Medi-Cal Handbook External Referral 20. External … 11/23/2016 Update # 2016-42 page 20-2 Medi-Cal Handbook External Referral During Covered California Open Enrollment period CalHEERS

Medi-Cal Handbook page 20-1External Referral

20. External Referral

Applications submitted through Covered CA (i.e. CalHEERS), which have potential Modified Adjusted Gross Income (MAGI) Medi-Cal (MC) eligibility are transferred to the applicant’s county of residence via the Statewide Automated Welfare System (CalWIN for Santa Clara County) External Referral Subsystem. The External Referral Data (ERD) must be processed and entered into the CalWIN system to disposition the application.

An Unsolicited Determination Eligibility Response (DER) interfaces from CalHEERS to the CalWIN External Referral Subsystem if:

• There is no current CalWIN case, or

• The CalWIN case was closed and information has been updated in CalHEERS.

Medi-Cal Handbook Chapter 18.6 illustrates the interface between CalWIN and CalHEERS.

The interface may occur at any time between CalWIN and CalHEERS when:

• A client applies through CalHEERS and has potential Medi-Cal (MC) eligibility,

• A Covered California client receiving Advanced Premium Tax Credit (APTC), Cost Sharing Reduction (CSR), and/or Qualified Health Plans (QHP) renews eligibility during the Covered California Renewal Period (beginning in October each year) and updates information indicating potential MC eligibility.

• A CalWIN case that has had a successful interface with CalHEERS closes but the client provides updated information through CalHEERS indicating potential MC eligibility.

20.1 Open Enrollment Results

Clients who apply for health coverage through CalHEERS during open enrollment will receive MAGI MC effective the month of their application if eligible. If a client is not eligible for MAGI effective the month of their application, CalHEERS will run and determine eligibility for January of the next open enrollment year.

Update # 2016-42 Revised: 11/23/2016

https://ssaconnect.sccgov.org/ssa_departments/debs_program/Documents/handbooks/medical/mcchap18.pdf


Revised: 11/2

page 20- Medi-Cal HandbookExternal

Dur al Referral DER for January of the follo DERs with Received status in the Sea ange from Received to OE Result. The OE and application registration completed with

3/2016 Update # 2016-42

2 Referral

ing Covered California Open Enrollment period CalHEERS sends an additional Externwing year. The day that the transaction takes place there will be two External Referralrch for External Referral window. Over night the January DER Referral Status will ch

Result line is for reference only. The earliest DER in Received status must be identified the earliest request date.


20.2 Carry Forward

Applications received through the External Referral Subsystem with a Carry Forward status should be processed first and assigned as "Urgent" to Eligibility Workers. [Refer to Table 20-1, “Identifying & Completing Application Registration for ERD,” on page 20-4] During Application Registration use Carry Forward for the Type.

Refer to Transitions Chapter 19.7 Carry Forward (APTC/QHP to MAGI)

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page 20-4 Medi-Cal HandbookExternal Referral

20.3 Identifying and Application Registration

This section provides step by step processes for identifying and completing application registration for CalHEERS applications received in CalWIN through the External Referral Subsystem.

Table 20-1: Identifying & Completing Application Registration for ERD

Step Action

1. Receives the listing of the day with CalHEERS cases in the External Referral Subsystem.

(1) Sort and prioritize the listing by Application Type:

a. Carry Forward

b. Blank or all other Application Types

(2) Sorts and prioritizes the listing by MAGI MC status:

a. Pending

b. Approved

c. Denied

Note: Priority is given to the application in Pending status.

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2. In CalWIN:

(1) Click on Interface Activities from the Select Function menu.

(2) Select Search for External Referral Data from the External Referral selection.

(3) Click on the [Open] button.

3. On the Search for External Referral Data window:

(1) Select CalHEERS from the Source Name field.

(2) Enter the CalHEERS case # (500xxx) in the Source ID field.

a. Also search by SSN to determine if another Source ID exists for the sameclient.

(3) Click on the [Search] button to display results.

(4) Select the case from Search Results.

• If there is more than one application listed for the same applicant, determine if there is a difference in data (i.e. Date, Name, etc).


Step Action

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If two or more records have... Then...

The same data, a. Select each duplicate record.

b. Click on the [Detail] button.

c. On the Maintain External Referral Detail window, on the [Applicant] tab, change the Status to Duplicate and enter the current date on the Status Date field.

d. Save & Close.

