Medi-Cal (not Medicare or medical)
Annual Redetermination form

Here’s the most comprehensive redetermination explanation and forms that I could find.

I checked with Medi-Cal and here is an excerpt of  their response.

The majority of MAGI Income Medi-Cal renewals are now handled electronically via an ex parte [means you don’t have to appear in person] review process.  Specifically if a beneficiary’s information can be electronically verified through the Federal Hub, then the beneficiary is automatically renewed for a year which does not require any paperwork or verification to be completed by the beneficiary.

As always, if the beneficiary has any change in circumstance, they must report that to the county within 10 days of the event or Medi-Cal might make a Federal Case of it!

For beneficiaries whose information cannot be electronically verified through the Federal Hub, the counties now send the beneficiary a pre-populated renewal form (MC216) only asking them to provide the information that could not be verified.  Therefore this new process minimizes the paperwork necessary to complete the beneficiary’s annual renewal.

Non MAGI Income qualifiers like Aged & Disabled would use MC 210 RV (Rev 5/11)  which is in the process of being updated.

Scroll down and get more detail, where it says Redetermination of Eligibility, changes.

Reply from Medi-Cal, about their asking for the most current information:

Medi-Cal is a state program administered at the county level.  DHCS is not able to make changes.  Your changes need to be reported to the human services agency of your  county dhcs.ca.gov/CountyOffices .

Medi-Cal & County contact information

If you’ve found more information on redetermination, please put a link in the comments below.

Medi-Cal Handbook

Blog Post – Insure Me Kevin.com  11.9.2016

We didn’t get a redetermination packet this year. Are we OK, what’s going on?

Medi-Cal may have done your renewal through  electronic verification through the Federal Hub   Try checking our pages for various counties, our contact page for Medi-Cal and the link for all counties.  Many counties have an online system that you can enroll in, to get up to the minute status and give them your updates online.

Our website is #MUCH more than just
Pro Bono helping you with Medi-Cal

We've developed the Medi-Cal portion of our website, as many of our Covered CA clients unfortunately end up here, if their income drops below 133% of FPL, Federal Poverty Level, see the income chart.

We do not get a nickel, for this site or for helping people enroll in Medi-Cal, nor answering complex questions.  When you have other questions or need coverage, take a look at   our other websites:

Caretakers & Parents

Get a term life quote here, to protect your loved one

Medi-Cal - Re-determination - #MC216

Informational Only
mc 216 medi-cal redetermination

 The sample redetermination form  MC 216 states:

We may need some information about people in your household who live with you or are listed on your tax return, who do not have Medi-Cal and who do not want to apply for Medi-Cal.Sample MC 216

Please note that, Medi-Cal wants to cover everyone and may go beyond the law to gather information to do that.  There are also many other programs that Medi-Cal has that you might qualify for and no one would know unless they asked.  Such as:

MORE Social Services – In Addition to Medi-Cal

IHSS In Home Supportive Services

Household Size Flow Chart

Our webpage on Medi Cal Redetermination

Program Comparisons

 

What do I write on expenses/tax deductions part of

the MC-216 Medi-Cal Redetermination form?

 

Medi-Cal under ObamaCare/ACA/Health Care Reform  is based on MAGI Income, line 37 – 8b of your Tax Return and add in Social SecurityForeign Income & Tax Exempt Interest.

I would venture that your income and expenses are the same rules as filing your tax return, even if you are under the filing threshold.   Plus, the MC 216 form under expenses, even says tax deductions.

 

Here’s the pages on our website that relate to filing income and expenses on your 1040 tax form.

Learn More:  

LA Care – FAQ’s

FAQ for Enrollers assisting Medi Cal Enrollment  

Kaiser Instructions

End of Medi-Cal Expansion under Donald Care – American Health Care Act * §112    * Sec. 116. Providing incentives for increased frequency of eligibility redeterminations.

Contact Information for your Local Medi-Cal Office

Western Law Center Guide on redetermination – Page 6.227

Medi-Cal Consulting Services provides assistance to families seeking Medi-Cal benefits for loved ones.  Here’s their initial assessment form.  Fees for our services are based on the complexity of the issues surrounding the case.

