where the person maintains his/her home is the county of responsibility.

15.10.3 Homeless Persons

HOMELESS PERSONS


Person is homeless with no permanent living arrangements.

County of physical presence at time of application is the county of responsibility. If the homeless person moves to another county or requests the case be transferred to another county, an eICT shall be initiated.

Homeless person intends to reside in one county but maintains a mailing address or P. O. Box in another county for mail pick up and delivery.

County where the homeless person intends to reside is the county of responsibility. An eICT is not required.

Update # 2016-46 Revised: 12/19/16


15.10.4 Person with a Guardian

PERSON WITH A GUARDIAN


Client has a private guardian. Private guardian has no effect on county of responsibility. Determine as if there were no private guardian.

Client has a public guardian. Public guardian is a county agency. County in which public guardian is located is the county of responsibility.

15.10.5 Persons Under 21 Years of Age Not living at Home

PERSONS UNDER 21 YEARS OF AGE NOT LIVING AT HOME


Person is between 18-21 years of age and NOT claimed as a tax dependent and NOT under parental control.

County in which the person resides. This person is NOT considered living in the parent’s household.

Person is between 18-21 years of age and living away from home and IS claimed by his/her parent as a dependent for state or federal income tax purposes.

County in which the claiming parent resides if the parent lives in the state.

If the parent resides in another state, the county of responsibility is the county in which the child resides. However, the parent must complete the application/redetermination form(s), provide the county with information/verification, and cooperate with county staff in the child’s eligibility determination process. The EW must grant benefits to the child if eligibility conditions are met.

Person is under 21 years of age and is living away from home and doesn’t have any information on tax dependency status.

County in which the person resides.

Example 1:

A 19-year old applied for Medi-Cal in San Joaquin County. During the interview, the applicant informs the eligibility worker that his/her parents reside in Santa Clara County and claims him/her as a tax dependent. San Joaquin County must deny the application unless the applicant is applying for the Minor Consent program. San Joaquin County must inform the applicant that if he/she wants full-scope benefits, his/her parents must file an application in Santa Clara County.

Revised: 12/19/16 Update # 2016-46


Example 2:

The applicant is an 18 year old attending school in California. The applicant’s parents reside in the state of Oregon but he/she is the parents’ tax dependent. The parents must apply for the child because the child is claimed as a tax dependent of his/her parents. The county of responsibility is where the child resides because his/her parents reside out of state.

[Refer to MC Chapter 24, Non-MAGI MFBU and MC Chapter 16, MAGI MC Tax Household determination.]

Update # 2016-46 Revised: 12/19/16

https://ssaconnect.sccgov.org/ssa_departments/debs_program/Documents/handbooks/medical/mcchap16.pdf




15.10.6 Deceased Individual

Deceased Individual


The deceased individual incurred hospital bills,

The county where the person was residing at the time of death.

NOTE: If the deceased person’s family or representative applies in any county within the state, the county in which the applicant’s representative applies must accept and process the application under the courtesy application procedures.

15.10.7 Out of Home Placement

OUT OF HOME PLACEMENT


Foster children and children eligible for the Adoption Assistance Program (AAP).

County in which the placing agency is located.

Person is placed in county or private facility in another county by a county agency.

County that made placement, unless counties and beneficiary agree otherwise.

Person is placed in county or private facility in another county by a private party.

County in which the facility is located unless the person’s family resides in another county.

NOTE: This does not apply to persons who are in separate MFBUs from their families, e.g., LTC persons.

Person is placed in state hospital by county mental health agency or Regional Center for the Developmentally Disabled.

County in which state hospital is located.

NOTE: This situation supersedes all other situations except situations where MFBU/Tax Household includes other family members.

Persons placed in county or private facility in another county after release from a state hospital.

County in which the facility is located.

NOTE: This situation supersedes all other situations except situations where MFBU/Tax Household includes other family members.

Revised: 12/19/16 Update # 2016-46


15.10.8 Pending SP-DDSD Disability Determination

PENDING SP-DDSD DISABILITY DETERMINATION


Case has MFBU/Tax Household member(s) already active on Medi-Cal and one of them has a pending DDSB determination,

The county where the family currently resides is the county of responsibility.

• The Sending County must initiate an eICT to the new county of residence. Include copies of the DDSB referral in the ICT packet.

• The Receiving County must notify DDSB of the client’s new address.

Case consists of only the applicant (there is no active case),

The original (Sending) county that initiated the DDSB referral must keep the case until a decision is received:

• If the client is disabled, approve Medi-Cal and then initiate eICT.

• If the client is not disabled and there is no eligible for other MC programs, deny the Medi-Cal application. No eICT is required.

15.10.9 County of Responsibility in CalHEERS

CalHEERS County of Responsibility is released immediately when a case is discontinued in CalHEERS unless the case is discontinued for any of the following reasons:

• Failure to provide• Failure to complete redetermination• Whereabouts unknown

If the above applies, then County of Responsibility is not released in CalHEERS until the end of the 90-Day Cure Period. If the client applies in another county during the 90-Day Cure Period on a case in a different county, the ICT Coordinator must be contacted to request an ICT from that County. The County with the case in the 90-Day Cure Period will have to rescind and send the ICT to the new county.

Update # 2016-46 Revised: 12/19/16


Revised: 12/19/16 Update # 2016-46