C-IV/CalHEERS Interface

Created by Shannon Tolbert and Valarie Rangel (Region 3)November 2013

Agenda1) Behind the scenes of C-IV/CalHEERS 2) MAGI Referrals3) New Screen Shots along with functionality4) Scenarios with MAGI Determinations5) Miscellaneous Items and Review 6) Questions and Answers

1) Please keep your questions to the end of the training. There is a good chance that your question will be covered before the end of the training.

2) This is courteous to both your trainer and to your fellow trainees.

2

Behind the Scenesof C-IV and CalHEERS communication.

3

Batches• There are five new batch types that have been

added to C-IV for CalHEERS communication. o EDR (Eligibility Determination Request) – C-IV to CalHEERS in real time.o DER (Determination Eligibility Response) – CalHEERS to C-IV in real

time. o Disposition – C-IV to CalHEERS in real time. o Update – can be initiated by either system in an overnight batch

process.o Image/NOA – can be initiated by either system in an overnight batch

process.

• The batch system ensures that the two systems can communicate changes and referrals to one another along with the resulting eligibility determinations.

4

Batch Process

CalHEERS The HubC-IV

ED

R

DERDisposition

Images

Updates

Data

e-verifications

DE

R

Disposition

5

MAGI ReferralSimilar functionality to other e-transactions.

6

MAGI Referral Search• This will be the starting point for the

communication between C-IV and CalHEERS. • This page will alert us to the different types of

referrals or change requests that have been submitted.

• The functionality of this page is very similar to other e-transactions. (eICT’s, e-apps, IAT’s, etc.)

7

MAGI Referral Search

In Case Info, select e-Tools. MAGI is an option under the external agencies portion of the tasks. Follows the same functionality as eICT’s and Healthy Family transmittals.

8

MAGI Referral Search

Each of these options represent a type of batch that was initiated.

9

Referral Types• Referral – this is an unsolicited communication from

CalHEERS. They have prescreened a customer and have found that one or more of the household members have MAGI eligibility.

• Determination Change – this is an unsolicited communication from CalHEERS alerting us that a case in common has a change that requires a new MAGI determination.

• Determination Response – this is a determination response from CalHEERS in which we initiated the response. This happens after we run MAGI Determination in our system.

• Information Change – This is an unsolicited communication from CalHEERS alerting us that there is a change that was reported that does not require a new MAGI determination.

10

MAGI Referral Search

The date and time stamp will take you to the MAGI Referral page. The C-IV case number will take you to the case summary.

11

New Screens and Their Functionality

Let’s start from the very beginning.

13

Case Summary

14

Administrative Roles

A new admin role has been added for CEC. This information will be sent over from CalHEERS as an authorized representative.

15

Administrative Roles

This is the information that is requested to be entered once a Certified. Enrollment Counselor option as been selected as the admin role.

16

Certified Enrollment Counselor (CEC)

• This is not the same as an authorized representative when comparing the two roles with ATPC/CSR and MC programs.

• With ATPC/CSR, the CEC or any authorized representative has all the same rights as the customer themselves.

• MC does not allow these same rights UNLESS the customer has provided written permission using the MC 306 (Appointment of Representative) that must be updated annually.

17

Non-Financial

18

Individual Demographics

New fields will now auto populate if a customer does not have a social.

19

Individual Demographics

• If the ATIN/ITIN is selected, another field will populate and will become a required field. This is where the ATIN/ITIN will need to be entered. o “An ATIN is an Adoption Taxpayer Identification Number issued by the Internal Revenue

Service as a temporary taxpayer identification number for the child in a domestic adoption where the adopting taxpayers do not have and/or are unable to obtain the child's Social Security Number (SSN). The ATIN is to be used by the adopting taxpayers on their Federal Income Tax return to identify the child while final domestic adoption is pending.” www.irs.gov

o “An Individual Taxpayer Identification Number (ITIN) is a tax processing number issued by the Internal Revenue Service. It is a nine-digit number that always begins with the number 9 and has a range of 70-88 in the fourth and fifth digit. Effective April 12, 2011, the range was extended to include 900-70-0000 through 999-88-9999, 900-90-0000 through 999-92-9999 and 900-94-0000 through 999-99-9999. IRS issues ITINs to individuals who are required to have a U.S. taxpayer identification number but who do not have, and are not eligible to obtain a Social Security Number (SSN) from the Social Security Administration (SSA).ITINs are issued regardless of immigration status because both resident and nonresident aliens may have a U.S. filing or reporting requirement under the Internal Revenue Code.Individuals must have a filing requirement and file a valid federal income tax return to receive an ITIN, unless they meet an exception.” www.irs.gov

20

Customer Options

New options that will need to be used when completing a MAGI determination.

