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Common-Place Handbook page 57-1Medi-Cal Eligibility Bureau VMC (Valley Medical Center) Procedures

57. Medi-Cal Eligibility Bureau VMC (Valley Medical Center) Procedures

The VMC Medi-Cal Eligibility Bureau is located on the Valley Medical Center (VMC) campus and at Valley Health Center (VHC) and community clinics in order to maximize Medi-Cal reimbursement.

The VMC Medi-Cal Eligibility Bureau processes applications for VMC inpatients and patients seen in the outpatient clinics as well as other specialized applications for Medi-Cal (i.e., Long-Term Care, Mental Health Minor Consents, JPDs, Special Treatment Programs, TB, SSI Denials, Craig v. Bonta, LIS, BCCTP, etc.).

57.1 Applications Processed in the VMC Bureau

57.1.1 Walk-Ins

The following process applies to Walk-In applications taken at 650 South Bascom, Comprecare Health Center, East Valley Health Center, Gardner Health Center, and Tully Valley Health Center.

Step Who Action

1. Applicant Walks into lobby and expresses her/his desire to apply for benefits.

2. Application Support/at Reception

Performs preliminary file clearance procedures to ensure the application is valid.

If it is... Then...

A valid application,

• Gives the applicant a SAWS 1, SCD 41, and SCD 1264.

• Asks applicant to complete these forms and return them to the Receptionist.

NOT a valid application,

• Gives the client the appropriate referral.

3. Applicant Returns the completed SAWS 1, SCD 41, and SCD 1264 to the Receptionist.

Update # 14-21 Revised: 09/22/14

2 Common-Place HandbookMedi-Cal Eligibility Bureau VMC (Valley Medical Center) Procedures


• Reviews SAWS1, SCD 41, and SCD 1264 for completeness and signatures.

• Confirms with the applicant which program(s) s/he is applying for.

Note: If the applicant wishes to apply for CalWORKs, the Receptionist will take a “Courtesy” intra-office application (SAWS 1, SCD 41, and SCD 1264) and forward to AAC for processing.

• Gives the applicant the pertinent “Informational Packet” according to the program(s) for which s/he is applying.

• Asks the applicant if s/he is able to wait to be seen now.

If the applicant...

Then...

Is unable to wait, and the application is for CalFresh or CalFresh AND Medi-Cal,

• Gives the applicant the SAWS series.• Completes a "mini" app/reg" of the application.• Schedules a telephone interview to occur within the

next three business days unless the applicant specifically requests a face-to-face interview.

Note: If the applicant requests a face-to-face interview, asks her/him to complete the application packet prior to the interview.

• Assigns the telephone or face-to-face interview to the next available Walk-In worker in CalWIN Appointment Scheduling and on the Walk-In Log.

• Kofaxes and then gives the applicant the CalWIN-generated appointment letter specifying the date and time of the telephone or face-to-face interview.

• Advises the applicant that the telephone or face-to-face interview will take one-to-two hours to complete and gives the applicant an SCD 2300, which notes which documents will be needed for the interview.

• Photocopies and then Kofaxes the applicant’s ID and any other available verifications.

• If the applicant does not have a valid EBT card, and is scheduled for a telephone interview, advises the applicant that s/he may pick up the card within 3 days if eligible for immediate issuance.

• Creates a TMT ticket in the INTAKE>CF>PhoneInterview (or Walk-In) Request Category, assigns to the identified worker, and notes the following in the Notes section of the ticket:• Telephone (or Walk-In) interview scheduled for

(time) on (date).

Step Who Action

Revised: 09/22/14 Update # 14-21



Continued...

If the applicant....

Then....

Is unable to wait, and the application is for CalFresh or CalFresh AND Medi-Cal,

Continued...

• DOA: (the date of application).• (Language, if other than English, Spanish, or

Vietnamese.)• (The documents that are) in Kofax.

• Forwards screen shot of the assigned ticket to TMT Assignment Clerk for notation of assignment on TMT Request form.

Is unable to wait and the application is for Medi-Cal only,

• Completes a "mini app/reg" of the application.• Gives the applicant the MC 210 application packet

with an SCD 1121 noting the 10-day due date.• Instructs the applicant to mail back or drop off the

completed Medi-Cal application within 10 days or the application will be denied.

Note: If verifications include DRA documents, complete DHCS 0005.

• Kofaxes any documents and verifications available.• Creates a TMT ticket in Pending status in the

INTAKE>MC>AppProcessing>(language) Request Category, places in the Unassigned VMC group, and notes the following in the Notes section of the ticket:• MC-only app;• DOA (the date of application).• (Language, if other than English, Spanish, or

Vietnamese.)• (The documents that are) in Kofax.

Is able to wait,

• Gives the applicant a lobby ticket number with a copy of the SAWS 1 and an Informational Packet”.

• Asks the applicant to wait for her/his number to be called.

• Enters applicant information on the Walk-In Log.

• At 650 South Bascom, places the SAWS 1, SCD 41, and SCD 1264 in the Walk-In App Reg basket for the Walk-In Application/Registration Support Staff. At all other sites, proceeds to the next step.