The same date but one (or more) is Pending and one is Approved,

a. Select the Pending record(s),



d. Save & Close.

Have different dates, but all other data is the same,

a. Select the oldest record(s).



d. Save & Close.

Note: The application date that is used during application registration must be the date of the oldest application; however, use the most current ERD.


Step Action

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• If the Program is CF/MC or CW/MC, DO NOT complete application registration for programs other than Medi-Cal through the CalHEERS ERD.

(1) Determine if there is a BCW application [Refer to CalWIN Announcement 328 Horizontal Integration in MyBCW for CalHEERS Applicants]

(2) If there is no MyBCW application for the other programs requested, send the client the applicable program’s application packet along with the coverletter, “Request for CalWORKs and/or CalFresh Benefits.”

(3) Document in the Maintain Case Comments window in CalWIN: “Applicant was sent to client per CalHEERS application External Referral request.”

• If the Non-MAGI column is Yes, document in the Maintain Case Comments window: “Non-MAGI evaluation requested.”

(4) On the remaining record, Click on the [Detail] button to initiate identification process and application registration.


Step Action

Update # 2016-42 Revised: 11/23/2016

https://ssaconnect.sccgov.org/ssa_departments/debs_program/Documents/calwin_searchable/calwin_announcements/ca_327.pdf


4. Performs Index Clearance to determine if there is already an existing case in CalWIN and/or MEDS.

On the Maintain External Referral Detail window:

(1) On the [Applicant] tab:

(2) Click on the [Summary View] button to enable CalHEERS information (on the right hand side).

(3) Click on the [Index Clearance] button to run clearance in order to verify it is a valid application (i.e. not already in CalWIN with a Pending or Approved status).

Note: Index Clearance from the Maintain External Referral Detail window can only be done for the applicant, not for the rest of the household individuals.


Step Action

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If There Is... Then...

No existing case in CalWIN, • Proceed with identification in MEDS and application registration in CalWIN.

• On the Maintain External Referral Detail window, on the [Applicant] tab, the Status will be updated to Completed.

• Assign to a designated EW.

A closed case in CalWIN (Closed for more than 90 days),

• Proceed with identification in MEDS and application registration in CalWIN. [Refer to “CalHEERS application with closed case in CalWIN,” page 20-12]

• On the Maintain External Referral Detail window, on the [Applicant] tab, the Status will be updated to Completed.

• Assign to a designated EW.


Step Action

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A closed MC case in CalWIN (Closed for less than 90 days),

Notify the Continuing Office which last held the MC case for that office’s clerical to create the TMT and assign to the unit who last worked on the closed case.

On the Maintain External Referral Detail window, on the [Applicant] tab, change the Status to Completed.

An existing MC case pending in CalWIN, Notify the District Office where the MC program is pending. The EW must explore potential linking [Refer to CalWIN Announcement 312.2 MLT]. [Refer to “CalHEERS application with pending Medi-Cal CalWIN application,” page 20-29]

Exception: If the Pending MC application is for DDSD, notify the appropriate Continuing office for that office’s create the TMT and assign to a continuing EW.

An existing case pending in CalWIN for any other program (not MC),

i.e. Pending CalWORKs, CalFresh, General Assistance, etc.

Notify the appropriate Intake office for the clerical staff to complete application registration from the ERD, and assign to the Intake EW, handling the pending case, to process the MC request.

Note: The Status will be updated after application registration is completed.

An active case in CalWIN for any other program (not MC),

Notify the appropriate Continuing office for the clerical staff to complete application registration from the ERD, create the TMT and assign to a Continuing EW to add the MC program.

Note: The Status will be updated after application registration is completed.

[Refer to “CalHEERS application with active CalWIN case (not Medi-Cal) - Add a Program,” page 20-32]


Step Action

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An active MC case in CalWIN where the individual is not active,

Notify the appropriate Continuing office for the clerical staff to create the TMT and assign to a continuing EW to determine if the individual(s) is to be added on the existing MC case.

On the Maintain External Referral Detail window, on the [Applicant] tab, change the Status to Completed.

[Refer to “CalHEERS application with active Medi-Cal in CalWIN,” page 20-35.]

