Update 2014-26: Medi-Cal Background

Santa Clara County
Social Services Agency
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MEDIL# I-14-45
Handbook Revision:
Update 2014-26: Medi-Cal
Medi-Cal Eligibility for Deferred Action for Childhood Arrivals (DACA)
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).
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.
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 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.
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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.
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
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 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.
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.
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
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Implementation The information contained in this Medi-Cal Update is effective immediately
upon receipt.
The information contained in this Medi-Cal Update only affects the Medi-Cal
Department of Employment and Benefit Services
Contact Person(s): Idelle Villarreal, Application& Decision Support Specialist, (408) 755-7540.