Step Who Action



5. Application Registration/Application Support

• Completes full file clearance and application registration.

• Registers ES “program” in CalWIN if ES was requested by the applicant.

• Creates a TMT Walk-In ticket and assigns it to the next available, language-appropriate Walk-In EW.

• Calls the assigned Walk-In EW to inform her/him that they have a Walk-In assignment. If unable to speak directly to the assigned Walk-In EW by phone, emails the EW and her/his supervisor to inform them that the EW has a Walk-In applicant waiting.

6. Walk-In EW • Receives TMT Request assignment.

• Obtains the SAWS 1, SCD 41, and SCD 1264 from Application Support.

• Reviews available case information, such as the Maintain Case Comments window in CalWIN, IDM, MEDS, IEVS, etc.

• Initiates queue in CalWIN and conducts interactive interview.

• Assists applicant in completing supplemental forms.

• Reviews the verifications the client has provided.

• Screens for ES.

If ES... Then...

Eligible, • Adds ES in CalWIN if not already pending.• Approves and authorizes benefits.• Issues EBT card.

Ineligible, • Denies ES in CalWIN only if the applicant requested ES.

• Documents ES denial in Maintain Case Comments window in CalWIN and in County Use Section of SAWS 1.

• Processes regular CalFresh application.

Note: There is no requirement to issue an ES denial NOA.

• Prints the Statement of Facts (SOF) from CalWIN and has the applicant sign it.

• Requests IEVS.

Step Who Action



6. Walk-In EW Continued...

If the application is...

Then...

Complete, • Runs EDBC, reviews Wrap-Up and authorizes the case in CalWIN.

• Documents in the Maintain Case Comments window.

• Changes TMT Request status to Authorization Pending.

• Waits for current IEVS and MEDS turnaround and prints applicable MEDS screens (i.e., INQM, INQ1, INQE, etc.)

• Submits all application documents and MEDS screens with batch header sheets to be scanned into IDM.

• Clears IEVS.• Updates TMT Request status to Task Clearance

Finalized.

Incomplete, • Explains to the applicant which verifications are missing

• Gives the applicant an SCD 1121 noting which verifications and supplemental forms must be submitted within 10 days.

• Prints the Statement of Facts (SOF) from CalWIN and has the applicant sign it.

• Changes TMT status to Intake Collection Initiated and edits the Notes section of the ticket with the due date.

Note: If the applicant submits the missing forms/verifications at a later date, processes the application and approves benefits.

OR

• For CalFresh, if by the 10-day due date, the applicant has still not submitted the missing verifications or application, sends the appropriate denial NOA(s).

• For Medi-Cal, if by the 10-day due date, the applicant has still not submitted the missing verifications, sends the “Final” SCD 1121 with another 10-day due date.

Note: Hospital applications still require three (3) notices and a referral to Outreach, if necessary.

• Denies the Medi-Cal application if the applicant does not submit all required documents by final due date.

Step Who Action



57.1.2 Telephone Interviews

The following are procedures for telephone interviews. There are two types of telephone interviews; those scheduled by Application Support staff and those scheduled by the Eligibility Workers. Scheduled by Application Support.

7. EWS • Receives the TMT Request assignment under “My Request.”

• Clicks on appropriate sub folder under “My Request.”

• Selects and reviews applications for accuracy and completeness as per policy.

Note: Updates the TMT Request Status to Transfer Pending for all non-reviewed cases.

Step Who Action

1. Application Support

• Schedules a phone interview while client is present. [See Walk-Ins Section

57.1.1]

2. Eligibility Worker

• Receives TMT Request for a CalFresh application.

• Screens for ES.

• Reviews the application and other available case information such as case comments, IDM, MEDS, IEVS, etc.

• Calls the client for the scheduled phone interview. At least two attempts must be made, one at the scheduled time and another fifteen minutes later.

(Chart page 1 of 4)

Step Who Action



2. Eligibility Worker Continued

If the client is...

Then...

Not contacted,

• CalWIN will send the “Notice of Missed Interview” (DFA 386).

Note: This will not occur if the queue is initiated.

• Records ES Denial in CalWIN if applicant requested it on the SAWS 1.

• Documents SAWS 1 on the County Use Section, “Unable to contact client; unable to screen for ES,” if client did not request ES. (ES questions not answered.)

• Documents in Maintain Case Comments window in CalWIN.

• Updates the TMT Request Status to Intake Collection Initiated with due date 30 days from date of application.

• Denies CalFresh if the applicant does not contact the worker after the 30th day of application.

Step Who Action

(Chart page 2 of 4)



2. Eligibility Worker Cont...

Contacted, • Reviews the application and other available case information such as case comments, IDM, MEDS, IEVS, etc.

• Conducts interactive interview in CalWIN by initiating the queue and screens for ES

• If ES approved, [Refer to “Walk-Ins,” page 57-1] (Step 6 the ES If...Then...chart.)

• Asks the applicant if he/she has an EBT card and checks EBT status to ensure the applicant has a valid card.

• If the applicant has a valid EBT card, then no action is required.

• Reviews if any additional forms/verifications are needed.

