Santa Clara County Social Services Agency page 1 Date: 10/31/14 References: MEDIL# I-14-45 Cross-References: None Clerical: Yes Handbook Revision: No Update 2014-26: Medi-Cal Medi-Cal Eligibility for Deferred Action for Childhood Arrivals (DACA) Background On June 15, 2012, the Secretary of Homeland Security announced that certain people who came to the United States (U.S.) under the age of 16 and meet other specified criteria may request consideration of deferred action status for a period of two years, subject to renewal. Individuals who can demonstrate through verifiable documentation that they meet the guidelines will be considered for deferred action by United States Citizenship and Immigration Services (USCIS). Policy Individuals with DACA status are eligible for state-funded, full scope Medi-Cal (MC) if they meet all eligibility requirements. Deferred action status is listed among the existing Permanently Residing in the United States Under Color of Law (PRUCOL) categories that are eligible for state-funded full scope MC. APTC/CSR Under the Affordable Care Act (ACA), DACA individuals are not considered to be lawfully present for purposes of purchasing insurance coverage through Covered California. This exclusion only applies to Advance Premium Tax Credit (APTC)/ Cost Sharing Reduction (CSR), it does not apply to Modified Adjust Gross Income (MAGI) MC. Verification Verification of DACA is initiated by entering the information provided on the application into CalWIN. EWs may accept a verbal declaration of immigration status (i.e. over the phone) and note the individual’s status declaration in CalWIN on the Maintain Case Comments window. page 2 Electronic Verification Update 2014-26: Medi-Cal Electronic verification of DACA status is first done using the information provided on the application via an e-HIT from CalWIN to the federal hub (CalHEERS). If DACA status cannot be electronically verified via the federal hub, the EW must use the manual Systematic Alien Verification for Entitlements (SAVE) process to verify the individual’s DACA status. Verification If electronic verification of DACA status fails, applicants have 90 days to Documentation provide documentation. If the documentation is not provided within 90 days, MC benefits must be reduced from full-scope to restricted scope. Documentation of DACA status may include an Employment Authorization Document (EAD) with the status code “C-33” and/or a Form I-797 Notice of Action. If an individual claims DACA status but a document other than an EAD or I-797 is provided to the county, the document should be verified through the SAVE process. If satisfactory immigration status for full scope MC is not verified by the SAVE process, MC benefits must be reduced to restricted scope MC, if the individual meets all other MC eligibility. MC 13 Even though the MC 13 is no longer a required form, the MC 13 should only be used if the individual’s DACA status is not verified through the federal hub and the EW is unable to determine the immigration status the client is claiming. DACA individuals who complete an MC 13 to declare their DACA status are expected to claim deferred action status on the form. An applicant who attests to having DACA status (verbally or in writing or who claims deferred action status on the MC 13), must be granted full scope MC while immigration status is verified, if they meet all other MC requirements. CalHEERS CalHEERS is not currently programmed to determine if an individual meets the PRUCOL requirements or the extent to which a Lawful Permanent Resident (LPR) is under or over the 5 year bar. Therefore, DACA individuals may be determined eligible for restricted scope benefits when they are otherwise be eligible for full scope MC benefits. MEDS/ BLO The EW must process the case in CalWIN. If needed, complete a Bottom Line Override (BLO) and SCD 1296 to ensure the DACA individual is granted full-scope MC benefits. MTO The (MEDS Terminal Operator (MTO) must ensure that an “S” is entered in the Citizen/Alien indicator field in MEDS, in order to indicate “other documented full scope alien” and to ensure proper funding of the services provided to this population. Update 2014-26: Medi-Cal page 3 Implementation The information contained in this Medi-Cal Update is effective immediately upon receipt. Other Programs The information contained in this Medi-Cal Update only affects the Medi-Cal program. DENISE BOLAND, DIRECTOR, Department of Employment and Benefit Services Contact Person(s): Idelle Villarreal, Application& Decision Support Specialist, (408) 755-7540.