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County Eligibility & Enrollment “New Customer” Workflows County Eligibility & Enrollment Workflow Subgroup

County Eligibility & Enrollment “New Customer” Workflows County Eligibility & Enrollment Workflow Subgroup. August 2, 2013 Version 3.0. Overview Of Content. Overall Purpose of Workflow Effort

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County Eligibility & Enrollment “New Customer” Workflows County Eligibility & Enrollment Workflow Subgroup

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  1. County Eligibility & Enrollment “New Customer” WorkflowsCounty Eligibility & Enrollment Workflow Subgroup August 2, 2013 Version 3.0

  2. Overview Of Content Overall Purpose of Workflow Effort To collaboratively develop “as-is” and “to-be” visual representations (e.g., Diagrams), and accompanying narratives, of a general model for “end-to-end” New Customer County Eligibility and Enrollment Workflows. County specific flows are the purview of each County. Approach Efforts reflect a collaboration between counties, DHCS, CWDA, CalHEERS, CDSS, SAWS Consortia, and other stakeholders. Approach is comprised of 4 Workflow Stages : • Define Initial Flow - Identify “As-Is” (Current) flows and “To-Be” (Future) health benefit flows including integration with CalFresh and CalWORKs • Create Flow Narrative & Correct Flow - County representatives develop flow narratives with review for “must use” elements to comply with law and regulation as well as “recommended use” elements for standardization. • Review and Revise with Broader Audience - CWDA sponsored review and revision of workflows and narrativesface-to-face followed by edits out of meeting and some teleconference confirmation • Finalize for Use - Final revisions to prepare for county use (e.g., personalization to each county, training, Organizational Change Mgmt.) Scope of Flows Below • Flows contained below are focused on “Health Only” and “Health Plus” (Health, CalFresh, CalWORKs) workflows for three periods: “As-Is” (Before Oct 2013), “Early Open Enrollment” (Oct-Dec 2013), “To-Be” (Jan 2014 forward). The Visual Flows reflect a summary view of activities. Always refer to the “Narrative” documentation for actual workflow steps.

  3. “As-Is” Health Only Before Oct 2013

  4. “As-Is” Health Only (Before Oct 2013)Overview("Level 0" Context Diagram - v3.0) Summary Only – Read Narrative for Important Detail Customer / Application Entry • Customer Entry Paths • In-Person (walk-in & Appt) • Phone-In • SAWS On-Line Portal • Mail-in & Faxed Applications 2 1 Data Collection/Assistance (EW) Customer / Application Entry (CW) • Tasks Include: • Complete Request for Aid / Benefits • Perform File Clearance & Create Case • Process flow dependent on type of entry • Advance ALL cases to process through Pre-ACA rules via SAWS Eligibility & Enrollment Intake 6 3 7 Send NOAs & Benefit Card(s) (EW/FI) Run Eligibility (EW) Select Health Plan(HCO) 4 Additional Data Collection/Verification (EW) 5 Ineligible Post-Processing (EW) EW = Eligibility Worker CW = Clerical Worker FI = Fiscal Intermediary MC = Medi-Cal SOF = Statement of Facts HCO = Health Care Options NOA = Notice of Action ACA = Affordable Care Act CalW = CalWORKs CalF = CalFresh IAP = Insurance Affordability Programs APTC/CSR = Advance Premium Tax Credit/Cost Sharing Reductions