Four Page Summary on How to Enroll, Shop & Compare Covered CA  for 2016

 terrible renewal form  california health line.org – confusing forms   california health  line.org how state will handle renewals   california healthline.org Lawsuit filed against Medi-Cal for making it hard to renew coverage california health line.org/ Redeterminations of Medicaid Eligibility

Call Blue Cross Direct - They don't pay me to help you with Medi-Cal
Call Blue Cross Direct - They don't pay me to help you with Medi-Cal Call Blue Cross Direct - Medi-Cal's Website - Contact Page, including secure email to ask a question

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Life Insurance Buyers Guide

NAIC Life Insurance Buyers Guide

How much  life insurance you really need?

Video Insurance Unnecessary Cost?

Medi Cal - #County Office Lookup

County Offices

Covered CA Certified Agent

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iii. Redetermination of Eligibility

Change in Circumstances 

The county must determine a beneficiary’s ongoing eligibility upon learning of a change potentially affecting eligibility  [Medi-Cal and the law require changes be reported within 10 days]  from the beneficiary or from its own review as follows:

• Determine if the change in circumstances affects eligibility. For example, a change of address may not affect eligibility for Medi-Cal, but a change in household size might. If there is no change in eligibility based on the new information, no other action is needed.  Another example: If income increases $100/month, but the annual household income remains below the eligibility limit, the individual remains eligible for the same program so no further action is needed.

• If the county determines that the change in circumstances may affect eligibility, the county must attempt to gather all eligibility information using the ex parte process – [beneficiary doesn’t have to appear in person] a review of all available data resources such as the beneficiary’s CalWORKs file or the federal data services hub.

• If the ex parte process does not provide the county the information it needs to find the beneficiary still eligible, the county shall ask the beneficiary for the information it needs. To request information from a beneficiary, the county must use a pre-populated form containing the information that the county already has and that requests only the information needed from the beneficiary to renew eligibility.  The beneficiary has 30 days from the date the pre-populated form is mailed to respond. The beneficiary must be allowed to provide the information requested on the pre-populated form by mail, phone, in person, or any other commonly available electronic means authorized by the county or DHCS.

• During this 30-day period, the county must try to contact the beneficiary by phone, in writing or other commonly available electronic means at least once in an effort to obtain the necessary information. If the beneficiary has identified a preferred method of contact, the county must use that method, otherwise, the county must use reasonable efforts to determine the best method of contact.

• If the beneficiary responds, the county must determine if the beneficiary remains eligible based on the information provided by the beneficiary. If they remain eligible, the county completes the redetermination and sends written notice to the beneficiary. The beneficiary’s next renewal date should be reset to 12 months from the date the county determines the beneficiary is eligible.

° In evaluating information regarding changed circumstances, the county must follow the SB 87 process described at Section A.3.a.iv below and in Welfare & Institutions Code 14005.37 subsection (d) and evaluate the beneficiary for eligibility for all Medi-Cal programs (MAGI and non-MAGI) before terminating the beneficiary from Medi-Cal.   If based on the new information the beneficiary is found not eligible for any Medi-Cal program (if they are over income due to an increase in income or change in family composition, for example) the county must determine eligibility for Covered California with financial assistance.   If eligible, the county should assist the individual with enrollment into Covered California and, if requested, with Covered California plan selection.  After completing the beneficiary’s eligibility determination for Covered California, the county is required to send the beneficiary a ten-day Notice of Action terminating their Medi-Cal.   Note that the county is supposed to take any steps necessary to ensure that a Covered California-eligible beneficiary being discontinued from MediCal can transition to Covered California without a break in coverage.  Beneficiaries found eligible for Share of Cost Medi-Cal must also be evaluated for Covered California financial assistance.   Beneficiaries eligible for Covered California have the choice of having just Share of Cost Medi-Cal, Covered California, or both.

° If the beneficiary does not provide the necessary information to the county within the 30-day period, the county may send the beneficiary a ten-day Notice of Action of terminating Medi-Cal.   At this point in the process, the county is required to immediately evaluate the beneficiary for premium tax credits and forward the case to Covered California.   At the end of the ten days, the beneficiary may be discontinued or terminated from Medi-Cal; however, if the beneficiary provides the  requested information prior to the termination date, the county must rescind the termination action and conduct an eligibility evaluation and redetermination.

° If terminated, the beneficiary still has 90 days from termination to “cure” or provide the information requested and if they do so, the county must treat the information as if it was received timely.  Note that the “good cause” rule regarding submitting information even beyond the 90 days applies.   See also Section B.1 later in this chapter for the Medi-Cal notice and hearing rights, including the right to continue receiving MediCal pending appeal (aid paid pending).

