Article 3, Section 2  Intercounty Transfers

 

Table of Contents

 

Title

MPG Cite

Intercounty Transfer Guidelines

3.02.01

Intercounty Transfer Packets

3.02.02

Access to Medical Services During/After the ICT

3.02.03

Miscellaneous ICT Case Process

3.02.04

 

 


 

3.02.01 Intercounty Transfers

 

A.
General

When a Medi-Cal beneficiary moves permanently or for an indefinite period from one county to another within the state, the old county (referred to here as the “Sending County”) is to transfer the responsibility for the maintenance of the individual’s Medi-Cal benefits to the new county (referred to here as the “Receiving County”).  The process of transferring responsibility for an individual’s Medi-Cal benefits from one county to another is called an Intercounty Transfer (ICT).

 

The statewide Electronic Intercounty Transfers (eICT) system connects all California counties allowing workers to electronically perform an ICT of a case from one county to another regardless of the system that county is using for eligibility determinations.  The eICT automates the processes that are essential to the transfer of client benefits throughout California counties.

 

MPG LTR 721 (3/11)

ACWDL

04-14

 

 

 

 

 

 

 

 

 

 

 

County Policy

 

B.
ICT Guidelines

1.    Counties cannot require an individual to apply or reapply for Medi-Cal or complete a redetermination packet based solely on the individual moving from one county to another within the state.

 

2.    The Sending County may not terminate Medi-Cal when an individual moves from one county to another until an effective date of benefits for the individual in the new county is confirmed.

 

3.    Workers in both Sending and Receiving Counties must ensure all Medi-Cal cases remain active throughout the ICT period with no interruption in benefits.

 

4.    The Receiving County shall not require the individual to complete a new application or a full eligibility review until the next redetermination date, as established in the case by the Sending County.

ACWDL

03-12

 

C.
Initiating ICTs

When a Medi-Cal beneficiary reports a permanent change of county residence or that he/she is living in another county for an indefinite period, the Sending County worker must initiate an ICT using the eICT system within 3 business days.  The worker must complete the following steps.

 

Step

Action

1

Confirm the beneficiary’s new address and telephone number.

2

Change the beneficiary’s address and county residence.

3

Initiate the ICT process.

4

Determine documents that need to be attached to the eICT in DoReS.

5

Notify the Receiving County by submitting the completed ICT.

 

MPG LTR 721 (3/11)

 

D.
Incoming ICTs

All incoming ICTs to San Diego County are received through Benefits CalWIN via the eICT system.  ACCESS OAs are responsible for the retrieval, clearance, and application registration.  External Referral Application (ERA) workers will process all Medi-Cal ICTs coming into San Diego County not pending at an FRC.  When the ICT is pending to an FRC, ACCESS will assign the case to the associated ICT case bank and forward the ICT packet to the FRC ICT Liaison for processing.

 

MPG LTR 721 (3/11)

County Policy

 

E.
ICT Transfer Period

The Receiving County shall complete the ICT within 30 days of receipt of the ICT packet.  The beginning date of aid in the Receiving County shall be determined by the date the ICT packet is received.  For example, if the packet is received May 1, the ICT transfer will be effective June 1.  However, if it was received on May 15, the transfer will be effective July 1.

 

MPG LTR 721 (3/11)

 

F.
Receiving Action

The eICT function allows the worker to receive ICT case data and imaged documents.  The following table shows the steps the worker must take.

 

Step

Action

1

Retrieve the ICT using the eICT system.

2

Verify the individual’s current address and active Medi-Cal status on MEDS.  Ensure the Sending County updated new address and new county of residence on MEDS so beneficiaries can access medical care in the Receiving County during the ICT period.

3

Complete case clearance and application registration within one workday of receipt of the ICT packet.

4

Contact the Sending County worker listed in the ICT packet if there are questions regarding the ICT or if there are missing documents.

5

Process the ICT within 30 days of receipt of the ICT packet and send appropriate client correspondence.

6

Verify that the correct county address and residence county code are on MEDS for the future month.