• Mails CalWIN Statement of Facts, SCD 1121 with a 10-day due date, and additional forms, (i.e., signature and informational packets) unless signature is present or it is a BCW application and no changes are recorded.

• Updates the TMT Request Status to Intake Collection Initiated with due date.

• Documents in Maintain Case Comment window.

• Denies application after the 30th day of application if verifications/forms are not returned by due date.

[Refer to “The family of three applies for CalWORKs and CalFresh on July 25. Mom has just been laid off an received her last paycheck on July 20. Her total earnings for July are $2,000. Each child also receives $200 from absent Dad’s disability. The current income puts the family over the applicant income test for CalWORKs and CalFresh, but it appears they would be eligible beginning in August. The AU/household is denied benefits for the month of July and is approved for the second month forward using the same application for benefits.,” page 3-31]

• Mails appropriate NOAs.

•

• Enters all available information into CalWIN. •

Step Who Action

(Chart page 3 of 4)





• Selects and reviews applications fro accuracy and completeness as per policy. Note: Updates the TMT Request Status to Transfer Pending for all non-reviewed cases.

Step Who Action

(Chart page 4 of 4)



Scheduled by Eligibility Worker

Step Who Action


• Receives TMT Request for a non-ES CalFresh application such as BCW CalFresh applications.

• Reviews the application and other available case information such as case comments, IDM, MEDS, IEVS, etc.

• Schedules the appointment no later than 15 days from the date of application. This may be done via mailed appointment letter or a phone call.

•

If client... Then...

Not contacted,

• Enters the appointment in CalWIN Appointment Scheduling.

• Sends the CalWIN generated appointment notice.

Contacted • Initiates interview if client is available as specified in [Refer to “Telephone Interviews,” page 57-6] Step 2 (p.7)

• Sends appointment letter if client is not available.

• Calls the client for the scheduled phone interview. At least two attempts must be made.

If client is... Then...

Not contacted,

• CalWIN will automatically send “Notice of Missed Interview” (DFA 386).

Note: This will not occur if the queue is initiated.

• Documents in Maintain Case Comments window in CalWIN.

• Updates the TMT Request Status to Intake Collection Initiated with due date 30 days from date of application.

• Denies CalFresh if the applicant does not contact the worker after the 30th day of application.

(Chart page 1 of 2)




Contacted, • Reviews the application and other available case information such as case comments, IDM, MEDS, IEVS, etc.

• Conducts interactive interview in CalWIN by initiating the queue.

• Asks the applicant if he/she has an EBT card and checks EBT status to ensure the applicant has a valid card.



• Mails CalWIN Statement of Facts, SCD 1121 with a 10-day due date, and additional forms, (i.e., signature and informational packets) unless signature is present or it is a BCW application and no changes are recorded.



• Denies application after the 30th day of application if verifications/forms are not returned by due date.

[Refer to “The family of three applies for CalWORKs and CalFresh on July 25. Mom has just been laid off an received her last paycheck on July 20. Her total earnings for July are $2,000. Each child also receives $200 from absent Dad’s disability. The current income puts the family over the applicant income test for CalWORKs and CalFresh, but it appears they would be eligible beginning in August. The AU/household is denied benefits for the month of July and is approved for the second month forward using the same application for benefits.,” page 3-31]


Step Who Action

(Chart page 2 of 2)



57.1.3 BCW CalFresh Applications

The following process must be adhered to when processing CalFresh applications received through other sources.

Step Who Action

1. Applicant Completes the BCW application for CalFresh.

2. AAC Application Support

• Checks CalWIN Interface Activity subsystem.

• Opens and reviews the Search for External Referral Data window in CalWIN.

• Completes preliminary file clearance to determine if the individual is known to CalWIN.

• Determines validity of the application.

Note: If not valid for intake:

• Scans documents into IDM.

•Documents the filing of documents into IDM in Maintain Case Comments.

•Selects the appropriate value in the Status field of the External Referral window.

• Completes application/registration in CalWIN and MEDS.

• Assigns to the appropriate CCS caseload number.

• Scans into KOFAX using application number or case number. [[Refer to “Benefits CalWIN CalFresh,” page 60-1] Step 2]

• Saves the application and attachments.

• Forwards applications to the screener at AAC.

• Receives CalFresh applications from screener.

• Creates phone interview TMT Requests for CalFresh applications for VMC.

3. VMC Application Support

Assigns appropriate number of TMT Tickets per EWS request.



4. VMC Intake EW

• Receives TMT assignment.

• Reviews available case information such as the Maintain Case Comments window, IDM, MEDS, IEVS, etc.

• Checks the verifications the client has submitted.

• Schedules phone interview in CalWIN and sends an appointment letter.

If client is... Then...

Not Contacted,

(No show for phone interview)

• Sends “Notice of Missed Interview” (DFA 386).

• Updates the TMT Request Status to Intake Collection Initiated with due date

• Checks that CalWIN denied CalFresh after the 30th day from date of application

• Transfers all documents from KOFAX to IDM

• Updates TMT Request Status to Task Clearance Finalized.

