Medi-Cal counties would verify work rules before ending coverage

Medi-Cal applicants and beneficiaries covered by the work rule would use the revised definitions and income options to show monthly work or community engagement. This applies to people who qualify for or receive Medi-Cal and meet the bill’s definition of an applicable individual, subject to listed exclusions and exemptions. A person may qualify through work, community service, a work program, education, or specified monthly income. Federal rules and federal Centers for Medicare and Medicaid Services guidance determine some definitions and eligibility details. The requirement applies only while the related federal Medicaid law remains operative. The work or community engagement condition applies no sooner than January 1, 2027, after the department confirms that its systems are programmed for implementation.

A county must ask the person to confirm the conflicting information before denying or reducing eligibility based on it. This protects Medi-Cal applicants and beneficiaries when reliable data sources conflict and the conflict could harm an application or renewal. The county must request confirmation before taking adverse action on the application or renewal. The department must use available reliable information and avoid extra requests when sufficient verification has already been submitted. The confirmation request is required when the county finds a harmful conflict in reliable data during an application or renewal.

Counties must notify enrolled applicable individuals about the work rule and provide time and information to show compliance or an exemption before ending coverage. This applies to applicable individuals enrolled in Medi-Cal, including people renewing during a six-month redetermination period who otherwise meet eligibility rules. The notice must be sent by regular mail or, if chosen, electronically, plus one or more additional delivery methods. If the county cannot verify compliance, the person generally receives 30 calendar days to respond, and enrolled people keep services during that period. A person is treated as receiving a noncompliance notice five days after it is dated; saying the notice was not received on time is good cause for missing the response period. Before denial or disenrollment, the county must check other Medi-Cal or insurance affordability eligibility and provide written notice and a fair-hearing opportunity. During a six-month renewal period, active eligibility continues pending verification through at least the last day of the month in which the 30-day response period ends. The department may defer these changes if an unfunded additional appropriation is needed.