7

Automatic notification occurs when the eligibility determination has been completed.  The case disposition is sent to the Sending County.  This automatic notification allows the Sending County to take action to terminate benefits in their County.

 

MPG LTR 721 (3/11)

County Policy

 

G.
Reasons for not Initiating an ICT

An ICT is not required if the individual:

·   Reports loss of California residency

·   Sends in a written request to discontinue Medi-Cal benefits

·   Is incarcerated

·   Is ineligible due to institutional status

·   Is deceased

·   Is an incompetent long-term care (LTC) individual and a family member/representative residing in San Diego County requests that the case not be transferred when the individual moves out of the county.

ACWDL

03-12

 

H.
FRC Walk-Ins

When an individual with an active Medi-Cal case in another county walks in to an FRC and reports that he/she is now a San Diego County resident, the worker assigned to the individual shall not require him/her to complete a new application.  Instead, the worker will take the following steps.

 

Step

Action

1

Verify the individual’s current Medi-Cal status on MEDS.

2

Initiate the ICT process by sending an eICT request to the current county of record on MEDS.

3

Explain the ICT process to the beneficiary.

4

Process the incoming eICT when received.

 

Certain beneficiaries discontinued in the Sending County for whereabouts unknown or for an incomplete redetermination can also receive an ICT.  See MPG 3.2.4, below, for information regarding how to process these individuals.

 

MPG LTR 721 (3/11)

 

I.
Evaluating for Ongoing Eligibility after the ICT is Complete

An ICT is complete when San Diego County has taken over the MEDS record, the case is active in CalWIN and the correct address and county code are on MEDS.

 

If ...

Then ...

information is received indicating that there was a change in circumstances (other than the ICT) that could affect a beneficiary’s ongoing eligibility

After the ICT is complete, workers are allowed to re-evaluate the beneficiary for ongoing eligibility.

 

The following are examples of changes in circumstances during an ICT that would justify an eligibility evaluation after the ICT is complete.

 

·   Additional family members were added to the MFBU, which may result in Sneede income and property computation.

·   There is a new MFBU composition, which would result in changes in aid category, ineligibility or reduced benefits for some members of the household.

·   There is new income or property information that could affect the eligibility of MFBU members.

 

When following up on changes that can affect ongoing eligibility, workers must always do an ex parte review based on SB 87 guidelines.  They must not request information that:

·   has been previously provided and is not subject to change

·   can be verified on MEDS

·   is not necessary to complete the eligibility evaluation.

 

If the worker cannot complete the evaluation based on the ex parte review, he/she is allowed to request the information from the beneficiary.  If the beneficiary does not comply with the worker’s request for information, the worker will discontinue the case following SB 87 guidelines.

 

MPG LTR 721 (3/11)

 

J.
ICT
Reference Material

“How-Tos” for the eICT process can be found on the CalWIN Intranet here.

·   HT172 Send an Inter-County Transfer

·   HT173 Cancel an Inter-County Transfer

·   HT174 Request an Inter-County Transfer

·   HT 175 Process Received Inter-County Transfer

 

MPG LTR 721 (3/11)

 


 

3.02.02 Intercounty Transfer Packets

 

A.
General

When the Sending County worker is informed of a beneficiary’s move (either permanent or for an indefinite period) to another county within the state, the worker must send an eICT request to the Receiving County within 3 calendar days.

 

MPG LTR 721 (3/11)

 

B.
ICT Packet Requirements

·   The ICT request from the Sending County must contain all information necessary for the Receiving County to initiate a Medi-Cal case for the individual.

 

·   The Sending County must ensure any documentation supporting the individual’s eligibility is attached to the eICT.

 

·   If the Sending County is unable to attach the documents or verifications, the Sending County must notate in the eICT comment box all income and property that was verified by a worker.

 

MPG LTR 721 (3/11)

 

C.
Receiving County Responsibility

1)    The Receiving County must make every effort to contact the Sending County and complete an ex parte review if additional information is needed.

 

2)    The Receiving County must not delay processing the ICT while waiting for additional information from the Sending County because the receipt of benefits is not contingent upon the transfer of case documents from one county to another.