Step Who Action



4. VMC Intake EW Cont...

Contacted • Conducts interactive interview in CalWIN on the scheduled date/time.


• Mails CalWIN Statement of Facts, SCD 1121 with a 10-day due date, and additional forms, (i.e., signature and informational packets).

• Updates the TMT Request Status to Intake Collection Initiated with due date 30 days from the date of application, unless exceptions apply.

• Approves CalFresh when all signed forms and verifications are received.

• Checks the Maintain Card Request window in CalWIN to verify if client has a valid EBT card.


• Issues EBT card if approved and needed.

• Documents in Maintain Case Comment window. OR

• Denies application after the 30th day if verifications/forms are not returned by due date.[Refer to “The family of three applies for CalWORKs and CalFresh on July 25. Mom has just been laid off an received her last paycheck on July 20. Her total earnings for July are $2,000. Each child also receives $200 from absent Dad’s disability. The current income puts the family over the applicant income test for CalWORKs and CalFresh, but it appears they would be eligible beginning in August. The AU/household is denied benefits for the month of July and is approved for the second month forward using the same application for benefits.,” page 3-31]


• Checks MEDS and prepares case for transfer.

Step Who Action



57.1.4 BCW Medi-Cal with CalFresh

Applicants have the option to submit Medi-Cal and CalFresh applications via on-line. Below are the procedures when an individual submits a Medi-Cal with CalFresh application online using BCW:



• Selects and reviews applications fro accuracy and completeness as per policy.

Note: Updates the TMT Request Status to Transfer Pending for all non-reviewed cases.

Step Who Action

1. Client Submits a BCW Medi-Cal and CalFresh applications.

Step Who Action



2.. AAC Application Support

• Checks CalWIN Interface Activity subsystem.

• Opens and reviews the Search for External Referral Data window in CalWIN.

• Completes mini-id to determine if the individual is known to CalWIN.

• Determines validity of the application.

Note: If not valid for intake,

• Scans documents into IDM.

•Documents the filing of documents into IDM in Maintain Case Comments.

•Selects the appropriate value in the Status field of the External Referral window.

• Completes application/registration in CalWIN and MEDS.

• Assigns to the appropriate CCS caseload number.

• Scans into KOFAX using application number or case number.

• Saves the application and attachments

• Forwards applications to the screener at AAC.

• Receives non-ES CalFresh applications from screener.

• Creates phone interview TMT Requests for a determined number of screened, non-ES CalFresh applications for VMC.

3. VMC Application Support

Assigns appropriate number of TMT Tickets per EWS request.

Step Who Action



4. VMC Intake EW

• Receives TMT assignment.

• Reviews available case information such as the Maintain Case Comments window, IDM, MEDS, IEVS, etc.

• Checks the verifications the client has submitted.

• Schedules phone interview in CalWIN and sends an appointment letter for CF.

If the Client is...

Then...

Not contacted,

• Sends “Notice of Missed Interview” (DFA 386).


• Checks that CalWIN denied CalFresh after the 30th day from date of application.

• Transfers all documents from KOFAX to IDM.


• Processes Medi-Cal application per[Refer to “Benefits CalWIN (BCW) Medi-Cal,” page 60-6]

Step Who Action



5. Intake EW Continued.

Contacted, • Conducts interactive interview in CalWIN on the scheduled date/time.


• Mails CalWIN Statement of Facts, SCD 1121 with a 10-day due date, and additional forms, (i.e., signature and informational packets). For CalFresh, if changes are made on the SOF, mails the SOF to the client for signature.

• Updates the TMT Request Status to Intake Collection Initiated with due date 30 days from the date of application, unless exceptions apply.

• Approves CalFresh/Medi-Cal when all signed forms and verifications are received.

• If Medi-Cal is approved:• Updates TMT Status to Authorization Completed.

• Transfers documents from KOFAX into IDM.

• Checks the Maintain Card Request window in CalWIN to verify if client has a valid EBT card.


• Issues EBT card if approved and needed.


• Denies CalFresh application on the 30th day if verifications/forms are not returned by due date.

• Denies MC after the 2nd notice due date.


• Checks MEDS and prepares case for transfer.


Step Who Action



57.1.5 VMC Face-to-Face In-Patient, PACE, Renal/ EW Screener Process

The following process applies to In-Patient Applications:

6. Eligibility Work Supervisor

• Receives TMT Request assignment under “My Request.”

• Clicks on appropriate subfolder for accuracy and completeness as per policy.

• Updates TMT Request Status to Transfer Pending for all non-reviewed cases.

If Application Processing is...

Then...

Accurate and complete,

Updates TMT Request Status to Transfer Pending.

Not accurate or complete,

Updates TMT Request Status to Returned.


• Receives the TMT Request assignment under “My Request.”

• Updates TMT Request Status to Transfer to Continuing.

• Transfers case to appropriate CCS office in CalWIN.

Step Who Action

1. Financial Counselor

• Makes a financial determination that a patient needs Medi-Cal.

• If applicable, calls the CCS 800 number to determine if application is valid or invalid.

• If application is valid, completes SAWS 1, SCD 41, and Admitting Face Sheet.

