California Department of Healthcare Services

What if acceptable evidence is provided after restricted benefits are granted? ............... page 32

• Question 1:  If a beneficiary is reduced to restricted coverage because evidence of citizenship/identity was not provided, then has a break in aid and subsequently provides evidence of citizenship/identity, will full scope be restored back to the original month that coverage was reduced if it is within 12 months? 
• Answer 1:  Yes, applicants or beneficiaries who receive restricted Med-Cal for failure to provide evidence of citizenship/identity will have their full-scope eligibility restored (22 CCR 50089) back to the month that restricted-scope eligibility began, if they provide the required evidence up to one year after their application or redetermination date and have good cause.        
• Question 2:  If an applicant is approved for restricted benefits, has a break in aid, then reapplies and provides acceptable documents at reapplication, will full scope be granted from the reapplication date?      
• Answer 2:  Yes, if a person reapplies (22 CCR 50081) and provides acceptable documents at reapplication, full-scope eligibility would be effective as of the reapplication date.      
• Question 3:  ACWDL 07-12 states that full scope eligibility can be restored back to the application date including any retroactive eligibility if an applicant/beneficiary provides evidence of citizenship/identity within 12 months of their application date.  ACWDL 07-12 also states an applicant/beneficiary having good cause for not providing the required documents can receive full scope Medi-Cal.  Additionally, the suggested notice language included in the letter does not indicate that good cause is required to restore full scope eligibility.  Please clarify.      
• Answer 3:  An applicant or beneficiary declaring U.S. citizenship or national status that is granted restricted Medi-Cal because they failed to meet the citizenship/identity documentation requirements can be eligible for full Medi-Cal if the required documents are provided within one year of the date of application or redetermination by showing good cause as described in ACWDL 07-12, P.32.  We will review the notice language and make any necessary changes.        
• Question 4:  When the good faith effort ceases and the applicant is granted restricted benefits, what is the date that full scope benefits would be established when the citizenship/identity documents are presented with or without good cause after 12 months?  For example; an applicant is receiving restricted benefits as of 1/08 and continuing, then provides documents establishing citizenship in 3/09 (which is more than12 months after restricted Medi-Cal began), what date would full scope be granted?      
• Answer 4:  If documents are presented in 3/09 with or without good cause, because it has been over 12 months, full scope can only be granted as of 3/09, the date the documents were presented. 
• Question 5: (Posted 11/02/07): What is the appropriate action that should be taken when there is a break in aid and there is or is not good cause?
• Answer 5: (Posted 11/02/07): Applicants or beneficiaries who receive restricted Medi-Cal for failure to provide evidence of citizenship/identity should have their full-scope eligibility restored back to the month that restricted-scope eligibility began, if they provide the required evidence up to one year after their application or redetermination date and have good cause. If it is determined that the recipient does not have good cause, the individual should only receive full scope benefits beginning the first of the month they have complied with the citizenship documentation requirements.