 

D.
Documents required in ICT Packet
Documents required in the ICT packet:

·   Current statement of facts and appropriate supplements including the MC 210S-W for Primary Wage Earner or the last redetermination form (MC 210 RV);

 

·   Identification verification and social security numbers;

 

·   Budget worksheets for MFBU/MBU (manual or computer generated);

 

·   Description of MFBU/MBU;

 

·   Last NOAs for eligibility or SOC;

 

·   Case comments for the past 12 months; and

1)   Copy of ICT Informing Notice sent to the individual. The following imaged documents are also required in the ICT packet if applicable:

·   Income or property verification (MC 176P) or case comments of how income or property was verified for current eligibility;

 

·   Pregnancy verification for full-scope benefits;

 

·   MC13;

 

·   DHS 6155 (Other Health Coverage Information);

 

·   CW 2.1 (Child, Spousal and Medi-Cal Information), including any court orders for child/spousal support;

 

·   CA-5 (Veteran’s Referral);

 

·   Copy of DDSD decision or verification of incapacity; and

 

·   Authorized Representative form or letter. 

 

MPG LTR 721 (3/11)

 


 

3.02.03 Access to Medical Service During/After the ICT

 

A.

General

For ICTs, the new residence county and address must be updated on MEDS as soon as possible to facilitate the beneficiary’s access to medical care both during and after the ICT transfer period.

 

B.
New Residence County Code and Address on MEDS

1)    When initiating an ICT, the worker must submit a request to the FRC MEDS clerk for an online MEDS transaction to update the county of residence on MEDS for each individual in an ICT case.  Entering the new residence address will send an update transaction to MEDS in the batch process, but the county of residence code can only be updated online.

 

2)    Whenever possible, address changes are to be made before MEDS cutoff the month the move was reported to the county.

 

3)    Any address changes made after MEDS cutoff will not take effect on MEDS until the first of the following month.

 

4)    Timely reporting of address/ county of residence code changes to MEDS will facilitate the beneficiary’s access to health care service or emergency disenrollment from a health plan during the ICT.

 

C.
Access to Care

1)   Beneficiary enrolled in Managed Care in a Sending County

When a beneficiary enrolled in managed care in a Sending County moves to a Receiving County, he/she will not be able to access routine medical care or get prescription refills without prior authorization until he/she is disenrolled from the managed care plan in the Sending County. To be disenrolled from a managed care plan, the new address and residence county must be updated on MEDS; the beneficiary will be disenrolled the first of the month following the next MEDS cutoff.

 

If ...

Then ...

An ICT beneficiary enrolled in a Sending County plan contacts the sending or receiving county and indicates he/she does not have access to medical services/ prescriptions,

Instruct the beneficiary to contact the DHS Medi-Cal Managed Care, Office of the Ombudsman at 1-888-452-8609 for assistance with emergency disenrollment or for prior authorization.

 

 Geographic Managed Care

San Diego County is a Geographic Managed Care County (GMC). ICT beneficiaries who move to our county will initially receive fee-for-service Medi-Cal once their new residence county (37) is effective on MEDS. The following table provides additional information on these beneficiaries.

 

If the beneficiary...

Then ...

Is not in a mandatory enrollment aid code or had an exemption,

They will continue to receive fee-for-service Medi-Cal.

Is not in a mandatory enrollment aid code but wants to enroll in a managed care plan,

Instruct the beneficiary to contact Health Care Options (HCO) at 1-800-430-4263 for plan information and enrollment options.

Is in a mandatory enrollment aid code,

They must enroll in a managed care plan or they will be defaulted into one.  They will get fee-for-service Medi-Cal until enrolled.

Requests information regarding health plan choices,

Instruct the beneficiary to contact Health Care Options (HCO) at 1-800-430-4263 for plan information and enrollment options.

2)    County Organized Health Systems (COHS)

A beneficiary who moves to a COHS county will automatically be enrolled in that county’s health system. This happen the first of the month following MEDS cutoff after the new address and residence county have been updated on MEDS. There are five COHS plans covering eight counties, they are:

 

 

·   Santa Barbara,

 

·   San Mateo,

 

·   Orange,

 

·   Solano/Napa/Yolo,

 

·   Santa Cruz/Monterrey.