• Places sticker on SAWS 1 to indicate it is an In-Patient Hospital application.

• Forwards forms to designated Application Support staff at 650 Bascom.

• Forwards copies to EW Screeners.

Step Who Action



2. Application Support/ Application Registration

• Retrieves forms from designated basket.

• Completes Full Scope ID and Application Registration. [Refer to “Identification Process: Index Clearance,” page 8-2].

• Scans SAWS1 and SCD 41 using the Case Number into Kofax.

• Creates and Assigns TMT Request

• Clicks File on Menu bar.• Selects New Request.• Clicks on the link Requester.• Clicks on [Create New] button.• Enters last name, first name, case number, and primary language.• Clicks [Save] button.• Clicks the Request Category link.• Selects MC. InpatientHospital.Screener.• Verifies status is Pending.• Enters application type (Inpatient, PACE, Renal, etc) in the Notes

field.• Deletes Application Support name from Assigned To field.• Clicks on Received Date link.• Clicks [Save] button.

NOTE: TMT Request will remain in Pending Status.

3. Eligibility Support/ Intake EW Screener

• Receives copies of SAWS 1, SCD 41, and Admitting Face Sheet.

• Attempts to make contact with client in the hospital.

If... Then...

Contact is not successful,

• Forwards to next shift EW Screener.• Notifies EWS.

Note: TMT Request remains unassigned and pending until EW Screener confirms the client contact is successful.

Step Who Action



Contact is successful,

• Reviews and assists client in completing Medi-Cal application and supplemental forms.

• Collects any verifications.• Completes an SCD 1121 for any missing

verifications.• Completes Outreach and pends the Case AU for

10 days. • Documents in the Maintain Case Comments

window.• Updates TMT to enter their name in the Assigned

To field.• Updates TMT Request Status to Transaction

Completed.• Forwards completed EW screener packet to EWS

for review.

4. EWS • Reviews EW Screener packet for accuracy and completeness.

• Places in designated basket for IDM scan.


• Receives EW Screener packet from designated basket.

• Scans any verifications using the Case Number into the Temporary Folder.

• Creates TMT Request as hospital cocreator to a VMC EW.

• Clicks File on Menu bar.• Selects “New Request”.• Clicks on the link Requester.• Clicks on [Create New] button.• Enters Last Name, First Name, Case Number and Primary Language.• Clicks [Save] button.• Clicks the Request Category link.• Selects MC. Inpatient Hospital.language.• Updates status to Assigned.• Enters application type (Inpatient, PACE, Renal, etc) in the Notes

field.• Deletes Application Support name from Assigned To field.• Clicks on Received Date link.• Clicks [Save] button.

6. VMC Intake EW

• Receives TMT request for MC Inpatient Hospital Application.

• Reviews CalWIN Data Collection, Case Comments, IDM, Temporary Folder, MEDS, IEVS, etc.

• If necessary, reviews and assists client in completing additional Application/Supplemental forms.

• Enters information into CalWIN from verifications/forms provided.

Step Who Action



If... Then...

Verifications/ forms are complete,

• Runs EDBC and authorizes the case. • Reviews client correspondence and processes as

appropriate.• Reviews and resolves CalWIN and MEDS alerts.• Documents in the Maintain Case Comments

window.• Goes to Step 7.

Verifications/ forms are not received or not complete,

• Completes the SCD 1121 and mails to the client with due date.

• Sends referral to Outreach.• Documents in the Maintain Case Comments

window.

Reminder: 3 notices are required prior to denial.

7. VMC Intake EW

• If Medi-Cal is approved:

• Consults with EWS if unable to run EDBC due to batch issues.• Updates TMT Status to Authorization Completed.• Validates Kofax and commits into IDM.• Documents in the Maintain Case Comments window.• Reviews MEDS to verify eligibility and submits MEDS screens to be

scanned into IDM.• Updates TMT Request Status to Task Clearance Finalized.

• TMT Request automatically transferred to EWS Scoreboard for review.


• Clicks on appropriate subfolder under “My Request.”


Note: Updates TMT Request Status to Transfer Pending for all non-reviewed cases.

If Application Processing is... Then...

Complete, Updates TMT Request Status to Transfer Pending.


• Returns case to EW for corrections.• Updates TMT Request Status to Returned.

Step Who Action



57.1.6 Long Term Care Process

The following workflow applies when processing Long Term Care Medi-Cal applications:

9. Application Support/ Control Clerk

• Receives the TMT Request in “My Transfers.”

• Updates TMT Request Status to Transferred to Continuing.


Step Who Action


• Receives Long Term Care (LTC) application.

• Performs full file clearance and Application Registration (Refer to Clerical handbook, section 8.2)

• Selects LTC from the Type field’s drop down list on the Collect Applicant Information window in CalWIN.

• Assigns case to the LTC case load CVLT in CalWIN.

• Creates TMT Request

• Clicks the Request Category link• Selects Intake.MC.LTC.language• Updates status to Pending• Changes Priority from Standard to Urgent• Enters in the Notes field:

•Application Type (LTC)•Application Date•Language (if other than English, Spanish or Vietnamese)•Comment “LTC packet enroute” along with date sent and initials of

sending AS.•Clicks the Group link

• Selects Unassigned.VMC

• Forwards hard copy application to VMC Medi-Cal Eligibility Bureau (VMC), attention to the VMC Office Management Coordinator (OMC).

