(a) When determining whether an individual is eligible for Medi-Cal benefits, the department shall verify the accuracy of the information identified in this section that is provided as a part of the application or redetermination process in conformity with this section. (b) Before requesting additional verification from an applicant or beneficiary for information they provide as part of the application or redetermination process, the department shall obtain information about an individual that is available electronically from other state and federal agencies and programs in determining an individualâs eligibility for Medi-Cal benefits or for potential eligibility for an insurance affordability program offered through the California Health Benefit Exchange established pursuant to Title 22 (commencing with Section 100500) of the Government Code. Needed information shall be obtained from the following sources, including any other source the department determines is useful: (1) Information related to wages, net earnings from self-employment, unearned income, and resources from any of the following: (A) The State Wage Information Collection Agency. (B) The federal Internal Revenue Service. (C) The federal Social Security Administration. (D) The Employment Development Department. (E) The state administered supplementary payment program under Section 1382e of Title 42 of the United States Code. (F) Any state program administered under a plan approved under Titles I, X, XIV, or XVI of the federal Social Security Act. (2) Information related to eligibility or enrollment from any of the following: (A) The CalFresh program pursuant to Chapter 10 (commencing with Section 18900) of Part 6. (B) The CalWORKs program. (C) The stateâs childrenâs health insurance program under Title XXI of the federal Social Security Act (42 U.S.C. 1397aa et seq.). (D) The California Health Benefit Exchange established pursuant to Title 22 (commencing with Section 100500) of the Government Code. (E) The electronic service established in accordance with Section 435.949 of Title 42 of the Code of Federal Regulations. (c) (1) If the income information obtained by the department pursuant to subdivision (b) is reasonably compatible with the information provided by or on behalf of the individual, the department shall accept the information provided by or on behalf of the individual as being accurate. (2) If the income information obtained by the department is not reasonably compatible with the information provided by or on behalf of the individual, the department shall require that the individual provide additional information that reasonably explains the discrepancy. (3) For the purposes of this subdivision, income information obtained by the department is reasonably compatible with information provided by or on behalf of an individual if any of the following conditions are met: (A) Both state that the individualâs income is above the applicable income standard or other relevant income threshold for eligibility. (B) Both state that the individualâs income is at or below the applicable income standard or other relevant income threshold for eligibility. (C) The information provided by or on behalf of the individual states that the individualâs income is above, and the information obtained by the department states that the individualâs income is at or below, the applicable income standard or other relevant income threshold for eligibility. (4) If subparagraph (C) of paragraph (3) applies, the individual shall be informed that the income information provided by them was higher than the information that was electronically verified and that they may request a reconciliation of the difference. This paragraph shall be implemented no later than January 1, 2015. (d) (1) The department shall accept the attestation of the individual regarding whether they are pregnant unless the department has information that is not reasonably compatible with the attestation. (2)
‹ Prev All California sections Next ›
Lexace provides legal information, not legal advice, and no attorney–client relationship is created. Statute text is provided for general information and may not reflect the most recent amendments; verify against the official state code.