 


 

3.02.04 Miscellaneous ICT Case Processing

 

A.
General

This section provides instructions on processing various ICT case situations.

 

B.
Beneficiaries Discontinued for Whereabouts Unknown

The following two tables provide information regarding how to process individuals who were discontinued in a Sending County for whereabouts unknown.

 

Within 30 days of the whereabouts unknown discontinuance

If the individual contacts the …

Then the …

Sending County

Sending County worker shall:

1.    restore the individual’s case without a break in aid

2.    notify the individual that an ICT will be initiated to the Receiving County

Receiving County

Receiving County worker shall:

1.    contact the Sending County worker to request that the individual’s case be reinstated and the ICT initiated

2.    Instruct the individual to contact the Sending County to:

§ ensure the case is restored and the ICT is initiated

§ report other changes associated with the change

 

The individual contacts either county 30-60 days from the whereabouts unknown discontinuance

If the …

Then the …

Sending County has erroneously terminated the individual’s benefits

Sending County worker must:

1.    restore benefits to the individual

2.    initiate an eICT

individual has evidence of good cause

Sending County correctly terminated the individual’s benefits

the individual will have to apply for benefits in the Receiving County

 

 

C.
Annual Redetermination

The following two tables provide information regarding how to process ICTs that have an RV due or overdue.

 

Sending County

 

If …

Then …

Due/Overdue RV

The RV is:

·   initiated

·   due

·   overdue

when the Sending County worker is notified of the move

the worker must not delay initiating the ICT

RV Information Received During ICT Period

The Sending County worker has initiated an RV prior to sending the ICT

Any RV forms or verification the worker receives shall be forwarded to the Receiving County for follow up

Beneficiary Ineligible

During the transfer period, the Sending County worker receives information from the RV process that clearly demonstrates that the individual or MFBU cannot be eligible for Medi-Cal

the worker shall:

·   discontinue Medi-Cal benefits, following 10-day notice

·   notify the Receiving County of the discontinuance

·   rescind the ICT, if appropriate

 

Receiving County

 

If the …

Then …

Due/Overdue RV

annual RV is:

·   due

·   overdue

during the ICT period

it is the responsibility of the Receiving County to process the annual RV.  The Receiving County worker cannot reject an ICT based solely on the RV being due/overdue.

Uncooperative

beneficiary does not cooperate in the redetermination process

the Receiving County worker can discontinue benefits following SB 87 guidelines.

 

 

D.
Individuals Discontinued for Failure to Complete the Annual RV

The following two tables provide instructions regarding how to process ICTs for individuals discontinued in the Sending County for failure to complete the annual RV.

 

Within 30 days of discontinuance for failure to complete the annual RV

If the individual contacts the …

Then the …

Sending County and completes the annual RV

Sending County must:

1.    restore the individual’s benefits

2.    promptly change the address and county of residence code

3.    initiate an ICT to the Receiving County

4.    forward any information received to the Receiving County

Receiving County within 30 days after the discontinuance

Receiving County must:

1.    shall not require a new application

2.    assist the individual in completing the RV forms

3.    ask the Sending County to rescind the discontinuance and ask them to initiate an ICT

4.    contact the Sending County for copies of verifications and documentation already in the case file in that county

5.    ask the individual to provide only new or changed information

6.    ensure the individual’s Medi-Cal is activated in the Receiving County with no interruption in benefits

 

More than 30 days after discontinuance for failure to complete the annual RV

If the individual contacts …

Then …

either county

the individual is to be instructed to reapply in the Receiving County

 

 

E.
MSR

The following table provides instructions on processing Midyear Status Reports (MSR) for ICT cases.

 

Responsibility for Processing MSR

MSR due prior to initiating ICT

The Sending County worker shall not delay initiating an ICT in the MSR due month because the MSR sent to the beneficiary is pending.