Note that these rules generally apply to both MAGI and Non-MAGI Medi-Cal beneficiaries.

Also note that the county can terminate without doing a redetermination only when it has proof that the beneficiary cannot be eligible for Medi-Cal such as proof that the beneficiary died or moved out of state.   Copied from Western Poverty Guide  *

 

 

51 comments on “Redetermination? Renewals? Verification

  1. 5 comments on “MC 216 Income & Expense Definitions”

    1. DSL says:

      Hi,

      Just wonder if income on MC216 referring to the new calendar year or the past one? It’s confusing since this is the 1st time I do this annual report. Thank you

      Reply
      • What specific questions are you asking about?

        In general, I’d say it’s going forward as that is what MAGI Income for Covered CA subsidies is based on. Also, if anything changes, you are mandated to notify Medi Cal within 10 days.

        Please note that I’m not an authorized Medi Cal representative and do not speak on their behalf.

        Did you want to add life insurance to your program?

        Reply
        • DSL says:

          Thank you for replying.

          I talked to DPSS worked and she clarified the income to be on renewal form is not previous year’s, but expected income for current calendar year.

          Reply
    2. Carla R says:

      What address do I return the MC 216 Spanish 4/2015 form?

      Reply
  2. Why would my under age 19 daughter’s  medi-cal effect our Covered California subsidies?

    We just want the subsidies in Covered CA and don’t want Medi-Cal for your kids.
    We went direct and get coverage from an Insurance Company without subsidies for the kids and the adults will stay on Covered CA.

    Do we still have to complete the Redetermination Form?  

    Why?

     

    Answer

    If you are getting subsidies and your kids qualify for Medi-Cal, you have to complete the Redetermination Form or it can really mess you up.  Even if you don’t want the subsides. That’s how and the why subsidies work. It’s part of  Line 37 of your 1040 MAGI Income Qualification

    Medi-Cal Redetermination shows your qualification if Medi-Cal can’t verify eligibility through electronic sources – the Federal Hub  – ex-parte – you don’t have to appear in person.

    Learn More==>

    Western Center on Law & Poverty = Getting & Keeping Coverage for Low Income California’s

    Medi-Cal pre-empts Covered CA

    It’s part of  Line 37 of your 1040 MAGI Income Qualification.

     

     

     
     

    Here’s how to appoint us as your agent with Covered CA, no additional charge.

     

    Technical Resources & Links

    DHCS 4.8.2014 Guidance Discontinuance from Medi-Cal

    Guidance on Release from Medi-Cal

    The state statute establishing the upper income limit for TLICP sets the limit at 261% FPL. Welf. & Inst. Code § 14005.26(b). But because the income is determined according to MAGI methodology, which provides for an across the board 5% income disregard (see Welf. & Inst. Code § 14005.64(b)), the upper income limit for children in TLICP is 266% FPL.

    ii. Children

    A qualifying child dependent for tax filing is a child residing in the United States, Canada, or Mexico under 19 (or under 24 if a full-time student) at the end of the
    calendar year who is the taxpayer’s child (whether natural, adopted, step, or foster); brother; sister; stepbrother; stepsister; half-brother; half-sister; or one of their
    descendants, and

    • lives with the taxpayer for more than one-half of the taxable year;
    • has not provided over one-half of their own support for the taxable year; and
    • has not filed a joint tax return with a spouse in that taxable year.76

    The age requirement is waived for adult children who are permanently disabled.77 The requirement to live with the taxpayer is waived for full-time students, so long as they are not part of another tax household.78 When two parents can claim the child but do not file a joint tax return, the child is considered the qualifying child of the parent with whom the child lives with more during the tax year. If the child lives with both parents equally, the child is considered the qualifying child of the parent with the highest adjusted gross income.79 The parent claiming the child is known as the custodial parent. The custodial parent can choose to not claim the qualifying child as a dependent by signing IRS Form 8332. The non-custodial parent must attach this form to the return for that taxable year and may include the child in the household when claiming for premium tax credits.80  Western Center on Law & Poverty = Getting & Keeping Coverage for Low Income California’s

     

     

  3. I didn’t fill out my annual redetermination forms and got disenrolled. When I went to the County Office, they said that since I got a job and didn’t inform them, that I was banished from getting Medi-Cal.

    What do I do?

      • OK, it looks to me like you simply “pissed off” the Social Workers at your county office.

        Maybe they think you are lying, even if your income change, didn’t make a change in benefits!

