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Program Policy: Medi-Cal

Published on: 4/11/2017 5:09 PM

This page contains all of the policy documents related to the Medi-Cal program. To open a document, click the underlined text in the "Name" column. Clicking the buttons below will scroll the page down to the Update and Policy Interpretation sections.

updates policy interpretations

​Handbook Chapters

mc.bkIXMedi-Cal Handbook Index
mc.bkTOCMedi-Cal Handbook Table of Contents
mcchap01Chapter 1: Medi-Cal Overview
mcchap02Chapter 2: Covered CA Overview
mcchap03Chapter 3: Acronyms & Definitions
mcchap04Chapter 4: Inquiries & Resources
mcchap05Chapter 5: Applications
mcchap06Chapter 6: Citizenship/Immigration Status
mcchap07Chapter 7: Residency
mcchap08Chapter 8: Verifications
mcchap09Chapter 9: Budgeting
mcchap10Chapter 10: Redeterminations
mcchap11Chapter 11: Ex Parte Process
mcchap12Chapter 12: Denials/Discontinuances
mcchap13Chapter 13: Reporting a Change and Notices of Action
mcchap14Chapter 14: Health Care Options (HCO)/Managed Care
mcchap15Chapter 15: Inter County Transfer (ICT)
mcchap16Chapter 16: MAGI MC Tax Household
mcchap17Chapter 17: MAGI MC Income
mcchap18Chapter 18: eHIT
mcchap19Chapter 19: Transitions (MAGI/Non-MAGI/APTC)
mcchap20Chapter 20: External Referral Data
mcchap21Chapter 21: External Change Data
mcchap22Chapter 22: Reserved for Future Use
mcchap23Chapter 23: Reserved for Future Use
mcchap24Chapter 24: Non-MAGI MC MFBU
mcchap25Chapter 25: Non-MAGI MC Income
mcchap26Chapter 26: DDSD
mcchap27Chapter 27: DDSD
mcchap28Chapter 28: Pickle and Aged, Blind, and Disabled (ABD) Programs
mcchap29Chapter 29: Long Term Care (LTC)
mcchap30Chapter 30: Medi-Care Coverage
mcchap31Chapter 31: Medically Needy (MN) & Medically Indigent (MI)
mcchap32Chapter 32: 250% Working Disabled Program (250%WDP)
mcchap33Chapter 33: Share of Cost (SOC)
mcchap34Chapter 34: 1931B
mcchap35Chapter 35: Continued Eligibility for Pregnant Women, Infants, and Children (CE, DE, CEC)
mcchap36Chapter 36: FPL Programs
mcchap37Chapter 37: Transitional Medi-Cal (MC)
mcchap38Chapter 38: Minor Consent
mcchap39Chapter 39: Specific Institutional Programs
mcchap40Chapter 40: Refugees/TCVAP
mcchap41Chapter 41: State/County Administered Health Insurance Program
mcchap42Chapter 42: State Waiver Programs and Limited Services
mcchap43Chapter 43: Special Treatment Programs
mcchap44Chapter 44: Reserved for Future Use
mcchap45Chapter 45: Diligent Search/Estate Recovery/Fraud Referrals
mcchap46Chapter 46: Other Health Coverage (OHC)
mcchap47Chapter 47: Third Party Liability (TPL)
mcchap48Chapter 48: In-Home Supportive Services (IHSS)
mcchap49Chapter 49: Benefits Identification Cards, Overpayments, Billing & LOA (BOBLOA)
mcchap50Chapter 50: Court Orders


