Automated Medi-Cal Discontinuances: Enhancing Efficiency for County Users

Automated Discontinuances Automated Discontinuances for Medi for Medi- -Cal Cal Redeterminations Redeterminations

Automated Automated Discontinuances Discontinuances for Medi for Medi- -Cal Cal Issue The C-IV System Medi-Cal caseload count has increased by 184% since October 2013 (implementation of the Affordable Care Act (ACA)). Currently, the C-IV System does not automatically discontinue Medi-Cal programs; Users must complete discontinuances manually. With the increased caseload size, completing manual discontinuances has created a significant workload increase for counties. County Request Counties (including the CalACES MC committee) have requested the C-IV Project explore automating Medi-Cal discontinuances. They are aware that both the LRS and CalWIN Systems have a process to automatically discontinue Medi-Cal programs. Since the C-IV System will migrate to the LRS System, they would like to have this functionality in the C-IV System sooner rather than later. DHCS Approval Previously, DHCS advised the C-IV Project that they did not approve of automated discontinuances, as they wanted the Worker to review the case prior to discontinuance to ensure that the discontinuance action was correct. However, Department of Health Care Services (DHCS) provided written confirmation that supports C- IV System automated Medi-Cal discontinuances.

Automated Automated Discontinuances Discontinuances for Medi for Medi- -Cal Cal Automated Medi-Cal Discontinuances One of the automated discontinuance processes run by the LRS System occurs when the Customer fails to return the RE packet (nothing returned by the Customer). Currently, C-IV Users must complete these discontinuances manually. The following data identifies the number of discontinuances for C-IV counties associated with failure to return the RE packet. Month MAGI RE Packet MC RE Packet ABD MC RE Packet Mixed MC RE Packet LTC and Other RE Packets TOTALS 6/1/2017 4396 1016 7/1/2017 4920 8/1/2017 5895 9/1/2017 6854 1139 1100 10/1/2017 11/1/2017 5451 861 792 164 48 7316 6528 1019 1075 221 81 8924 894 771 117 28 6730 942 934 182 60 8013 748 111 43 6314 226 97 9416

Automated Batch Discontinuances for Automated Batch Discontinuances for Medi Medi- -Cal Cal Preparation for Automated Discontinuance Functionality In order for automated discontinuances to work effectively, counties must ensure that all RE packets, or other designated items, are barcoded or entered into the C-IV System correctly and timely. Once available, counties will need to evaluate and enhance their business process to support this functionality. The model for this effort will be the existing LRS functionality. If the teams or the MC committee identifies a need to modify the LRS functionality, an LRS SCR will be created to address the change. Additional Batch Discontinuances In addition to designing SCR 11086 for RE packets not returned by Customers, the CalACES North/South teams are currently evaluating an SCR design to automate the MC 355 process. This will also assist counties with reducing User workload. Placeholder SCRs (LRS 50988/C-IV 12049) were created to track this effort.

Automated Batch Discontinuances for Automated Batch Discontinuances for Medi Medi- -Cal Cal Next Steps Design SCR 11086 recommendations to automate Medi-Cal program discontinuance when the Customer fails to return the RE packet (nothing returned by the Customer). Review the proposed design with the MC committee, seeking Approval to move forward. Identify a proposed release.