1. C-IV/CalHEERS Interface
Created by Shannon Tolbert and Valarie Rangel (Region 3)
November 2013

2. Agenda Behind the scenes of C-IV/CalHEERS MAGI Referrals
New Screen Shots along with functionality
Scenarios with MAGI Determinations
Miscellaneous Items and Review
Questions and Answers
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.
This is courteous to both your trainer and to your fellow trainees.

3. of C-IV and CalHEERS communication.
Behind the Scenes
of C-IV and CalHEERS communication.

4. Batches
There are five new batch types that have been added to C-IV for CalHEERS communication.
EDR (Eligibility Determination Request) – C-IV to CalHEERS in real time.
DER (Determination Eligibility Response) – CalHEERS to C-IV in real time.
Disposition – C-IV to CalHEERS in real time.
Update – can be initiated by either system in an overnight batch process.
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.

5. Batch Process Data Disposition C-IV CalHEERS The Hub DER
EDR
DER
C-IV
Images
CalHEERS
The Hub
Updates
Use this screen to explain the process of running MAGI determination.
DER
e-verifications
Disposition

6. Similar functionality to other e-transactions.
MAGI Referral
Similar functionality to other e-transactions.

7. 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.)

8. 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.

9. Each of these options represent a type of batch that was initiated.
MAGI Referral Search
Each of these options represent a type of batch that was initiated.

10. 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.

11. 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.

12. New Icons This icon represents data that has been added by Covered CA.
This icon will show in areas where we have seen the trees or blue arrows for e-applications.
This icon is new to us but not to C-IV.
This is used in the message center functionality that is currently in C-IV but our county does not utilize this function.
There will be more on this functionality.

13. New Screens and Their Functionality
Let’s start from the very beginning.
Starting with the case summary and working to MAGI Determination

14. Case Summary

15. Administrative Roles
Ask: Where do to find the admin roles?
A new admin role has been added for CEC. This information will be sent over from CalHEERS as an authorized representative.

16. 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.

17. 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.

18. Non-Financial

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

20. 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.
“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.”
“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 in the fourth and fifth digit. Effective April 12, 2011, the range was extended to include through , through and through 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.”

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

22. 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.
This will need to be entered for each person for which they are requesting non-MAGI screening.

23. Financial

24. 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.

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

26. 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.

27. Determining Eligibility

28. Running EDBC Error Message
MAGI Determination MUST be done before running the case.

29. Running EDBC
Before a case can be ran, MAGI determination MUST be done first. Running MAGI determination will not automatically load into C-IV.
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.

30. 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.

31. Check all screens to make it clean
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.
For Example: There are not any root questions regarding primary tax filer or tax filing status.
Check all screens to make it clean

32. Running MAGI Determination
See next slide for more information regarding this screen.

33. 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.

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

35. Running MAGI Determination
Choices for negative actions for MAGI.

36. Running MAGI Determination
Choices for life change events also known as special enrollment period reasons.

37. Running MAGI Determination
After the benefit month and MAGI Determination button have been pressed, this will show on the screen while waiting for the DER/Hub responses.
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.

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

39. Message Center Double click the globe icon to open the 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.

40. 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.

41. Message Center
This is in the event that a worker is unable to work a message from the message center the same day they receive it.
The CalHEERS icon will show when a case has a MAGI determination that needs to be reviewed and completed.

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

43. 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)

44. 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.

45. 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.

46. 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.

47. 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.

48. 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.”

49. You’ll notice that the arrows are the same as an e-App.
e-Data from CalHEERS
You’ll notice that the arrows are the same as an e-App.

50. 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.

51. e-Data From CalHEERS
By clicking on the information brought up, this will fill in the field for which it is intended.

52. 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.
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.
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.

53. 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.

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

55. Possible MAGI Scenarios
and the coordinating EDBC results that could happen.
In the training environment in which these cases were done, all MAGI aid codes were M3. Income had no bearing on how the case would be determined. The MAGI results were driven by the last number of the SSN. Due to this, I was unable to give real world examples of running cases with undoc’s.

56. 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.

57. Sally Lemoore MAGI Determination
Sally passes with aid code M3.

58. Sally Lemoore EDBC Results
You will notice that both the MAGI and non-MAGI results. Pay attention to the arrow and see next page.

59. 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.

60. Sally Lemoore EDBC Results with Elected Benefit
Screen shot after the apply button has been selected.

61. Sally Lemoore Case Summary
Case Summary after EDBC results were accepted with MAGI results.

62. Sally Lemoore MAGI 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.

63. 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.

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

65. 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.

66. Jane Armona EDBC 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.

67. Jane Armona Case 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.

68. 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.

69. James Hanford MAGI Determination
In this scenario, both individuals show as pending eligibility.

70. 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.

71. 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.

72. James Hanford EDBC Error Message

73. James Hanford Case Summary
Example of the pending status on the case summary since the MAGI determination is pending.

74. 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.

75. Maria Corcoran MAGI Determination

76. 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.

77. 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.

78. Things You Need
to know.

79. Tax Filers – Not Required
Customer is not required to file taxes and doesn’t.
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.

80. 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.

81. MAGI Images (from CalHEERS)
This screen will only track images that have been sent from CalHEERS.

82. MAGI Images To access the MAGI Images Transfer Summary
Click on Distributed Documents from the Global bar.
Click on MAGI Images Transfer Summary.
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.

83. Have you learned all that you need to know?
Review
Have you learned all that you need to know?

84. Explain the different batch types
Real Time
Overnight
Eligibility Determination Request (EDR)
Determination Eligibility Results (DER)
Disposition
Images/NOA
Updates

85. 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

86. 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.

87. 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.

88. Questions?