        What is an Intentional Program Violation?

        An Intentional Program Violation (IPV) is the Department of Social Services’ way of saying someone lied in order to obtain benefits. DSS may claim that a person has committed an IPV if he or she failed to report information, made a false or misleading statement, or engaged in conduct which violated DSS rules.

        There are many reasons for IPVs. However, two of the most common situations involve a public assistance recipient’s failure to report earned income from a job and a recipient’s failure to report a change in household composition, such as when a spouse or parent has returned to the household. Under both these circumstances, the unreported information could result in the recipient receiving more public assistance than he or she is eligible to receive.

        What are the possible penalties for committing an Intentional Program Violation?

        The penalties for committing an IPV can be severe. If DSS chooses to sanction a recipient administratively, the sanction may be for six months for the commission of a first public assistance-IPV or for twelve months if it is the second IPV or if the recipient wrongfully received benefits in the amount of $1,000 to $3,900. A third IPV, or an IPV resulting in the wrongful receipt of benefits in an amount over $3,900 may result in a sanction of eighteen months, and a fourth or subsequent IPV may result in a sanction of five years.

        What should a recipient who is charged with welfare fraud do?

        It is always important to remember that welfare fraud can result in criminal prosecution, and ultimately time in jail or prison. Consequently, the recipient must be very careful when speaking with DSS, its investigators, and the District Attorney. The recipient has the right to remain silent, and the right to an attorney. If criminal charges are brought, the recipient may be eligible for a court appointed criminal defense lawyer.

        If criminal charges are not brought, the recipient should have the opportunity to try to “negotiate” a settlement. The recipient can agree to pay back an overpayment without admitting to fraud. If a deal can be worked out without criminal charges being brought, the recipient should make sure that DSS and the DA promise, in writing, not to prosecute. If this agreement cannot be reached, the recipient should consult with an attorney. https://www.lasnny.org/lifelines/ipv-welfare-fraud/

        ******

        Q: I received a notice in the mail to re-determine my eligibility for Medicaid.

        Do I have to respond?

        A: Yes, you must respond to every notice asking you for more information related to your eligibility for State programs, even if none of your information has changed. If you do not respond, your coverage will end.

        Q: My application for health coverage through Medicaid was denied for failure to provide
        requested information
        or verification documents, what should I do now?

        A: Applicants who are denied Medicaid for failure to provide requested documents have 60 days from the date of the denial notice to submit the documents to the office that sent the denial notice. If an applicant submits the requested documents within 60 days, the case will be reopened. After 60 days, someone must reapply.

        Additionally, applicants can appeal this and any other denial. This will allow them to dispute https://www.illinois.gov/hfs/SiteCollectionDocuments/ACA_FAQApplicationforMedicalAssistance.pdf

        Again, go online and see if you can fix the problem.

        We are NOT attorney’s!!! https://boardtraining.info/links-resources/unlawful-practice-of-law/

        You might need one. We are not qualified to tell you if you need an attorney. Check out the link to attorney websites above!

  4. i would have lost my medi-cal but in california the craig vs bonta 12.6.2010 letter to county employees lawsuit stops them

    I’m wondering if im going to lose my medi-cal after the worker re-does my case??

    i also get medicare so wondering if this re-determination is something they have to do to kick me off medi-cal

    Craig vs Bonta says something about Medi-Cal cannot terminate until you do the redetermination

    so im confused i’ll ask my case worker tuesday

    i guess but wondered if you have insight

    • It’s my understanding that Craig v Bonta provides that if you lose eligibility for Medi-Cal based on having SSI Supplemental Security Income and you are no longer eligible for SSI Medi-Cal can’t terminate your benefits until they do a redetermination for all other Medi-Cal programs that you might qualify for.

      As you can see from the page above, Medi-Cal does redeterminations for everyone annually.

      Check out our Medi-Cal Eligibility Page, the chcf.org guide to Medi-cal and Western Poverty Law’s guide to Programs for Low Income Americans.

      Here’s a case where a guy was terminated by Medi-Cal but the Administrative Law Court forced Medi-Cal to fix it. Page 1 second case Office of Clients rights Advocacy

      If you do lose Medi-Cal and have Medicare, that will give you a special enrollment period. You might want to check out Medicare Advantage Plans, we do get paid to help you with that.

      • also if they reviewed me for medi-cal when i was on SSI they did it without my input when iw as on SSI medi-cal never sent me anything

  5. Am i allowed to have gained monies from the refinance of my home? Do i need to pull that money out of my bank account prior to sending in my redetermination forms?

