Page 10

Section A. Additional Comments The verification process is virtually the same for all consumers regardless of the modality in which the application is received. One exception relates to the verification of state residency. In the event that a consumer presents in person at a county office and brings with them paper-based verification of state residency, the Statewide Automated Welfare Systems (SAWS) will verify the authenticity of the consumer's paper verification and if the paper-based verification document is acceptable to verify state residency, SAWS set the state residency electronic verification by-pass flag logic to inform CalHEERS that state residency has been verified. Eligibility results for MAGI-Based MC will be determined in CalHEERS via the Business Rules Engine (BRE). Data verified via the Federal Hub, or other electronic data sources will be flagged as verified data when it goes to SAWs. Any verification documentation that the consumer provides to CalHEERS will be sent, via electronic Health Information Transfer (eHIT) to SAWs. If the individual is referred to SAWs for a full Medi-Cal determination, any verifications and/or documentation provided in CalHEERS will be sent to SAWs via eHIT. Effective July 1, 2022, California implemented the use of reasonable explanation as part of the verification process. California is unable to fully automate reasonable explanation until July 2024 and has developed a short term manual process for use prior to system implementation. Reasonable Explanation Short Term Plan: Effective July 1, 2022 Manually obtain a reasonable explanation at application, annual renewal or a change in circumstance: - If more than 20%/10% difference in reasonable compatibility, the county will make an attempt to reach the individual by their preferred method of contact to obtain a reasonable explanation, or if in person, the county will obtain the reasonable explanation directly from the individual. The county will try to resolve the discrepancy with obtaining a reasonable explanation prior to requesting paper documentation. -Since automated functionality for reasonable explanations will not be implemented until 2024, the state developed a form for counties to use in conjunction with the redetermination form in situations where a reasonable explanation was not able to be obtained in person or verbally. Reasonable Explanation Automated Plan: Beginning July 2024 Automate systems to obtain a reasonable explanation at application, annual renewal or a change in circumstance: -Update the California Health Eligibility Enrollment and Retention System (CALHEERS) to provide drop down the option for an individual to choose from pre-populated reasonable explanations when income is not reasonably compatible. If certain reasonable explanations are selected, income will be verified automatically and eligibility will be determined "real time" without additional verification. -Update the Statewide Automated Welfare System portal providing the option for an individual to choose from pre-populated reasonable explanations when completing an application, annual renewal, or reporting a change in circumstance. -If unable to obtain a reasonable explanation electronically, the county will make an attempt to reach the individual by their preferred method of contact to obtain a reasonable explanation, or if in person, the county will obtain the reasonable explanation directly from the individual. The county will try to resolve the discrepancy with obtaining a reasonable explanation prior to requesting paper documentation. -Update the paper application and annual renewal to include the reasonable explanation options. Except as otherwise noted, the implementation date of this verification plan is 7/1/22. MAGI-BASED ELIGIBILITY VERIFICATION PLAN Additional Comments 11