21

Customer Options• There are three new options that have been added to

this screen. • The Verification Consent and Maintain Verifications

need to be added for the primary tax filer only. • Remember, customer has to consent to verifications

(The Hub) in order for their application in CalHEERS to continue.

• Full Medi-Cal Hierarchy will only be filled out IF the customer has opted for this. This means the customer wants to be screened for traditional MC (now known as non-MAGI). If the customer has not declared, then the assumed answer is no. o This will need to be entered for each person for which they are requesting non-

MAGI screening.

22

Financial

23

Tax Household List

This has been added to the Financial Section. This is a mandatory field to run MAGI. This determines the tax filing household status.

24

Tax Household List

This is an example of the primary tax filer Tax Household Detail screen.

These are the only two options for dependent types. Non-Custodial Parent is used when the child is not in the home but claimed on taxes.

25

Tax Household List

Another screen will need to be added when a case has two adults. Remember, a spouse is not a dependent. The dependents will need to be added to the primary tax

filers’ screen.

26

Determining Eligibility

27

Running EDBC Error Message

MAGI Determination MUST be done before running the case.

28

Running EDBC• Before a case can be ran, MAGI determination MUST be

done first. Running MAGI determination will not automatically load into C-IV. o You will also notice that the message indicates that the results must be marked as

reviewed. This just means you need to review the results of the MAGI Determination after a response has been received from CalHEERS before you can proceed. This process will be explained in more detail later in presentation.

• After the MAGI results have been determined, then you MUST run the case with EDBC to upload the MAGI or non-MAGI aid code into C-IV.

• If the customer has opted for Full MC Hierarchy, then this is where you can show which choice the customer has made.

• The functionality of this will be shown later in this presentation.

29

Navigating to MAGI Eligibility

• MAGI Eligibility is located in Customer Information. This task will be near the Run EDBC task.

• Before MAGI Eligibility can be run, you MUST have the tax filer information completed.

• It will also be mandatory to have the customer options for the primary tax filer completed.

• As with EDBC, the relationship grid will need to be completed.

• The Vital Statistic screen will not be mandatory for MAGI Determination but you will need to have this screen completed before running EDBC.

30

Reminder Time!!!!• As with every Re-Evaluation, Application, e-

Transaction, etc., you should be checking EVERY task in both non-financial and the financial sections of the case.

• Even if this case is a new to C-IV case, there could be some information that transferred over from the e-Source that may not show in the root questions. o For Example: There are not any root questions regarding primary tax

filer or tax filing status.

Check all screens to make it clean

31

Running MAGI Determination

See next slide for more information regarding this screen.

32

Running MAGI Determination

• The Benefit Month will default to the future month. • This will also show the history of all the benefit months

that have been previously ran. • To complete a negative action (such as customer

withdrawal), you will select the box labeled “Request Negative Action Determination.”

• The resulting changes to the page will reflect current functionality on the negative actions task from the Case Summary.

• The Life Change Event will determine if the customer is eligible to a special enrollment period and this information will be located within the MAGI Referral page.

33

Running MAGI Determination

Changes to screen when the Request Negative Action Determination is selected.

34

Running MAGI Determination

Choices for negative actions for MAGI.

35

Running MAGI Determination

Choices for life change events also known as special enrollment period reasons.

36

Running MAGI Determination

This message is received once you have selected the request MAGI button. This page runs in real time similar to EDBC. Clicking the view button will refresh the page so that

the results will post and the message center will appear.

37

Message Center

The Message Center appears once the MAGI determination results have been completed.

38

Message Center

There are two hyperlinks in the message. The first indicates the time the message was received and will direct you to the MAGI Referral Detail Page. The second is the case

number and will direct you to the case summary.

Double click the globe icon to open the message center.

39

Message Center• The message center is both case sensitive and worker

sensitive. • Ideally, these will come back within seconds upon

requesting MAGI determination. • In the event that there is a lag in response, the message

center will show for one day upon the receipt of the determination. It will also show on any page you are currently working, in or out of the case.

• The message will automatically drop at the end of the day. • The message will show in the workload inventory after it is

dropped in the message center. • Remember that EDBC cannot be run until after the MAGI

determination response (DER) has been received from CalHEERS.

40

Message Center

The CalHEERS icon will show when a case has a MAGI determination that needs to be reviewed and completed.

41

MAGI Determination Results

Once a message has been received, the results for the month that was ran will show under the Search Results Summary.

42

MAGI Determination Results

This page is accessed from the hyperlink of the benefit month. This shows who is eligible and their aid code. The hyperlink of each person will take you to the individual

demographis associated with the MAGI Referral Page. (Shown later)

43

MAGI Referral Detail

There are two ways to get to this page. One is from the hyperlink from the message center. The other is through the referral search shown previously.