Handbook Updates

mc17-47.updProcessing Applications from Individuals Affected by Disasters
mc17-46.updUpdate 17-46: The Work Number
mc17-45.updUpdate 17-45: Ex Parte and Transitioning from CW to MC
mc17-44.updUpdate 17-44: IRS MEC Reporting and 1095B
mc17-43.updUpdate 17-43: Retroactive MC When Adding a Person
mc17-42.updUpdate 17-42: TMC and CEC
mc17-41.updUpdate 17-41: County Inmate Compassionate Release Medical Probation Program
mc17-40.updMC 17-40: Uploading CalHEERS Results on CF/MC, GA/MC, CAPI/MC Combo Cases
mc17-39.updUpdate 17-39: Denial Notice for Medicare Savings Programs
mc17-38.updUpdate 17-38: CalHEERS BRE Call Reasons
mc17-37.updEligibility for IAP Based on Immigration Status
mc17-36.updUpdate 17-36: MCAP Transition to Medi-Cal
mc17-35.updUpdate 17-35: MC Eligibility for Same-Sex Spouses
mc17-34.updUpdate 17-34: MC 210 or SOF for Minor Consent
mc17-33.updUpdate 17-33: Informing SSI of an MCIEP Individual
mc17-32.updUpdate 17-32: Covered CA Notices
mc17-31.updUpdate 17-31: Updated Income Types Chart in MC Chapter 17
mc17-30.updUpdate 17-30: Express Lane Enrollment Program Ended 6/30/2017
mc17-29.updUpdate 17-29: MCAP Managed Care
mc17-28.updUpdate 17-28: Mega-Mandatory and Medicare Savings Programs
mc17-27.updUpdate 17-27: Self-Attestation for Plan to File Taxes
mc17-26.updUpdate 17-26: MC Hierarchy
mc17-25.updUpdate 17-25: OTLICP and Participation in Home and Community-Based Services
mc17-24.updUpdate 17-24: Potential Third Party Liability Notification
mc17-23.updUpdate 17-23: Combined Mixed Medi-Cal Notice Generation (Intake and Retro)
mc17-22.updUpdate 17-22: Special Needs Trust Policy Change
mc17-21.updUpdate 17-21: State-Funded BCCTP Changes
mc17-20.updUpdate 17-20: Application Registration- Get Case Number CalWIN Window
mc17-19.updUpdate 17-19: Presumptive Eligibility for Pregnant Women Program Automation
mc17-18.updUpdate 17-18: MC Fraud Referrals- Form MC 609
mc17-17.updUpdate 17-17: Authorized Representative
mc17-16.updUpdate 17-16: Home Equity Conversion Plans
mc17-15.updUpdate 17-15: Unconditionally Available Income for MAGI MC
mc17-14.updUpdate 17-14: Medicare and MAGI MC Individuals
mc17-13.updUpdate 17-13: Statement of Citizenship, Alienage, and Immigration Status (MC 13)
mc17-12.updUpdate 17-12: New Federal Poverty Level (FPL) Amounts Effective 4/1/2017
mc17-11.updUpdate 17-11: MCAP Fee-for-Service System
mc17-10.updUpdate 17-10: 2017 Social Security Title II and Title XVI COLA and Related Changes
mc17-09.updUpdate 17-09: Chapter 15 Revisions (Revised 5/16/17)
mc17-08.updUpdate 17-08: CalHEERS Primary Contact in CalWIN (Revised 3/24/2017)
mc17-07.updUpdate 17-07:  MAGI Budget Information in CalWIN
mc17-06.updUpdate 17-06: California Earned Income Tax Credit
mc17-05.updUpdate 17-05: Restricted-Scope to Limited-Scope
mc17-04.updUpdate 17-04: Errata to MC Update 2016-5
mc17-03.updUpdate 17-03: AB 720 Health Trust Application
mc17-02.updUpdate 17-02: The Community Spouse Resource Allowance and Community Spouse Allocation
mc17-01.updUpdate 17-01: Low Income Subsidy (LIS) Referrals
mc16-47.updUpdate 16-47: 2016 Tax Filing Threshold
mc16-46.updUpdate 16-46: County of Responsibility for Inter-County Transfers (ICTs)
mc16-45.updUpdate 16-45: Authorized Representative for Pre-Release Inmates and Newly Released Individuals
mc16-44.updUpdate 16-44: Medi-Cal Eligibility for Former Foster Youth (Revised 2/15/2017)
mc16-43.updUpdate 16-43: County Process When Mail Is Returned Undeliverable
mc16-42.updUpdate 16-42: Application Registration from External Referral Data
mc16-41.updUpdate 16-41: Error Message 215
mc16-40.updUpdate 16-40: New Benefits Identification Card (BIC)
mc16-39.updUpdate 16-39: Medi-Cal Estate Recovery
mc16-38.updUpdate 16-38: Self-Attestation of Pregnancy