An active MC case in CalWIN where ALL the individual who applied through CalHEERS are active,

On the Maintain External Referral Detail window, on the [Applicant] tab, change the Status to Invalid.


Step Action

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20.3.1 CalHEERS application with closed case in CalWIN

STEP ACTION

1. On the Clear Individual through CalWIN window:

(1) If the search returns a potential match, confirm that the individual's DOB and SSN are the same as in the CalHEERS data received in the External Referral subsystem.

(2)

If the data... Then...

Does match, Click on the [Case List] button.

Does not match, Review MEDS to determine the correct the DOB, Name, SSN, CIN and change in CalWIN, if necessary.

2. On the Inquire on Case Listing window:

(1) Ensure that the Case Status is Closed.

(2) Click on the [Case Detail] button to get additional information regarding the case programs (e.g. Case #, Case Members, CWINs and CINs in CalWIN)

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3. On the Inquire on Case Information window:

(3) Proceed with normal ID process: View the [Programs] tab, on the [Case Members] tab compare the Name, DOB, CIN, CWIN, and SSN for the Individual(s) and family composition.

(4) View the information in MEDS and verify/match it to CalWIN information.

Reminder: If there is a discrepancy, MEDS information is considered to be the correct information.

(5) Make sure the individual is also not active in MEDS.

STEP ACTION

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4. On the Maintain External Referral Detail window:

(1) On the [Applicant] tab, click on the [Application Registration] button. Note: the Case Number and CalWIN screen prints should be available for Index Clearance in order to avoid creating duplicate CWINs/CINs.

STEP ACTION

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5. On the Collect Applicant Information window, on the [Applicant] tab:

(1) Ensure that the Application Date matches the SAWS Signed Date and the information from CalHEERS (from the Apply for Benefits section in the [Summary View] tab.

(2) Select Regular from the Type field for most applications, select Carry Forward when the Application Type in Search for External Referral Data is Carry Forward.

(3) Select No on the Interpreter [Y/N] field.

On the [Address] tab:

(4) Click on the [Home Address] button, if the complete address is not already pre-populated on the window.

STEP ACTION

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STEP ACTION

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6. On the Maintain Address window:

(1) Use the address information on the Primary Applicant Contact Information section of the [Summary View] tab to enter on the window.

(2) Click on the [Save] button, (click on the [Save] button again, for zip code acceptance, when errors appear), and

(3) [Close] the window.

7. On the Collect Applicant Information window and on the Primary Applicant Contact Information section of the [Summary View] tab Compare:

(1) The Home Address with the Mailing Address to answer the Same as Home field in the Mailing Address section and

(2) The Contact Phone to the entry on the Home field for Telephone.

(3) Select Yes on the Is Your Home Address Permanent [Y/N] field.

(4) [Save] and click Next.

STEP ACTION

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8. On the Collect Application Information window on the [Program] tab:

(1) Ensure that the Medi-Cal program is selected.(The Medi-Cal Program should already be added via the Interface.) Reminder: If the Program Column on the Search for External Referral Data window showed programs other than MC (i.e. CalFresh-FS, CalWORKs-CR, etc.) Do NOT complete application registration the FS or CR programs.

• Send the client the applicable program’s application packet along with the coverletter, “Request for CalWORKs and/or CalFresh Benefits.”

• Document in the Maintain Case Comments window in CalWIN: “Applicant was sent to client per CalHEERS application External Referral request.”

(2) Click Next.

STEP ACTION

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9. On the Collect Household Members Detail window:

(3) Select Yes on that the Requesting Aid [Y/N] and In the Home [Y/N] field. Note: Modify the applicants name if needed, in order to match MEDS data.

(4) Click on the [Save] button.

(5) Click on the [Index Clearance] button to clear the applicant.

Reminder: At this point the CIN & CWIN have already been identified.

STEP ACTION

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10. On the Clear Individual through CalWIN window to:

(1) Enter the individual's Name and SSN on the Primary Parameters section and the DOB on the Secondary Parameter section.

(2) Click on the [Search] button.

(3) Select the individual and verify the CWIN.

(4) Click on the [Select] button.

STEP ACTION

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11. On the Clear Individual through SCI window:

(1) Compare the CIN and SSN to the individual's MEDS record to ensure they match. Reminder: Keep the MEDS window open while conducting the clearance process. Note: If MEDS has a Pseudo Number DO NOT enter a SSN into CalWIN. Regular ID rules continue to apply.