  5. “As-Is” Health Only (Before Oct 2013) Customer/Application Entry by Access Path("Level 1" Diagram - v3.0) Summary Only – Read Narrative for Important Detail Customers Mail–In & Faxed SAWS On-Line In-Person / In-Person Appt Phone-In 2 1 1 1 1 • Customer greeted; determine need. • Customers with Appts routed to EW • Customer directed to complete/ submit MC forms (e.g., SAWS1) to set App Date. Pend for MC SOF. • File clearance and case creation/ registration is completed. • Schedule Appt for same day/future assistance. • Additional forms provided to customer (e.g., MC SOF & local forms). • If interview not chosen, complete forms on paper or online at a self-service portal. Return forms by FAX, Mail, on-line, or in-person . • Customers needing assistance are supported by clerical or eligibility staff. • Apps are forwarded to EW for processing. • NOTE: Customer completes and submits On-Line Application. App Date set. • Staff check SAWS system queue for submitted Apps. • File clearance and case creation/ registration is completed. • Linked Medi-Cal applications are forwarded to eligibility staff for completion. • Customer greeted; determine need. • County completes SAWS1 for MC on behalf of customer to Set App Date. Pend for MC SOF. • File clearance and case creation/ registration is completed. • Schedule Appt for same day/future assistance. • Additional forms mailed to customer (e.g., MC SOF & local forms). • Complete forms on paper or online at a self-service portal. Return forms by FAX, Mail, on-line, or in-person . • Customers needing assistance are supported by clerical or eligibility staff. • Apps are forwarded to EW for processing. Data Collection/Assistance (EW) • Applications requested by phone (case already created) are screened and forwarded to E&E Intake. • If incoming App is SAWS1 only then App is pended for SOF. • File clearance and case creation/ registration is completed for other Mail and FAX applications. • Schedule Appt for same day/future assistance. • Apps are forwarded to EW for processing. Customer / Application Entry (CW) Customer / Application Entry (CW) Customer / Application Entry (CW) Customer / Application Entry (CW) E&E Intake EW = Eligibility Worker CW = Clerical Worker FI = Fiscal Intermediary MC = Medi-Cal SOF = Statement of Facts HCO = Health Care Options NOA = Notice of Action ACA = Affordable Care Act CalW = CalWORKs CalF = CalFresh IAP = Insurance Affordability Programs APTC/CSR = Advance Premium Tax Credit/Cost Sharing Reductions

  6. “As-Is” Health Only (Before Oct 2013) Eligibility & Enrollment Intake("Level 1" Diagram - v3.0) Summary Only – Read Narrative for Important Detail Customer/Application Entry 1 Eligibility & Enrollment Intake 2 Data Collection/Assistance (EW) • Submit to SAWS for Pre-ACA rules eligibility determination. • Eligible / Ineligible for MC. • Pended status until further data/verifications are provided. • Provide assistance with application forms, if needed. • Collect MC SOF to complete application. • Verify Data, as required. • Enter data into SAWS, as required, and compare to known 3rd party info. • Refer Eligible Customers to HCO for Plan Selection for 2-Plan and GMC counties. • COHS counties enroll Eligible Customers into their county’s managed care plan. • EW reviews case & amends NOA if required. • MC NOA Sent to Customer by SAWS. • Manual Mailing of NOA is optional. • Benefit Cards Created & Mailed to Customer automatically. • If immediate medical attention is needed, print temporary BIC. 6 3 7 Send NOAs & Benefit Card(s) (EW) Run Eligibility (EW) Select Health Plan(HCO) • Process or refer for other county medical services (e.g., LIHP, CMSP). • Gather additional post-run Data if required for MC, if provided on request. • Resolve Conditional or Pending States. • Enter data into SAWS, as required. • Re-Submit to Run Eligibility process. 4 Additional Data Collection/Verification (EW) 5 Ineligible Post-Processing (EW) EW = Eligibility Worker CW = Clerical Worker FI = Fiscal Intermediary MC = Medi-Cal SOF = Statement of Facts HCO = Health Care Options NOA = Notice of Action ACA = Affordable Care Act CalW = CalWORKs CalF = CalFresh IAP = Insurance Affordability Programs APTC/CSR = Advance Premium Tax Credit/Cost Sharing Reductions

  7. “To-Be” Health Only January 2014

  8. “To-Be” Health Only (Jan 2014)Overview("Level 0" Context Diagram - v3.0) Summary Only – Read Narrative for Important Detail Customer / Application Entry • Customer Entry Paths • In-Person (walk-in & Appt) • Phone-In • Warm Hand-offs (Transfer from Covered CA) • SAWS On-Line Portal & e-Referrals • Mail-in & Faxed Applications • SAWS On-Line includes Web Link to CalHEERS 2 1 Data Collection/Assistance (EW) • Customer / Application Entry • (CW/EW) • Tasks Include: • Complete Request for Aid / Benefits • Process flow dependent on type of entry • Perform File Clearance & Create Case • Advance ALL cases to process through ACA rules via SAWS • Non-MAGI cases will process through pre-ACA rules via SAWS Eligibility & Enrollment Intake 6 3 7 Send NOAs & Benefit Card(s) (EW/FI) Run Eligibility (EW) Select Health Plan(HCO) 4 Additional Data Collection/Verification (EW) NOTE: Other “To-Be” changes exist in E&E Intake detail. See E&E Intake Level 1 Diagram 5 Ineligible Post-Processing (EW) ** Changes from “As-Is” Health Only flow in Blue Italics EW = Eligibility Worker CW = Clerical Worker FI = Fiscal Intermediary MC = Medi-Cal SOF = Statement of Facts HCO = Health Care Options NOA = Notice of Action ACA = Affordable Care Act CalW = CalWORKs CalF = CalFresh IAP = Insurance Affordability Programs APTC/CSR = Advance Premium Tax Credit/Cost Sharing Reductions