2. OMC at VMC

• Receives hard copy LTC application.

• Forwards application to Application Support for daily assignment.

3. AS/ Application Registration at VMC

• Sorts all pending TMT requests by request category.

• Assigns all TMT request under the LTC category for which the packet is received.

Step Who Action



4. VMC Intake EW

• Receives TMT request assignment under “My Request.”

Note: LTC TMT requests are assigned as Urgent requests and must be processed as such.

• Reviews hard copy Application packet, CalWIN Data Collection, case comments, IDM, MEDS, IEVS, etc.


4. Cont’d

VMC Intake EW (Cont’d)

If... Then...

Verification forms are complete,

• Runs EDBC and authorizes the case.• Reviews client correspondence and processes as

appropriate.• Reviews and resolves CalWIN and MEDS alerts.• Documents in the Maintain Case Comments

window.• Goes to Stage 4.

Verifications are not received or not complete,

• Completes SCD 1121 and mails to the client and Authorized Representative (AR), if applicable, with a ten day due date.

• Includes a prepaid return envelope self-addressed to VMC Medi-Cal Eligibility Bureau, 650 S. Bascom Ave, with EW’s # written on the envelope.


• Submits all application documents and MEDS screens with Fasteners to be scanned into IDM.

• If the client submits the missing verifications and complete application, processes the MC application and approves benefits.

OR

• Follows up on the due date the verifications are due, if the client does not submit the missing verifications or application by the due date, and sends the “Final” SCD 1121 with another 10-day due date (and sends a copy to the AR, if applicable). • If by the 10-day due date the client has still not

submitted the missing verifications or application, sends the appropriate denial NOA(s).

Step Who Action



57.1.7 Craig v. Bonta Process

The following workflow applies when processing Craig v. Bonta Medi-Cal applications

5. Eligibility Support/ VMC Intake EW


• Updates TMT Status to Authorization Completed.• Reviews MEDS after two business days to verify eligibility.• Submits all Application documents and MEDS screens to be scanned

into IDM.• Updates TMT Request Status to Task Clearance Finalized.

• TMT Request automatically transfers to EWS Scoreboard for review.



6. Cont’d

EWS (Cont’d)


Then...

Accurate and complete


Not accurate or complete


7. VMC Application Support/ Control Clerk



• Transfers case to appropriate case load in CalWIN.

Step Who Action

1. Information Systems

Generates the MEDS 331 Craig v. Bonta report on the 28th of each month.

2. Management Analyst

E-mails the report in Excel spreadsheet to VMC Craig unit EWS and to designated Application Support.


• Receives Craig v. Bonta Excel spreadsheet.

• Performs full file clearance and Application Registration. (refer to Clerical handbook, section 8.2).

• Places application in designated basket for scanning and TMT Request creation.

Step Who Action




• Retrieves application from designated basket.

• Creates Temporary Folder using Case Number.

• Scans application to Temporary Folder.

• Creates TMT Request.

• Clicks File on Menu bar.• Selects New Request.• Clicks on the link Requester.• Clicks on [Create New] button• Enters last, first, case number, and primary language.• Clicks [Save] button.• Clicks the Request Category link.• Selects MC.CraigVsBonta. language.• Updates status to Assigned.• Enters application type 9Craig v. Bonta) in the Notes field.• Deletes Application Support name from Assigned To Field.• Clicks on Received Date link.• Clicks [Save] button.

Note: TMT Request will be auto assigned.


• Receives TMT request assignment under My Request.

• Reviews CalWIN Data Collection, case comments, IDM, Kofax, MEDS, IEVS, etc

• Performs SB 87 process and sends the MC 355 as necessary.

• Ex-Parte Review without client contact: Reviews IEVS/MEDS/SAVE information and other active/closed cases, etc.

• Ex-Parte Review with phone contact: Obtains necessary information.• MC 355 process

Note: SB 87 not necessary on cases if the client is deceased, lost California residency, or is incarcerated.


If... Then...

Ex-parte process is complete and no further verifications needed,

• Runs EDBC and authorizes the case.• Reviews client correspondence and processes as

appropriate.• Reviews and resolves CalWIN alerts.• Documents in the Maintain Case Comments

window.• Goes to Step 5.

Step Who Action



4. Cont’d

Eligibility Support/ VMC Intake EW (Cont’d)

Ex-Parte process is NOT complete OR verifications are needed:

• Sends the Information Packet (Cover letter MC 007, MC 219, SCD 391, DHCS 7077, DHCS 7077A) and MC 355 allowing 20 days for its return.


• Updates TMT Request Status to Intake Collection Completed. Note: for subsequent verifications, TMT Request Status must be Transaction Completed, unless all verifications are provided.

• Refers to Case alert process to create alert for follow up on the due date the verifications are due. Note: If due date falls after 10-day NOA cutoff, then Case alert due date must be the first of the following month.