44

MAGI Referral Continued

Bottom portion of the MAGI Referral Page. You will also notice that the results from CalHEERS are also present if the case was a referral from CalHEERS.

45

MAGI Referral • This page functionally works very similar to the eICT and

IAT detail screen. • There will be hyperlinks for each member of the case. • These hyperlinks will take you to their individual

demographics (including income) along with The Hub results. These will be on the bottom of the page and will be listed as E Verifications.

• There will also be indicators if the customer has physically verified any information.

• There is a referral section. If the customer has requested other programs such as CalFresh, then a checkmark will appear before the program.

• This page is both updated/created both by C-IV and CalHEERS.

46

MAGI Person Detail

To maneuver to this screen, you click the hyperlink for the person from the MAGI Referral page or from the MAGI Determination Results.

47

Bottom of MAGI Person Detail

The biggest change in this screen than from other e data screens is the Verification section. Admin-Verified is items that have been sight verified. E-Verified are items that

have been verified via “The Hub.”

48

e-Data from CalHEERS

You’ll notice that the arrows are the same as an e-App.

49

e-Data from CalHEERS

The accept all button usually located on the top of the screen is not there. You will notice that some fields are pre-filled with data. Clicking on the arrow (or CalHEERS

icon) will bring up the e-Data.

50

e-Data From CalHEERS

By clicking on the information brought up, this will fill in the field for which it is intended.

51

Newly Reported Changes

• When the customer reports a change to CalHEERS, we will receive notification via the MAGI Referral page.

• These will come over as one of two types. o Determination Response – this indicates that a new MAGI

determination is needed and the case will need to be run with a new MAGI Determination. This is due to the nature of the newly reported information. There may be a change in benefits such as birth of a child.

o Information Update – this indicates that the case just needs to be updated but the case does not need to be run for MAGI.

• This information will be communicated to C-IV via e-Tools under the MAGI task.

52

View Differences

On the Person Detail page, there will be a button that states “View Differences” in which the same screen will show but information that has not changed will be faded

out.

53

View Differences

Click icon to add picture

The information that has changed will show as normal but will look bolded.

54

Possible MAGI Scenarios

and the coordinating EDBC results that could happen.

55

Sally Lemoore• Pregnant female with no other persons in the

home.• Files her taxes as single with no dependents in

2013. • Due date for her pregnancy is May 2, 2014• She is a US Citizen. • She is currently employed with Kings County

Sheriff and makes $1755 every other week. • Sally did opt for full MC Hierarchy.

56

Sally LemooreMAGI Determination

Sally passes with aid code M3.

57

Sally LemooreEDBC Results

You will notice that both the MAGI and non-MAGI results. Pay attention to the arrow and see next page.

58

Sally Lemoore• Since Sally indicated that she wanted full MC hierarchy, she

will be given a choice as to which budget she would like.• The worker must select either MAGI or non-MAGI in the

elect box then press apply. • This must be done before the EDBC results can be

accepted. • The program that the customer selects will pass. The other

budget will show as a failed budget. • In this case, it is in the customer’s best interest to select

MAGI since that shows with a zero SOC. • If the customer has not opted for full MC hierarchy, then

only the MAGI aid code would be pulled into the EDBC results and the Elect Benefits field would now show.

59

Sally LemooreEDBC Results with Elected

Benefit

Screen shot after the apply button has been selected.

60

Sally LemooreCase Summary

Click icon to add picture

Case Summary after EDBC results were accepted with MAGI results.

61

Sally LemooreMAGI Determination

Summary

This summary page is accessed from the MAGI Eligibility task in the case and by clicking on the benefit month that has already been ran. You will notice that the EDBC results

also show indicating that this case has been completed.

62

Jane Armona• This case consists of a single mother, Jane, and her

three children Carlos, Leticia, and Mike. • Jane and Carlos are Lawful Permanent Residents.

Leticia and Mike are US Citizens. • Carlos is currently residing out of the home but

Jane claims him on her taxes. • Jane is employed with Hanford Nursing & Rehab

and makes $1200 every other week. • Carlos is employed with Taco Bell and makes $480

every other week. • In this instance, Jane requested that full MC

hierarchy be screened for her children.

63

Jane ArmonaMAGI Determination

This is the MAGI Determination established by C-IV. You will notice that it will only show aid code and eligibility status.

64

Jane Armona• You will notice that all persons were ineligible to

MAGI. • After they have been established to be ineligible

to MC, the case is then ran to establish the denied code and get the NOA along with screening the children for full MC hierarchy.

65

Jane ArmonaEDBC Results

You will see that Jane still failed since she didn’t request full MC hierarchy. Carlos also failed for not being in the home. Reminder, non-MAGI follows traditional MC rules in

which members of the household must be in the home.