(2) Save in order to obtain an application number.


STEP ACTION

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12. On the Collect Household Members Details window:

(1) If there is more than one household member, repeat the Index Clearance process (Steps 9 to11) for each individual listed.

(2) Once all Household Members have been cleared and CWINs & CINs have been selected/assigned, click Next.

STEP ACTION

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13. On the Display Application Summary window:

On the [Status] tab, if the Apply for Benefits information on the [Summary View] tab:

(1) Indicates the application was signed, click on the Signed radio button.

(2) Indicates the Client agrees to consent for verification, select on the Yes on the Agrees to consent to verification [Y/N] field.

On the [Summary] tab:

(3) Select the Medi-Cal program line.

(4) Click on the [Case Clearance] button.

STEP ACTION

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14. On the Get Case Number window:

(1) Click on the [Select] button since there is already a previous case number in CalWIN. Note: If the applicant(s) is not known to CalWIN or if there is a new family composition, click on the [New Case #] button.

STEP ACTION

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15. On the Display Application Summary window:

(1) Select the Medi-Cal Program line.

(2) Click on the [Case Assignment] button.

16. On the Manage Case Assignment window, click on the [Override] button to enter and search for the appropriate caseload.

STEP ACTION

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17. On the Get Override Detail window, click on the [Find] button in order to enter the caseload ID.

18. Assign the case to the appropriate caseload. On the Search User window:

(1) Enter the Caseload Number in the Caseload # field.

(2) Click on the [Search] Button.

(3) On Search Results, select the result.


STEP ACTION

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19. On the Get Override Detail window:

(1) Select Other on the Reason field.

(2) Save & Close.

20. On the Manage Case Assignment window, the Medi-Cal Program should show as Pending under the correct Assigned User.

Case assignment in CalWIN is complete.

STEP ACTION

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21. On the Maintain External Referral Detail window,

(1) On the Status field select Completed and enter the current date on the Status Date field.

(2) Save and Close.

22. Create and assign the TMT per district office policy.

STEP ACTION

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20.3.2 CalHEERS application with pending Medi-Cal CalWIN application

STEP ACTION


(1) If results are found, ensure that the individual's DOB and SSN are the same as in the CalHEERS data.

(2) If so, click on the [Case List] button.


(1) The Case Status is Pending.

(2) Click on the [Case Detail] button to get additional information regarding the case programs.

Note: If there is more than one line for the same Case # and Case Name, select the one with the most recent date.

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(1) On the [Case Detail] tab:

(2) The Program is Medi-Cal and the Program Status is Pending.

4. The CalHEERS applicant already has a pending MC case in CalWIN, refer the case to the appropriate EW to determine if the ERD should be linked to the CalWIN case.

5. (1) Search for the case on the Task Management Tool (TMT).

(2) On the TMT associated with the application, Document in the Notes section: “CalHEERS Application. CalHEERS ID: [type the appropriate CalHEERS ID]”

STEP ACTION

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STEP ACTION

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20.3.3 CalHEERS application with active CalWIN case (not Medi-Cal) - Add a Program

STEP ACTION


(1) If there is a hit, ensure that the individual's DOB and SSN are the same as in the CalHEERS data.



(1) The Case Status is Open.



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(1) Determine in which Continuing District Office the open Program is held.

(2) Take a screen shot of the this window (Inquire on Case Information) and e-mail to that office’s generic e-mail address with the Subject line: CalHEERS MC App.

STEP ACTION

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4. On the Maintain External Referral Detail window:

(1) If the active program is... Then on the Status field select...

CalFresh, Active FS

CalWORKs, Active CW

General Assistance,

(2) Click on the [Save] button.

(3) Click on the [Close] button.

5. Receiving Continuing District Office, will create and assign the Add a Program TMT to the appropriate EW, per their office procedures.

STEP ACTION

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20.3.4 CalHEERS application with active Medi-Cal in CalWIN

STEP ACTION


(1) If there is a hit, ensure that the individual's DOB and SSN are the same as in the CalHEERS data.



(1) The Case Status is Open.



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(1) On the [Case Detail] tab,

(2) The Program is Medi-Cal and the Program Status is Approved.

4. Since this CalHEERS applicant already has an Open case in CalWIN, On the Maintain External Referral Detail window:

(1) On the [Applicant] tab, Select Invalid on the Status field.