  9. “To-Be” Health Only (Jan 2014) Customer/Application Entry by Access Path("Level 1" Diagram - v3.0) Summary Only – Read Narrative for Important Detail • SAWS On-Line Web Link to CalHEERS Customers Mail–In & Faxed SAWS On-Line & e-Referrals In-Person / In-Person Appt Warm Handoff (Transfers) Phone-In • Customer greeted; determine need. • County completes SAWS1 for MC on behalf of customer to Set App Date. • File clearance and case creation/ registration is completed. • Complete App. over phone, if possible (step to P2) • Schedule Appt for same day/future assistance, if required. • Pend for MC SOF if SSApp cannot be completed with customer. • Additional forms provided to customer, as needed. • If assistance not chosen, customer completes paper forms or online at a self-service portal. Return forms by FAX, Mail, on-line, or in-person. • NOTE: SSApps will be processed as “Health Only” need. • Applications requested by phone (case already created) are screened and forwarded to E&E Intake. • If incoming App is SAWS1 only then App is pended for SOF. • File clearance and case creation/ registration is completedfor other Mail and FAX applications. • Schedule Appt for same day/future assistance. • Apps are forwarded to EW for processing. 2 • NOTE: Customers with SSApps will be processed as “Health Only” need. • Customer greeted; determine need. • Customers with Appts routed to EW. • Customer directed to complete/ submit MC forms (e.g., SAWS1) to set App Date. • File clearance and case creation/ registration is completed. • Schedule Appt for same day/future assistance. Should be same day. • Provide SSApp for MC need and assist customer understanding if needed. • Additional forms provided to customer, as needed (e.g., Non-MAGI request). • If assistance not chosen, customer completes paper forms or online at a self-service portal. Return forms by FAX, Mail, on-line, or in-person. • Customers needing assistance are directed to clerical or eligibility staff for support. • Apps are forwarded to EW for processing. • Customer greeted; determine need. • County completes SAWS1 for MC on behalf of customer to Set App Date. • File clearance and case creation/ registration is completed. • Complete SSApp. over phone, if possible by transfer to EW. • Schedule Appt for same day/future assistance, if necessary. Should be same day. • Provide SSApp for MC need and assist customer understanding if needed. • Pend for MC SOF (e.g., SSApp) if EW cannot continue initial call. • Additional forms provided to customer, as needed (e.g., Non-MAGI request). • If assistance not chosen, customer completes paper forms or online at a self-service portal. Return forms by FAX, Mail, on-line, or in-person. • Customers needing assistance are directed to clerical or eligibility staff for support. • Apps are forwarded to EW for processing. • NOTE: Customer completes and submits On-Line Application. App Date set. Referral for a Non-MAGI needs also sent by CalHEERS to SAWS work queue. • Staff check SAWS system queue for submitted Apps. & e-Referrals • County completes SAWS1 for Non-MAGI MC referral on behalf of customer to Set App Date. • Non-MAGI forms are mailed to the customer. • File clearance and case creation/ registration is completed. • Linked MC Apps are then forwarded to eligibility staff for completion. Non-MAGI Apps are pended for SOF. 1 1 1 1 1 Data Collection/Assistance (EW) Customer / Application Entry (CW) Customer / Application Entry (EW) Customer / Application Entry (CW) Customer / Application Entry(CW) Customer / Application Entry (CW) E&E Intake ** Changes from “As-Is” Health Only flow in Blue Italics EW = Eligibility Worker CW = Clerical Worker FI = Fiscal Intermediary MC = Medi-Cal SOF = Statement of Facts HCO = Health Care Options NOA = Notice of Action ACA = Affordable Care Act CalW = CalWORKs CalF = CalFresh IAP = Insurance Affordability Programs APTC/CSR = Advance Premium Tax Credit/Cost Sharing Reductions