  6. In Section 4 Question D of Annual re-determination form MC 210 RV it is asked ” did anyone in the home get inpatient care in a nursing facility or medical institution?”.

    I was admitted to the hospital for emergency CABG ( heart bypass ) surgery, and stayed in ICU for 10 days.

    Is this considered as having got inpatient care?

    • Here is Medicare’s definition – Criteria publication # 11435

      Here’s what I find to be the most relevant part.

      If you need help understanding your hospital status, [in patient or not] speak to your doctor or someone from the hospital’s utilization or discharge planning department.

      On the Medi-Cal form where it ask which family member, you could include that you were in icu for a bypass.

  7. I need to talk to a real person!!!
    I have a single question, but the automated calls CANNOT help me!!
    I have tried calling any number I can find for Medi-Cal, but no number leads me to a real person!!
    I just need to talk to a real person!!!

    Can someone give me an actual number that will get me to a real live Medi-cal representative?!

  8. I am 29, live at home, go to USC full time. I live with my mom who is retired & on social security. I just received a redetermination packet. Do I have to put my family who lives at the house on this form with their income? They do not want medical or aid. I do not know their income & my mother feels that its no ones business what her income is since she is not applying for any type of aid. In other words for section 1 of the MC210 form what do I put for family & income.

    ***We’ve answered very similar questions on these child pages.

    • Thank u so much for ur response. I only receive SSDI, $1091/mo. However, the month before my fathers transfer was my bday & I desperately asked for cash bc my HOA increased & I’ll be unable to pay my bills so I deposited every cent I had-$220 the previous month-the total amount of my bday gifts (more than usual obviously but I think my family is worried I’m going to lose my condo). So I’m worried if they ask for another bank statement from the month before it will show that huge bday money deposit. And it said u can only have $60 deposited quarterly I just read online??? I’m so scared. If I lose MediCal I don’t know what I’ll do. I have so many health problems I’m fighting. If my redetermination date is Nov; papers mailed in Oct do u know if I have Til Nov 30th? Should I wait Til my next bank statement comes out- bc I NEVER have deposits like that- this was just a one time thing& it could cost me so much. I’m so scared. Thank u so much,
      Amber. CA

  9. Under income and Expenses to renew my children’s medi-cal they also list my my children but they don’t receive any income. Would I leave it blank? They only have amounts under my name and my husbands.

    • See above

      it says annually

      but you only get a redetermination form if Medi-Cal isn’t able to verify everything through the federal hub

      When your income increases be sure to contact us so we can get you in with the regular insurance company through covered California with subsidies if applicable

  10. What address can I mail the medi-cal redetermination form to in the city of los angeles? Also can I fax it?
    Thank you

  11. My husband and I have been searching for the mc216 form that does NOT have “for informational purposes” stamped across it. Our contact person at medi-cal says they are out there but we can’t find one 🙁
    Amy suggestions??
    Thanks so much!!

    • No idea. If I had it, I would post or link to it. If you are able to find it online, please post the link here for others. How about asking your Social Worker to email it to you?

      • Thanks for your swift reply!! It has been frustrating…we don’t really have a social worker per se, but the person Bruno got thru to (after an HOUR on hold!!! grrr) was not helpful, just told him to look for it-that is is out there. We both searched and searched
        Seems they are making it intentionally difficult to get requalified???
        I guess we have to spend a day out in el Monte at the office??

        Arrrghhhh

        Thanks again, and Happy 4TH!!

  12. Is my boyfriend considered family when filling out the medi-cal redetermination form? Yes he lives with me, but he has his own expenses to worry about. I am referring to the part about job and checking account. Thank you for your help with this 😉

  13. I live with my daughter who has a job and provide me free rent and food. Is she considered a family member or only my husband is my family member? I have to fill out the annual redetermination form now. Please help.

    Thank you very much.

    • I don’t work or get paid for doing any Medi-Cal. This site is a public service. Your renewal is supposed to be automatic. If it’s not, Medi-Cal is supposed to send you the form. I checked your email address and you work for a company in Los Angeles. So, how about opening an online account and updating everything there?

      Otherwise, try contacting your Social Worker

    • Try taking a look at our contact page for Medi-Cal. I would suggest that you mail to your local office which can be found by clicking on the link on that page. If you are in Los Angeles, you can create an online account.

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