(2) Save and Close.

(3) Document in the Maintain Case Comments window, if all members in the CalHEERS application are not in the open CalWIN case.

.

STEP ACTION

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5. (1) Take a screen shot of the Inquire on Case Information window and e-mail to the appropriate generic Continuing Office e-mail address.

(2) The receiving Continuing District Office, will create and assign the TMT to the appropriate EW, per their office procedures.

STEP ACTION

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20.4 Processing a CalHEERS application received through the External Referral Subsystem in CalWIN

Once the CalHEERS application is identified and application registration is completed in CalWIN, an Eligibility Worker (EW) may begin the processing of the request for health care coverage. This section provides step-by-step instructions on how to process a Medi-Cal application in CalWIN, submitted through CalHEERS.

Reminder:All CalHEERS application information is virtual, therefore, there will be no actual CalHEERS application or “add a person” form available to IDM.

STEP ACTION

1. (1) From the Intake and Case Maintenance function, select the Data Collection Subsystem and Initiate Window Workflow window.

(2) Enter the Case #.

(3) Click on the [Open] button.

2. On the Initiate Window Workflow window:

(1) Check off on the Initiate Interview for box for the Medi-Cal Program.

(2) Click on the [Initiate Workflow] button.

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3. On the Collect Case Question window:

(1) Click on the External Data link to bring up the CalHEERS application information.

(2) The Display External Data Source Details pop-up window will show. Click on the [Summary View] button.

(3) Review the information (such as citizenship, tax data, income, etc.) contained in the Summary View section.

STEP ACTION

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STEP ACTION

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4. On the Collect Case Question window:

(1) Click on the External Data link to bring up the CalHEERS application information.

(2) The Display External Data Source Details pop-up window will show. Click on the [Floating View] button.

(3) Review all the tabs for applicable data for any data is applicable based on the Floating View section.

Note: If the applicant previously had a case in CalWIN, that information may still be checked off on this window. Make sure only the CalHEERS application information is checked off.

(4) Click on check box(es) in the Floating view section of the data to be imported from CalHEERS into CalWIN.

(5) Click on the [Import] button to populate the information from the CalHEERS application onto the CalWIN window.

Repeat (4) and (5) for each tab with information to be imported from CalHEERS to CalWIN. Note: If there is nothing for a particular CalWIN window or tab to import from the CalHEERS application, there will be no check box to check.

(6) Once all (in particular the [Non-Financial] and [Income]) tabs have been reviewed, click on the [Save] button and Next to proceed on the queue.

STEP ACTION

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STEP ACTION

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5. On the Collect Case Summary Detail window:

(1) On the [Case Information] tab, change/ensure the Effective Begin Date is the date of application.

a. Review for applicable information to be imported from the Floating View section. Click on the [Import] button to populate the information from the CalHEERS application onto the CalWIN window.

b. Ensure the mandatory Whereabouts Unknown [Y/N] and Designated Case Addressee fields are completed. Reminder: If there is nothing for a particular CalWIN window or tab to import from the CalHEERS application, there will be no check box to check.

(2) On the [Program Requested] tab, ensure the Medi-Cal Program is Pending.

(3) On the [Case Payee] tab, update the Effective Begin Date to the date of application.

(4) Once all tabs have been reviewed, and all applicable information has been imported, click on the [Save] button and Next to proceed on the queue.

STEP ACTION

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6. On the Display Individual Demographics Summary window, click on the individual’s information to open up the Collect Individual Demographics Detail window.

STEP ACTION

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7. On the Collect Individual Demographics Detail window:

(1) Review all the tabs for data that might already be pre-populated onto the CalWIN window and compare to the data on the Floating View information.

a. Check for any discrepancies. If there are discrepancies with the individual’s information, review MEDS to determine the correct information.

(2) Check off the information to be imported from CalHEERS into CalWIN on the Floating View section.

(3) On the [Demographics Detail] tab, update the Effective Begin Date to the date of application.

a. Ensure that the name, date of birth, sex are correct.

b. Marital Information must be entered/imported into CalWIN.

c. Click on the [Import] button once all information has been selected/updated before moving on to the next tab.