  10. “To-Be” Health Only (Jan 2014) Eligibility & Enrollment Intake ("Level 1" Diagram - v3.0) Summary Only – Read Narrative for Important Detail Customer/Application Entry 1 Eligibility & Enrollment Intake 2 Data Collection/Assistance (EW) • EW can assist with APTC plan choice for Exchange eligibles. • Customers choosing unsubsidized health coverage may be assisted by EW with plan selection via CalHEERS, if assistance is required. • MC Through March 2014... • Refer Eligible Customers to HCO for Plan Selection for counties with more than 1 plan choice. • MC April 2014 Forward... • Assist customers with plan selection, as requested or required via CalHEERS. • Advise customers to Pay Premium to Receive Benefit, if applicable • Refer Eligible Non-MAGI Customers to HCO for counties with more than 1 plan choice. • MAGI Notices are sent to SAWS to be mailed out once determination has been finalized by the county EW. • Non-MAGI MC Notices are generated by SAWS • APTC/CSR Notices are generated by CalHEERS • MC NOA Sent to Customer by SAWS. • Manual Mailing of NOA is optional. • Benefit Cards Created & Mailed to Customer automatically. • NOTE: Support for adding comments to MAGI/APTC-CSR NOAs is not supported. • Provide assistance with application forms, if needed. • Collect IAP SOF to complete SSAppor Non-MAGI SOF, as required. • Verify Data, as required. • Enter data into SAWS, as required. • Submit to SAWS for MAGI/APTC rules (via CalHEERS BRE) and Non-MAGI rules • Eligible / Ineligible for MAGI Medi-Cal • Eligible / Ineligible for APTC/CSR • Eligible / Ineligible for Non-MAGI Medi-Cal • Pended status until further data/verifications are provided. 6 3 7 Send NOAs & Benefit Card(s) (EW) Run Eligibility (EW) Select Health Plan(HCO/EW) • Initiate Non-MAGI Medi-Cal App if Denied for MAGI and Qualifiers Exist or if requested by customer. • Process or refer for other county medical services (e.g., CMSP). • Offer customer unsubsidized health insurance coverage as an option. • Gather additional post-run Data if required for MC, if provided on request. • Resolve Conditional or Pending States. • Enter data into SAWS, as required. • Re-Submit to Run Eligibility process. 4 Additional Data Collection/Verification (EW) 5 Ineligible Post-Processing (EW) ** Changes from “As-Is” Health Only flow in Blue Italics EW = Eligibility Worker CW = Clerical Worker FI = Fiscal Intermediary MC = Medi-Cal SOF = Statement of Facts HCO = Health Care Options NOA = Notice of Action ACA = Affordable Care Act CalW = CalWORKs CalF = CalFresh IAP = Insurance Affordability Programs APTC/CSR = Advance Premium Tax Credit/Cost Sharing Reductions

  11. “To-Be” Health Only Oct-Dec 2013

  12. “To-Be” Health Only (Oct-Dec 2013) Overview("Level 0" Context Diagram - v3.0) Summary Only – Read Narrative for Important Detail Customer / Application Entry • Customer Entry • In-Person (walk-in & Appt) • Phone-In • Warm Handoff (Transfers) from Covered CA • SAWS On-Line Portal & e-Referrals • Mail-in & Faxed Applications • SAWS On-Line Web Link to CalHEERS 2 2 1 Data Collection/Assistance (EW) Data Collection/Assistance (EW) Customer / Application Entry(CW/EW) • Tasks Include • Determine Customer Need & Choice of MC Now or Jan 1 • Complete Request for Aid / Benefits • Process flow dependent on type of entry • Advance “Now” cases to process through Pre-ACA rules via SAWS • Advance “Later” cases to process through ACA rules via CalHEERS Eligibility & Enrollment Intake Medi-Cal “Now” Path 3 3 6 6 7 7 Run Eligibility (EW) Run Eligibility (EW) Send NOAs & Benefit Card(s) (EW/FI) Send NOAs & Benefit Card(s) (EW/FI) Select Health Plan(HCO) Select Health Plan(HCO) NOTE: Other “To-Be” changes exist in E&E Intake detail. See E&E Intake Level 1 Diagram 4 4 Additional Data Collection/Verification (EW) Additional Data Collection/Verification (EW) Medi-Cal “Later” (Jan 1) Path 5 5 Ineligible Post-Processing (EW) Ineligible Post-Processing (EW) ** Changes from “As-Is” Health Only flow in Blue Italics EW = Eligibility Worker CW = Clerical Worker FI = Fiscal Intermediary MC = Medi-Cal SOF = Statement of Facts HCO = Health Care Options NOA = Notice of Action ACA = Affordable Care Act CalW = CalWORKs CalF = CalFresh IAP = Insurance Affordability Programs APTC/CSR = Advance Premium Tax Credit/Cost Sharing Reductions