MSR due during ICT period

The Sending County worker shall:

·   discontinue as appropriate any MSR non-exempt individuals in the case if the MSR is not returned

·   discontinue the case and contact the Receiving County to rescind the ICT if an MSR is not returned and there are no MSR exempt beneficiaries in the case

·   forward to the Receiving County for follow up any MSR (complete or incomplete) received by the Sending County for an ICT case

·   follow up on any information reported on an MSR only if that information clearly indicates that the beneficiary or MFBU are ineligible; when doing so they are to take the following steps as appropriate

 

Step

Action

1

Discontinue benefits (following adequate 10-day notice) for any ineligible individuals and notify the Receiving County immediately.

2

Rescind the ICT if all beneficiaries in the case are ineligible.

 

MSR due after the ICT is completed

The Receiving County worker shall:

·   process the MSR received during the ICT period

·   follow SB 87 guidelines when processing MSRs that are incomplete or in which the beneficiary reports information that can affect on-going eligibility or SOC.

 

ACWDL

03-41

 

F.
Pending DDSD Cases
1)    Pending Disability determination with DDSD on cases with no other linkage

If there is a change in residence county reported for a pending DDSD case which consists only of an applicant whose potential basis of eligibility is the allegation of disability, the Sending County worker shall:

·   notify DDSD of the applicant’s new address

·   not initiate an ICT until a disability decision is received from DDSD

·   if the applicant is determined not to be disabled and there is no other linkage to Medi-Cal, the worker shall deny the application and send a denial notice; an ICT is not required as the individual has no eligibility

2)    Pending DDSD cases with active Medi-Cal

If a case has a pending DDSD decision and there are beneficiaries in the case already active on Medi-Cal then the Sending County worker shall initiate an ICT for the case.

3)    Correcting aid code/SOC after the disability determination

Beneficiaries in a SOC aid code are entitled to ABD-MN deductions back to the onset date if determined disabled by DDSD.  The following table provides instructions for processing these cases.

 

If the ...

Then ...

Receiving County worker receives a decision from DDSD indicating the beneficiary is disabled and there is a SOC in the case

The Receiving County worker shall take the following steps.

 

Step

Action

1

Recalculate the budget for the months the case has been active in the Receiving County

2

Change the aid code/SOC on MEDS as appropriate

3

Send a copy of the decision to the Sending County’s Disability Liaison

 

Sending County Disability Liaison receives a copy of the disability decision from the Receiving County

He/she shall forward it to the last worker of record, who will take the following steps.

 

Step

Action

1

Recalculate the budget for the months the case has been active in their county

2

Change the aid code/SOC on MEDS as appropriate

 

 

 

G.
Change in Child Custody
1)    Sending County responsibilities

If a child on Medi-Cal moves out of the county due to a change in custodial parent/caretaker, the Sending County worker must initiate an ICT packet for the child.  The packet shall include information on the child only.

2)    Receiving County responsibilities

The following table provides instructions regarding the Receiving County responsibilities for change in child custody cases.

 

Step

Action

1

If a new custodial parent or caretaker relative applies in a Receiving County for Medi-Cal for a child, and the child is active on Medi-Cal in another county, the worker must initiate an ICT for the child only.

2

After the ICT is complete, the Receiving County worker must perform an eligibility review based on the child’s new living arrangement with the new custodial parent or caretaker.

3

If the review results in a SOC for the child, and the child did not have a SOC previously, the child is to be placed in CEC for the remainder of the 12-month CEC period established in the Sending County case.

 

 

H.
AC 38 Cases

The following table outlines the steps to be taken when a beneficiary in Aid Code (AC) 38 moves to a Receiving County.

 

Step

Action

1

CalWORKs case discontinues for incomplete status report and rolls into AC 38 case.

2

The Sending County must initiate an ICT on AC 38 cases without delay.

3

After the transfer is complete, the Receiving County shall perform a Medi-Cal only eligibility evaluation following SB 87 guidelines.

 

 

I.
Four-Month Continuing Cases

The Sending County worker must initiate an ICT to the Receiving County when a beneficiary moves from one county to another during the four-month continuing period.  At the end of the four-month continuing period, the Receiving County must evaluate the beneficiary for ongoing Medi-Cal eligibility.