66

Jane ArmonaCase Summary

After EDBC has been accepted, it will then show on the Case Summary. Jane is a FRI-Parent since she is not eligible. Carlos shows he was denied for being out of the

home.

67

James Hanford• Single father with one child. • Both are US Citizens. • Child resides with father and he is able to claim

him on his taxes. • James works at WalMart and makes $400 every

other week.

68

James HanfordMAGI Determination

In this scenario, both individuals show as pending eligibility.

69

James Hanford• This scenario shows that James and his son are

still pending eligibility for MAGI. • A full MAGI determination must be made before

EDBC can be ran for the customer. • This will leave the case in a pending status until

we are able to run the MAGI determination and get a active or failed response from CalHEERS.

• The following screen shot is an example of the error message you would receive if you tried to run EDBC without a full MAGI determination.

70

The Hub• The first time a case is ran for MAGI

determination, the hub will ALWAYS send back a pending eligibility response.

• This is due to the fact that The Hub cannot check for residency.

• This will happen even if we sight verify in C-IV. • The workaround is to do a second MAGI

determination for The Hub to accept that we have sight verified residency.

• The Hub will pull this information from the Residency Screen in the Non-Financial Section.

71

James HanfordEDBC Error Message

72

James HanfordCase Summary

Example of the pending status on the case summary since the MAGI determination is pending.

73

Maria Corcoran• Case include Maria, her husband Josue, two

children in common. • Josue also claims his daughter from a previous

relationship that lives with her mother. • All are US Citizens. • Maria and her family were previously eligible to

aid code M3. • Both Maria and Josue are now fully employed and

over the 138% FPL limit for MAGI.

74

Maria CorcoranMAGI Determination

75

Maria Corcoran EDBC Results

Since this family did not request full MC hierarchy, you’ll notice that the EDBC results did not give us the option for MAGI or non-MAGI.

76

Maria Corcoran EDBC Results

They were discontinued from the MAGI aid code (See failed budgets). They now are eligible to a non-MAGI aid code.

77

Things You Needto know.

78

Tax Filers – Not Required

• Customer is not required to file taxes and doesn’t. o Examples could be undocumented aliens, persons who make less than

$9500 per year in gross income, among other more rare instances.

• You will need to enter in the screen that shows they are the primary but do not plan to file taxes for that tax year.

• You will need to add the dependents so that the proper household size is used when determining benefits for MAGI.

• Make sure to add a separate tax information screen for spouse, if applicable.

79

Sight Verified Address• When running the initial MAGI determination from

C-IV to CalHEERS, you may get a determination that states that CalHEERS is unable to determine eligibility. This is because The Hub cannot e-verify address.

• In this instance, you will need to make sure the residency screen has been completed for all members of the household. This will update CalHEERS with the information.

• The case will then need to be re-ran for MAGI determination so that the residency will become “sight verified” for CalHEERS.

80

MAGI Images (from CalHEERS)

This screen will only track images that have been sent from CalHEERS.

81

MAGI Images• To access the MAGI Images Transfer Summary

o Click on Distributed Documents from the Global bar. o Click on MAGI Images Transfer Summary. o This screen will functionally run the same as Distributed Documents. You will be

given the choice to search using certain criteria (such as a range of dates).

• You will notice that there are buttons labeled “View Image.” This will take you to WebNow to view the image.

• The document will also need to be indexed similar to how we currently receive images from other counties with eICT’s.

• CalHEERS will send any/all documents that the customer uploads into CalHEERS as one package once a day.

• The Image/NOA update will also work to CalHEERS but the documents will not be tracked on this screen.

82

ReviewHave you learned all that you need to know?

83

Explain the different batch types

Real Time Overnight

• Eligibility Determination Request (EDR)

• Determination Eligibility Results (DER)

• Disposition

• Images/NOA• Updates

84

What do you need to run MAGI

Determination?• Customer options for Verification Consent and

Maintain Verifications needs to be completed for the primary tax filer.

• The tax filer(s) need to be added to Tax Household in the financial section along with the appropriate dependents.

• The relationship grid needs to be completed. AND

Check all screens to make it clean

85

What screens have been updated?

• Administrative Roles on Case Summary for Medi-Cal.

• Follow up questions regarding customers with no Social Security Number.

• New customer options for Full Medi-Cal Hierarchy, Maintain Verifications, and Verifications Consent.

86

What screens have been added?

• Tax Household in the financial section of customer information.

• MAGI Eligibility in the customer information section to be used to determine MAGI eligibility by requesting e-verifications from The Hub.

• MAGI search under e-Tools. • MAGI referral page.

87

Questions?

88