• Consults with the supervisor if unable to run EDBC due to batch issues.

• Updates TMT Status to Authorization completed.• Validates Kofax and commits to IDM.• Documents in Maintain Case Comments window.• Reviews MEDS to verify eligibility and submits MEDS screens to be

scanned into IDM.• Updates TMT Request Status to Task Clearance Finalized.

• TMT Request is automatically transferred to EWS Scoreboard for review.


• Clicks on appropriate subfolder under “My Request.”

• Selects and reviews application for accuracy and completeness as per policy.

Note: Updates TMT Request Status to Transfer Pending for all non-reviewed cases.


Then...

Accurate and complete,


Step Who Action



57.1.8 Low Income Subsidy (LIS) Applications Procedures

Medicare Part D LIS applications are received on a daily basis through a Business Objects report. Designated clerical staff at VMC prints the report, completes file clearance procedures, application registration, and sends the Medi-Cal informational packet with a VMC pre-addressed, postage paid envelope. In addition, as an outreach effort, the form “Good News for Seniors Receiving Social Security Benefits” (SCD 2329) and a CalFresh application packet must also be included.

Follow the steps below when the LIS applicant does not have a MEDS record: For LIS written policy, Refer to Medi-Cal handbook [“Low Income Subsidy Applications,” page 9-21] for policy.



8. Application Support/ Control Clerk




Step Who Action

1. Info Systems On a daily basis, posts Alerts 9055 in a report titled “Low Income Subsidy Applications” in Business Objects (BO) under Public Folders/DEBS/ AAC_A5 and VMC/Administration.

Step Who Action



2. Designated Clerical Staff at VMC

• Prints the “LIS Applications” report from BO daily.

• Completes file clearance procedures in CalWIN and MEDS.

• For applicants that already have an active or pending case, sends an e-mail notification to the current EW and copies the EW Supervisor. On the subject line, enters “Urgent - LIS Alert 9055.”

- For applicants with the same last name, checks address on the [LIS2] screen to see if they are spouses. If they are, app reg them in the same case.

• Completes the Application Registration process in CalWIN.

- Use the APPLICATION-DATE shown on the [LIS1] screen.

• Select “Low Income Subsidy” from the Application Source drop down field.

- Assigns the application to VMC Caseload # DMZ0.

• Prints and signs a copy of “Application For Cash Aid, Food Stamps, And/or Medi-Cal” (SAWS 1).

• Creates an application packet consisting of the following form and MEDS screens:

• Application for Cash Aid, FS and/or MC (SAWS 1)• Primary Medi-Cal/CMSP Information Screen (INQM)• Other Client Eligibility Information Screen (INQE)• LIS Inquiry, Client Data Screen (LIS1)• LIS Inquiry, Client Information Screen (LIS2)

• Sends the Medi-Cal Application with the following two packets of forms to the applicant along with a pre-addressed, postage paid envelope. Enter name, case # and due date (10 calendar days from current date) on the SCD 2269 and SCD 2270. SIGNATURE PACKET:

• Important Info on MC/MSPs (SCD 2269)• Supplemental Questions for MC/MSP (SCD 2270)• Statement of Citizenship/Alien Status (MC 13)• Notice Regarding Standards for MC Elig (DHCS 7077)• Notice Regarding Transfer of a Home (DHCS 7077 A)• Would You Like to Register to Vote (SCD 508).

INFORMATIONAL PACKET:

• Important Info for Persons Requesting MC (MC 219)• Important Info for Nursing Home Patients (MC 004)• Medi-Cal General Property Limitations (MC 007)• Important Info MC Beneficiaries-LTC (MC18)• Breast & Cervical Cancer Treatment (MC 372)• Medi-Cal What It Means to You (PUB 68)• Keep Your Medi-Cal on Target (SCD 391)• Papers Needed for MC Determination (SCD 1481)

Step Who Action



2. Designated Clerical Staff at VMC continued...

Sends CalFresh applications with the following items:

• CalFresh application packet. [Refer to CP HB 24.1.4 and 24.2.2]

• “Good News for Seniors Receiving Social Security Benefits” (SCD 2329)

• A VMC pre-addressed, postage paid envelope (writes LIS on the envelope).

3. Client • Returns application packet(s)

4. Designated Clerical Staff at VMC

• Conducts application registration for the requested program(s).

• Enters the Special Indicator “CF-LIS” if CF application is returned.

• Creates and assigns a TMT ticket.

5. Intake EW Receives TMT ticket

If the client returns the... Then...

Medi-Cal forms, Follows the instructions outlined in step 6 below.

CalFresh application, Follows the Telephone Interview procedures for a new CalFresh application. [Refer to CP HB 57.1.2]

Step Who Action



6. Intake EW Follows the procedures below to process the LIS application:

If the applicant... Then...

Returns the SCD 2269 and marks that he/she does not want Medi-Cal or MSP,

Denies the application as it is considered a written withdrawal.

Does not return the SCD 2269 or SCD 2270 by the due date OR the mail comes back as returned mail,

Contacts the client by phone or in writing and allows 10 calendar days to provide.