mc16-37.updUpdate 16-37: Closing Duplicate or Multiple CalHEERS Cases
mc16-36.updUpdate 16-36: Clarification of the Inter-County Transfer Process
mc16-35.updUpdate 16-35: Projected Annual Income
mc16-34.updUpdate 16-34: IHSS Wages in MAGI Eligibility Determination (Revised 5/1/17)
mc16-33.updUpdate16-33: Eligibile Immigrant Indicator in CalWIN
mc16-32.updUpdate 16-32: CalWIN Medicare Windows and CalHEERS
mc16-31.updUpdate 16-31: Pregnant Women and Qualified Health Plan
mc16-30.updUpdate 16-30: Non-Payment of Premium (NPP) Processes for the Optional Targeted Low-Income Children (OTLIC)(Revised 10/31/2016)
mc16-29.updUpdate 16-29: Carry Forward (APTC/CSR/QHP to MC)
mc16-28.updUpdate 16-28: Errata to Medi-Cal Update 2016-17
mc16-27.updUpdate 16-27: External Change Pending Batch Status
mc16-26.updUpdate 16-26: Errata to MC Update 2015-32
mc16-25.updUpdate 16-25: Employment Authorization Document Codes and Medi-Cal Scope
mc16-24.updUpdate 16-24: External Change Data (Chapter 21)
mc16-23.updUpdate 16-23: Unmarried Pregnant Women Under Age 21 Income Disregard (Revised 5/9/17)
mc16-22.updUpdate 16-22: MCIEP
mc16-21.updUpdate 16-21: 2016/2017 Family Member Base Allocation Amount
mc16-20.updUpdate 16-20: 250% Working Disabled EFT Web Address Change
mc16-19.updUpdate 16-19: Policy Guidance on Transitioning Cases from APTC to Medi-Cal
mc16-18.updUpdate 16-18: Errata to Medi-Cal Update 2016-10
mc16-17.updUpdate 16-17: Military Verification and Referral Form Procedure Change
mc16-15.updUpdate 16-15: Revision of MC 219 Rights and Responsibility Form
mc16-14.updUpdate 16-14: American Indian/Alaskan Native Income Exemptions
mc16-13.updUpdate 16-13: Full-Scope Medi-Cal Expansion for Pregnant Women
mc16-12.updUpdate 16-12: SB75 Health for All Children
mc16-11.updUpdate 16-11: New CalWIN Field - Suppress MAGI Determination
mc16-10.updUpdate 16-10: 2016 Social Security Title II and Title XVI COLA and Related Changes
mc16-09.updUpdate 16-09: Military Verification and Referral Form
mc16-08.updUpdate 16-08: New Federal Poverty Level (FPL) Amounts Effective 4/1/2016
mc16-07.updUpdate 16-07: Errata to Medi-Cal Update 2015-33
mc16-06.updUpdate 16-06: CCHIP
mc16-05.updUpdate 16-05: Internal Revenue Service Form 1095-B Mailing for Minimum Essential Coverage Recipients (Revised 2/10/17)
mc16-03.updUpdate 16-03: Former Foster Youth (FFY)
mc16-02.updUpdate 16-02: Disaster Assistance for MAGI and Non-MAGI MC
mc16-01.updUpdate 16-01: 2015/2016 Family Member Base Allocation Amount
mc15-35.updUpdate 15-35: Informing Notice of Internal Revenue Service Form 1095-B
mc15-34.updUpdate 15-34: Medi-Cal Handbook Modernization (Revised 04/11/17)
mc15-32.updUpdate 15-32: Baby Gateway (Revised 2/7/17)
mc15-31.updUpdate 15-31: Rivera v. Douglas Noticing Requirements and Procedures
mc15-29.updUpdate 15-29: Medi-Cal (MC) and Related Programs for State and County Inmates / Medi-Cal Inmate Eligibility Program (MCIEP)
mc15-28.updUpdate 15-28: Date Specific Policy Change to Medi-Cal Presumptive Eligibility Programs
mc15-27.updUpdate 15-27: Non-Citizen Victims of Human Trafficking, Domestic Violence and Other Serious Crimes - Trafficking and Crime Victims Assistance Program
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Policy Interpretations

mc16-02.piPolicy Interpretation 16-02: Income Verification
mc16-01.piPolicy Interpretation 16-01: Long Term Care (LTC) 30-Month Look Back
mc15-01.piPolicy Interpretation 15-01: Updating Income when Transitioning pre-ACA to ACA MC
mc13-01.piPolicy Interpretation 13-01: Referrals to a Social Security Administration for Unconditionally Available Income and Benefits
mc12-01.piPolicy Interpretation 12-01: Authorized Representative with Durable Power of Attorney
mc11-01.piPolicy Interpretation 11-01: Processing MIA Applications