(4) On the [SSN Detail] tab, update the Effective Begin Date to the date of application.

a. Ensure the SSN is correctly entered/imported into CalWIN and verified accordingly.

b. Click on the [Import] button once all information has been selected/updated in the CalWIN window, before moving on to the next tab.

STEP ACTION

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(5) On the [DRA Detail] tab, update the Effective Begin Date to the date of application.

(6) The following fields must be completed:

Field Name Field Descriptions

DRA US Citizen [Y/N] Indicates whether the individual meets the DRA US citizenship requirements.

DRA Identification [Y/N] Indicates whether the individual meets the DRA US Identification requirements.

Remote Identification Process Verification Complete [Y/N]

Indicates whether the client has met the RIDP verification has been met for electronic applications.

(7) f there are no documents to view or information to import from CalHEERS. Review IDM to determine if the verifications are already on file.

(8) Once all tabs have been reviewed, and all applicable information has been imported, click on the [Save] and [Close] buttons.

STEP ACTION

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STEP ACTION

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8. If the Name, DOB or SSN were updated in CalWIN to reflect correct information in CalHEERS or MEDS, the pop up Message Code 236 will show. Click on the [Ok] button to proceed to the Clear Individual through CalWIN window.

STEP ACTION

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9. On the Clear Individual through CalWIN window, select the individual who will need to be “index cleared” and click on the [Select] button.

10. Message Code 90 will pop up, confirming the change in data from what is existing in CalWIN. Click [Yes] to confirm the change(s).

11. On the Display Individual Demographics Summary window, click Next to proceed on the queue.

STEP ACTION

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12. On the Collect Communication Detail window:

(1) Change the Effective Begin Date to the date of application

(2) Select Mail from the Preferred Communication Method field and ensure the Preferred Written Language field is completed based on the information in CalHEERS.

(3) Import, if necessary.

(4) Click Next to proceed on the queue.

13. On the Collect Case Individual Detail window:

(1) On the [Program Requested] tab, update the Effective Begin Date, Requested Date and Report Date fields to the date of application.

(2) Ensure the Requesting Assistance [Y/N] field is correct for all household members by reviewing the Floating View windows for each member.

(3) Review case comments entered by clerical staff. If comments indicate client requested a Non-MAGI evaluation, contact the client and explain the Non-MAGI programs and the additional verification requirements.

If client states he/she... Then the Evaluate for Non-MAGI [Y/N] field will be...

Does want to proceed with Non-MAGI MC evaluation,

Yes

Does NOT want to proceed with Non-MAGI MC evaluation,

No

Note: If there is no comment from clerical staff leave field blank.

STEP ACTION

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(4) On the [Other Information] tab, the In Home [Y/N] field must be answered based on the information in the Summary View, Household Members section, for each household member in the [Contact Info*] tab.

(5) On the [CalHEERS Information] tab, update the Effective Begin Date to the date of application. Reminder: DO NOT manually enter data in the CalHEERS Information section.

(6) Click on the [Save] button and Next to proceed on the queue.

STEP ACTION

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14. On the Display Individual Attributes Summary window:

(1) Import any new or different and correct data from CalHEERS into CalWIN.

(2) Double click on the individual(s) to open up the detail window.

STEP ACTION

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15. On the Collect Individual Attributes Detail window:

(1) Update the Effective Begin Date to the date of application on the [Employment] tab.

(2) Review the [Health Care] tab and Import any data that may not be present or is incorrect in CalWIN. Save and Close to return to the summary window.

STEP ACTION

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16. On the Display Individual Attributes Summary window:

(1) Repeat Steps 16 & 17 for any additional household members.

Click Next to proceed on the queue.

17. On the Display Individual Residency Summary window:

(1) Import any new or different and correct data from CalHEERS into CalWIN.

(2) Double click on the individual(s) to open up the detail window.

STEP ACTION

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18. (1) On the Collect Individual Residency Detail window, the Floating View section may show as “Not Received.”

(2) Log into CalHEERS and review Documents & Correspondence for verifications uploaded into CalHEERS.

(3) Print the verification document(s) and request to have them scanned into IDM, per district office practice.

(4) In CalWIN, once State Residency has been verified update the CA Resident [Y/N] fields.

(5) Save and close to return to the summary window.

STEP ACTION

Update # 2016-42 Revised: 11/23/2016


19. On the Display Individual Residency Summary window, click Next to proceed on the queue.

STEP ACTION

Revised: 11/23/2016 Update # 2016-42


20. On the Display Employment History Summary window:

(1) Select the name of the person Referenced in the Floating View section.