  13. “To-Be” Health Only (Oct-Dec 2013) Customer/Application Entry by Access Path("Level 1" Diagram - v3.0) Summary Only – Read Narrative for Important Detail Customers • SAWS On-Line Web Link to CalHEERS Mail–In & Faxed SAWS On-Line & Referrals In-Person / In-Person Appt • Warm Handoff (Transfers) Phone-In • Customer greeted; determine need & Choice of MC Now or Later (Jan1). • Customers needing assistance are supported by clerical or eligibility staff. • If MC Now... • Customer directed to complete/ submit MC forms (e.g., SAWS1) to set App Date. • File clearance and case creation/ registration is completed. • Schedule Appt for same day/future assistance. • Assist Client w/ MC210 or provide App Pkg, if appropriate. • Additional forms provided to customer (e.g., MC SOF & local forms). • If assistance not chosen, complete paper forms or online at a self-service portal. Return forms by FAX, Mail, on-line, or in-person. • Apps are forwarded to EW for processing. • If MC Later (Jan 1)... • Complete SSApp. over phone, if possible by transfer to designated eligibility staff for CalHEERS processing. • Schedule Appt for same day/future assistance, if necessary. • The customer is provided with SSApp to completeif phone assist not accepted or possible. • Customer greeted; Choice of “Health Only” MC “Later” (Jan 1) is presumed. • County completes SAWS1 for MC on behalf of customer to Set App Date. • Assist client in CalHEERS with application and determination (jump to E&E Intake). • Schedule Appt for same day/future assistance, if required. • Pend for MC SOF if SSApp cannot be completed with customer. • If a Non-MAGI App is requested or indicated, that need is captured on the SSApp and managed as a referral • If assistance not chosen, customer completes paper forms or online at a self-service portal. Return forms by FAX, Mail, on-line, or in-person. • NOTE: Customer completes and submits On-Line Application. App Date set. . Referrals for a Non-MAGI need are in CalHEERS work queue. • NOTE: On-Line Apps are assumed to be Health “Now” Apps. CalHEERS link provided for “Later” Apps. • Staff check SAWS system queue for submitted Apps. • Staff check CalHEERS work queue for Non-MAGI referrals. • County completes SAWS1 for Non-MAGI MC referral on behalf of customer to Set App Date. • Non-MAGI forms are mailed to the customer. • File clearance and case creation/ registration is completed. • Linked Medi-Cal applications are then forwarded to eligibility staff for completion and pended for Non-MAGI SOF. • NOTE: SSApps will be processed as “Health Only” MC “Later” need. • Applications requested by phone (case already created) are screened and forwarded to E&E Intake. • If incoming App is SAWS1 only then App is pended for SOF • File clearance and case creation/ registration is completedfor other Mail and FAX applications. • Schedule Appt for same day/future assistance. • Apps are forwarded to EW for processing. • NOTE: Customers with SSApps will be processed as “Health Only - Later” need. • Customer greeted; determine need & Choice of MC Now or Later (Jan1). • Customers with Appts routed to EW • Customers needing assistance are supported by clerical or eligibility staff. • If MC Now... • Customer directed to complete/ submit MC forms (e.g., SAWS1) to set App Date. • File clearance and case creation/ registration is completed. • Schedule Appt for same day/future assistance. • Assist Client w/ MC210 or provide App Pkg, if appropriate. • Additional forms provided to customer (e.g., MC SOF & local forms). • If assistance not chosen, complete paper forms or online at a self-service portal. Return forms by FAX, Mail, on-line, or in-person. • Apps are forwarded to EW for processing. • If MC Later (Jan 1)... • The customer is provided SSApp to complete. • Schedule Appt for same day/future assistance. Should be same day. • The customer is routed to designated eligibility staff for CalHEERS processing. 2 1 1 1 1 1 Data Collection/Assistance (EW) Customer / Application Entry(CW) Customer / Application Entry(EW) Customer / Application Entry(CW) Customer / Application Entry(CW) Customer / Application Entry(CW) ** Changes from “As-Is” Health Only flow in Blue Italics E&E Intake EW = Eligibility Worker CW = Clerical Worker FI = Fiscal Intermediary MC = Medi-Cal SOF = Statement of Facts HCO = Health Care Options NOA = Notice of Action ACA = Affordable Care Act CalW = CalWORKs CalF = CalFresh IAP = Insurance Affordability Programs APTC/CSR = Advance Premium Tax Credit/Cost Sharing Reductions