 

J.
TMC Cases

An ICT is required for Transitional Medi-Cal (TMC) cases.  The following table provides instructions regarding TMC cases with a status report due during the ICT period.

 

If the status report is ...

Then the ...

due at the same time the change of residence has been reported

Sending County worker must not delay the ICT while waiting for the status report

not returned and the ICT is already in process

The Receiving County worker shall:

1.    discontinue the TMC case; an AC 38 case will be generated

2.    evaluate the beneficiary for eligibility under other Medi-Cal Programs following SB 87 guidelines

3.    activate or discontinue the beneficiary as appropriate

returned (complete or incomplete) and the ICT is already in process

The Sending County shall forward it to the Receiving County for follow up.

 

ACWDL

01-36

 

K.
IHSS-Linked Medi-Cal Cases

When an In-Home Supportive Services (IHSS) beneficiary moves to another county, the Sending County worker must complete a Medi-Cal evaluation.  If the beneficiary is eligible to ongoing benefits, a Medi-Cal only ICT must be initiated, even if the IHSS benefits are discontinued.

 

L.
CEC

The Continuous Eligibility for Children (CEC) period shall not change for a child when the case is transferred from one county to another.  The CEC period is twelve months from the initial eligibility determination or last annual redetermination in the Sending County case.

 

M.
Former Foster Care Children

If a child in a Former Foster Care Child (FFCC) aid code 4M moves to another county, an ICT is required.  Workers are to refer to MPG 5.15.10 for more information regarding FFCC cases.

 

N.
Craig v. Bonta

·   The worker shall notify the Receiving County by means of the MC 360 that the Craig beneficiary moved to their county.

 

·   An ICT packet is not necessary since there is no actual case file for an individual in a Craig aid code (these aid codes are under State control).

 

·   The worker must submit a request to the FRC MEDS clerk for an online transaction to transfer the beneficiary to the Receiving County on MEDS.  Refer to MPG 4.16 Appendix C Craig v. Bonta Automation Instructions for details.

 

O.
Homeless

The following table provides ICT instructions for homeless beneficiaries.

 

If the beneficiary ...

Then an ICT ...

declares that he/she maintains a P.O. Box in another county for mail pickup and delivery but intends to remain in the Sending County

is not necessary

moves to another county or request their case be transferred to another county

must be initiated

 

 

P.
CalWORKs ICTs

·   If the Receiving County does not approve a CalWORKs ICT, a Medi-Cal only ICT for the case must be processed.

 

·   In San Diego, ICTs referred to Medi-Cal because the incoming CalWORKs ICT was denied, shall be assigned to a Medi-Cal Intake worker in the appropriate FRC for the case ZIP code.

 

·   The Medi-Cal worker must not delay processing the Medi-Cal ICT while waiting for additional information from the Sending County; the receipt of benefits is not contingent on the receipt of these documents.

 

·   When additional information is needed, the worker must first attempt to get the information from the Sending County before contacting the beneficiary.

 

·   A CalWORKs Intercounty Transfer Continuation Request for Additional Documents form (CW 215A) was developed to request additional information/documentation needed from the Sending County to determine the family’s continued Medi-Cal eligibility.

 

·   The Annual RV due date for Medi-Cal shall be the same date established under CalWORKs before the case was discontinued.

ACWDL

04-14

 

Q.
Retroactive Requests

The following table provides information regarding processing requests for retroactive benefits for ICT cases.

 

If the beneficiary requests retroactive benefits ...

Then the ...

during the ICT transfer period

Sending County worker shall process the request, since the case is still active there

after the ICT transfer period, and the request is for the period prior to the application month in the Sending County

Receiving County worker is responsible for processing the request.

 

Note:  If the request is for the budget to be recalculated for a period in which the beneficiary was active in another (Sending) county, it is that county’s responsibility to process it.  San Diego County staff who receive such requests are to contact Medi-Cal Program for assistance in forwarding the request to the Sending County Medi-Cal Policy Liaison.