NOTE: Documents the case record the type of contact and the results.

Returns the SCD 2270 (with or without the SCD 2269), or only the SCD 2269 but marks just one checkbox,

• Reviews LIS screens in MEDS and the SCD 2270 questionnaire.

• Requests additional information and verification from the client, if necessary. Allows 10 calendar days to provide. Documents the case record.

• If the applicant is ELIGIBLE, approves Medi-Cal/MSP using the Application Date shown on the [LIS1] screen.

• If the applicant is INELIGIBLE, denies Medi-Cal/MSP with an appropriate NOA.

Step Who Action



57.2 VMC Process: Add-a-Program & Add-a-Person

57.2.1 Purpose

The VMC Bureau acts as a vehicle to ensure that when there is a Medi-Cal application taken at HHS, the referral along with verifications and forms, are forwarded to the appropriate district office for processing. VMC staff also meets with HHS staff to review what is needed for the referral, but the assigned EW at the district office is responsible for reviewing the application for accuracy and following up with the client as needed.

57.2.2 Priority Mail Boxes

The following are the district office’s priority email addresses used by VMC to forward referrals to add a program (Medi-Cal) or to add a person when there is a corresponding case that resides in another office and the client needs to be added to the corresponding case, or program added, or added to MEDS:

Office Outlook Global Address Name

North County North County - VMC Referrals

South County South County Intake District Office

General Assistance GA

Continuing Benefits Services CBS Priority Mail

Application Assistance Center AAC - VMC Referrals

Benefits Services Center Medical



57.2.3 Adding-a-Program

Who Steps

VMC Clerical Staff at 650 Bascom

• Receives SAWS1 and the SCD 41 from HHS in the daily drop off of applications from them.

• ID’s the individual in CalWIN.• Registers the requested program (Medi-Cal) in CalWIN.• Places in IDM the SAWS1, SCD 41 and any accompanying paperwork.• Prints, scans and emails screen shot of the "Program" tab on the

[Inquire on Case Information] window in CalWIN as an email attachment to the Priority email mailbox of the district office where the case resides.

Note: The Subject line of the email should read “MC Add-a-Program."

Designated Receiving District Office

• Receives the email referral via the Priority Mailbox.• Creates and assigns a TMT assignment.

Receiving District Office EW

• Processes the TMT assignment.

57.2.4 Adding-a-Person

Who Steps

VMC Clerical Staff at 650 Bascom

• Receives the Add-a-Person packet from HHS in the daily drop off of applications from them, which includes the “Health and Hospital System Services Referral” (SCD 2384) indicating the effective date (HHS Service Date) cent is requesting Medi-Cal coverage.

• IDs the individual in CalWIN.• Places in IDM the Add-a-Person packet and any accompanying

paperwork.• Sends an email to the Priority email Mailbox of the district office where

the case resides, indicating that there is an Add-a-Person packet in IDM that needs to be assigned and processed.t

Note: The Subject line of the email should read, "MC Add-a-Person."

Designated Receiving District Office Staff

• Receives the email referral via the Priority Mailbox.• Creates and assigns a TMT assignment.

Receiving District Office EW

• Processes the TMT assignment.



57.2.5 Add-a-Person Medi-Cal Packet

VMC staff will coordinate with HHS financial counselors to ensure that the referral packet is complete. To help expedite the processing of HHS Medi-Cal referrals for adding a person to the corresponding case, the following forms and verifications are placed in IDM by VMC staff to be processed by the district office where the case resides:

Referrals for Adding a Child Referrals for Adding an Adult

Health and Hospital System Services Referral (SCD 2384), which includes Medi-Cal effective date.

Health and Hospital System Services Referral (SCD 2384), which includes Medi-Cal effective date.

When corresponding program is CalWORKs... When corresponding program is CalWORKs...

• CA 2.1 for deprivation

• Proof of income • Proof of income

• Proof of resources • Proof of resources

• Proof of citizenship/US residency • Proof of citizenship/US residency

When the corresponding program is not CalWORKs...

When the corresponding program is not CalWORKs...

• "Request for Tax Household Information (RFTHI)" SCD 2350, CSC 91, or MC 01-2014.

• "Request for Tax Household Information (RFTHI)" SCD 2350, CSC 91, or MC 01-2014.

• SCD 2350 Supplemental, CSC 91, or MC 01-2014 APDX-RFTHI.

• SCD 2350 Supplemental, CSC 91, or MC 01-2014 APDX-RFTHI.

57.2.6 EW Supervisor/EW Responsibilities at District Office

WHO ACTION

District Office Clerical

• Creates TMT and uploads email received from VMC into TMT.• Assigns TMT to EW.

EW Supervisor • Reassigns a closed case, if necessary.



EW • Receives VMC referral.• Follows up with the client, as appropriate, to obtain any additional or missing

information/verifications needed for adding the person or program to the case.

• Processes the application for the appropriate month(s) and approves or denies.

• Corrects any MEDS error(s), as needed.

Note:

When denying Medi-Cal for non-MAGI, itemizes the NOA with denial reason and inform client to contact Ability to Pay Program.

WHO ACTION