(2) Click on the [Add] button to add the employment reported in the CalHEERS.

Note: If there is a different employer already recorded in CalWIN and not reported in CalHEERS, open the record and ensure there is an End Date.

21. On the Collect Employment History Detail window:

(1) Change the Effective Begin Date to the date of application.

(2) Enter the employer information from the Floating View section into the CalWIN window.

(3) Verify the employer information by reviewing uploaded documents in CalHEERS.

(4) Click on the [Earned Income] button.

(5) In CalHEERS, view the income verification(s) from the Documents & Correspondences section under “Eligibility” document type. Print and scan the verification into IDM.

STEP ACTION

Update # 2016-42 Revised: 11/23/2016


22. On the Display Earned Income Summary window, click on the [Add] button to open up the detail window.

STEP ACTION

Revised: 11/23/2016 Update # 2016-42


23. (1) On the Collect Earned Income Detail window, enter the date of application on the Effective Begin Date, select the Frequency and Type of income.

(2) Click on the [Income Received] button.

24. On the Collect Income Received Detail window, use the information from the verification (i.e. paycheck stub, etc) to add the income information into CalWIN.

Once all information is entered Save and Close the windows until able to continue in the queue.

STEP ACTION

Update # 2016-42 Revised: 11/23/2016


25. On the Display Tax Filer Detail window, complete the information for each person in the household based on CalHEERS application.

(1) Use the CalHEERS information from the Summary View section, under Household Members, [Tax Info*] tab, to enter the data in the Tax Information section in the CalWIN window. Each member will have their own tab.

(2) If the household has tax dependents, click on the [Dependents] tab to enter the dependent(s)’ information.

(3) Click on the [Add] button to enter the information for additional household members.

(4) Once all household members have been added, click [Save] and Next to continue in the queue.

STEP ACTION

Revised: 11/23/2016 Update # 2016-42


26. (1) On the Collect CHDP/Social Service Request Detail window, review the [CHDP], [Social Service] and [Healthy Families] tabs change the Effective Begin Date to the date of application. and “Import” the CalHEERS responses into CalWIN for each tab.

(2) Once all tabs have been reviewed, click on the [Save] button and Next to continue on the queue.

STEP ACTION

Update # 2016-42 Revised: 11/23/2016


27. On the Perform Data Collection Wrap-up window,

(1) Update the Effective Begin Date to the date of application.

(2) Import all the fields in the Floating View section into the CalWIN window.

(3) Click on the [Upload CalHEERS Results] button.

28. On the Authorize Eligibility Program Benefit window, click on the [Authorize] button, if there are no pending verifications and eligibility results are correct.

STEP ACTION

Revised: 11/23/2016 Update # 2016-42


29. If there are pending verification or verifications were manually verified (i.e. residency, etc.), on the Run EDBC window, select Immediate and click on the [Run EDBC] button.

Skip this step and proceed to Authorize, if there were no pending verification, additional verifications manually verified, or if the CalHEERS application was transferred to the External Referral Subsystem in Approved status.

30. Review eligibility results on the [Medi-Cal] tab of the Display Individual Eligibility Summary window for all individuals.

Click on the [Health Care] button, to open the Display Health Care Program window to see if the individual is Passing for APTC/CSR.

STEP ACTION

Update # 2016-42 Revised: 11/23/2016


31. (1) On the Search for CalHEERS Results window, enter the CalWIN Case # (must be in CAPS) and clear out the User Name.

(2) Click on the [Search] button.

(3) Review the Status of the Results to determine the status of the (Eligibility Determination Request) EDR and Determination Eligibility Response (DER).

If the Status is... It means that...

Sent, The EDR was sent and is awaiting a response from CalHEERS.

Note: it may take up to 4 hours to receive a response from CalHEERS. If it takes longer than 4 hours, create a GadWIN ticket.

Received, A response from CalHEERS (DER) has been received, review eligibility results.

Failed, EDR was not sent, rerun EDBC to re-send the request.

STEP ACTION

Revised: 11/23/2016 Update # 2016-42


STEP ACTION

Update # 2016-42 Revised: 11/23/2016


Revised: 11/23/2016 Update # 2016-42