Inter-County Transfers

Transcription

1 Medi-Cal Summary Inter-County Transfers Medi-Cal beneficiaries should keep their Medi-Cal with no interruption in benefits when they move from one county to another. This is called Inter County Transfer (ICT). I. Background! Medi-Cal is a statewide program, even though counties administer it for their residents.! Federal rules state that every Medi-Cal recipient is entitled to keep Medi-Cal when she moves to a new county 1) without a gap in coverage; 2) without having to re-apply; 3) and without having eligibility redetermined based solely on her move.! As of February 21, 2003, DHS instructed counties in ACL to change Inter-County Transfer (ICT) procedures to comply with federal law and ensure recipients keep and can use Medi-Cal when they move from one county to another.! On April 30, 2004, DHS issued ACL with Questions and Answers and an updated ICT liaison list.! Despite this new process, sometimes counties make mistakes. Each county has an ICT liaisons to help advocates and other counties troubleshoot these cases. Use these liaisons to help resolve problems. II. Terminology Inter-County Transfer (ICT): the process counties use when a recipient moves residence from one county to another to ensure they keep Medi-Cal and can use it in the new county SC = Sending County = Old County = First County: the county where the recipient lived before moving RC = Receiving County = New County = Second County: the county where the recipient lives after moving III. Your Clients Rights in ICT 1. No Interruption in Coverage: Counties must keep Medi-Cal active during the ICT; they may not terminate Medi-Cal until benefits begin in the new county. 2. No New Application: Counties may not ask or require recipients to re-apply for Medi-Cal when they move to a new county. HEALTH CONSUMER ALLIANCE 3/2006

2 3. No Redetermination: No redetermination of eligibility is required during ICT ever by either the sending or receiving counties. 5. No ICT for Temporary Move: The recipient does not have an ICT when reporting a temporary change in county address due to seasonal employment, medical care, or other reasons. An ICT happens only when a recipient makes a permanent change in county address or a change for an indefinite period. 6. No Delay Because of Documentation: Neither county can delay the transfer because they don t have documents from the recipient s file. The counties must make the transfer happen and work together to coordinate documents, with no interruption in benefits. IV. Procedures to Initiate an ICT The procedures to start the ICT depend on whether the county finds out about the move before or after termination. A. Recipient contacts a county before the move; Medi-Cal still active! It does not matter which county recipient contacts before the move. Either county must verify if f recipient contacts RC and recipient has current case on MEDS. If so, the county recipient contacts must get in touch with the other county to coordinate, and the SC will initiate an ICT.! The county recipient contacts must explains the ICT process to the recipient and instructs recipient to tell the worker in the SC if there are other changes that are occurring other than the move, like a new job or household composition.! Then see County Responsibilities To Process ICT (Below) B. Recipient contacts either county after Medi-Cal has been terminated! If less than 30 days since termination date, SC rescinds termination with no break in coverage and sends recipient notice that ICT will happen in the RC. Then see procedures above.! If more than 30 days since termination date, SC rescinds if termination was improper. If proper, SC instructs recipient to re-apply in RC. V. County Responsibilities During ICT During the ICT, the SC is responsible for the recipient s Medi-Cal until Medi-Cal starts in the RC. To ensure no break in coverage, Medi-Cal should end the last day Page 2

3 of the month in the SC and start the first day of the month in the RC, the day after the RC s termination date. A. Sending County: Within 7 days after the recipient reports an address change, the SC must:! Send the recipient an ICT Informing Notice (MC 358-S) confirming the move, telling the recipient she does not have to re-apply, Medi-Cal is still active, and that the RC will send her a notice with information about the new EW.! Attempt to confirm the change of address by phone! Complete an address change on using an online EW12 MEDS transaction.! Notify the RC in writing using an MC 360! Send the RC copies of available documents supporting the recipient s eligibility (see list of documents in ACL)! Not take any action to terminate until confirmation of effective date of eligibility in RC; no interruption in coverage B. Receiving County: Must complete the ICT no later than the first of the month after the SC sends notice of the ICT. *** Upon receipt of the ICT notice and ICT packet from the SC, the RC must:! Verify the recipient s current address and active Medi-Cal on MEDS! Review documents and initiate action to continue Medi-Cal in RC! Contact SC caseworker listed on MC 360 if there are any questions or missing documents! Verify that the county system has submitted a successful transaction to MEDS to assume responsibility for the upcoming month! Notify the SC s caseworker of the effective date of Medi-Cal! Send a Notice of Action (MC 359-R) to the recipient with the effective date of Medi-Cal benefits worker s name, number, and hours VI. Accessing Care During the ICT Page 3

4 If the recipient is in managed care in the SC, the plan won t pay for care in the new county without prior authorization, so the recipient can only use the plan for emergency care, family planning and STD services in the RC. A. Emergency Disenrollment The recipient can contact the state DHS s Medi-Cal Managed Care Office of the Ombudsman toll free at The recipient can access Fee-For Service (FFS) Medi-Cal on the day after the disenrollment action. Or, the recipient can contact Health Care Options (HCO) at for emergency disenrollment that is effective the first day of the month in which disenrollment is requested. B. Accessing Fee-For-Service Once Counties change the address in MEDS:! If the RC is a COHS county, the recipient will be enrolled in COHS automatically the first of the month after MEDS is updated.! If the SC is a COHS county, MEDS will automatically disenroll the recipient and the recipient will become FFS immediately if the RC is a non-cohs county.! If the RC is a GMC or two-plan model county, MEDS automatically changes the recipient to FFS.! The new residence code will initiate HCO to contact the recipient with health plan information in the new county. VII. When does a redetermination happen? A redetermination of eligibility only happens if once the ICT is completely done and the recipient is getting Medi-Cal in the RC the RC has information from either the recipient or the SC that the recipient has had a change in circumstances that may affect ongoing eligibility. Then, and only then, the RC does an SB87 redetermination (ex parte review, phone contact, Request for Information Form) and may not terminate until proving the recipient ineligible for all Medi-Cal categories. VIII. What happens if the recipient fails to meet the more stringent CalWORKs ICT process? Page 4

5 This does not affect Medi-Cal. The CalWORKs program must refer the case to Medi-Cal and a Medi-Cal only case continues with no gap in coverage. Additional Useful Authorities: 1. All County Letters and HCFA (federal) Dear State Medicaid Directors Letter, dated County Welfare Directors Association (CWDA) gentlepersons agreement, dated August 22, 2003 Page 5