  14. “To-Be” Health Only (Oct-Dec 2013) Eligibility & Enrollment Intake – 2 Paths("Level 1" Diagram - v3.0) Summary Only – Read Narrative for Important Detail Eligibility & Enrollment Intake – Medi-Cal “Now” Path (Uses SAWS) • Submit to SAWS for Pre-ACA rules. • Eligible / Ineligible for Pre-ACA MC. • Pended status until further verifications are provided. • Refer Eligible Customers to HCO for Plan Selection for counties with more than 1 plan choice. • COHS counties enroll Eligible Customers into their county’s managed care plan. • EW Reviews Case & Comments if required. • Pre-ACAMC NOA Sent to Customer by SAWS. • Manual Mailing of NOA is optional. • Benefit Cards Created & Mailed to Customer automatically. • If immediate medical attention is needed, print temporary BIC. • Provide assistance with application forms, if needed. • Collect MC SOF to complete application. • Verify Data, as required. • Enter data into SAWS, as required, and compare to known 3rd party info. 2 2 Data Collection/Assistance (EW) Data Collection/Assistance (EW) • Process or refer for other county medical services (e.g., LIHP,CMSP). • If Ineligible for Pre-ACA MC, route to Jan 1 Path using CalHEERS (P-3) • Gather additional post-run Data if required for MC, if provided on request. • Resolve Conditional or Pending States. • Enter data into SAWS, as required. • Re-Submit to Run Eligibility process. Customer/Application Entry 1 Eligibility & Enrollment Intake - Medi-Cal “Later” (Jan 1st) Path (Uses CalHEERS) 6 6 3 3 7 7 Send NOAs & Benefit Card(s) (EW) Send NOAs & Benefit Card(s) (EW) Run Eligibility (EW) Run Eligibility (EW) Select Health Plan(HCO) Select Health Plan(HCO) • Refer MC Eligible Customers to HCO for Plan Selection for counties with more than 1 plan choice. Others are auto enrolled. • Assist APTC/CSR eligibles with Plan Selection via CalHEERS. • Assist unsubsidized health insurance customers with Plan Selection via CalHEERS. • ACA Medi-Cal or APTC/CSR NOA sent by CalHEERS. • Manual Mailing of NOA is optional. • Benefit Cards Created & Mailed to Customer automatically. • Submit to CalHEERS for ACA rules. • Eligible / Ineligible for MAGI MC or APTC/CSR. • Pended status until further verifications are provided. • Provide assistance with application forms, if needed. • CollectIAP SOF (SSApp) to complete application • Verify Data, as required. • Enter data into CalHEERS, as required. 4 4 Additional Data Collection/Verification (EW) Additional Data Collection/Verification (EW) 5 5 Ineligible Post-Processing (EW) Ineligible Post-Processing (EW) • If denied for MAGI/APTC-CSR refer to “Now” Path if Qualifiers Exist or if requested by customer. • Process or refer for other county medical services (e.g., LIHP,CMSP). • Offer customer unsubsidized health insurance coverage as an option. • Gather additional post-run Data if required for MC, if provided on request. • Resolve Conditional or Pending States. • Enter data into SAWS, as required. • Re-Submit to Run Eligibility process. ** Changes from “As-Is” Health Only flow in Blue Italics EW = Eligibility Worker CW = Clerical Worker FI = Fiscal Intermediary MC = Medi-Cal SOF = Statement of Facts HCO = Health Care Options NOA = Notice of Action ACA = Affordable Care Act CalW = CalWORKs CalF = CalFresh IAP = Insurance Affordability Programs APTC/CSR = Advance Premium Tax Credit/Cost Sharing Reductions

  15. “As-Is” Health Plus Before Oct 2013

  16. “As-Is” Health Plus (Before Oct 2013)Overview("Level 0" Context Diagram - v3.0) Summary Only – Read Narrative for Important Detail Customer / Application Entry • Customer Entry Paths • In-Person (walk-in & Appt) • Phone-In • SAWS On-Line Portal • Mail-in & Faxed Applications 2 1 Data Collection/Assistance (EW) Customer / Application Entry (CW) • Tasks Include: • Complete Request for Aid / Benefits • Perform File Clearance & Create Case • Process flow dependent on type of entry • Advance ALL cases to process through Pre-ACA rules via SAWS • Supports CalFresh & CalWORKs Flows Eligibility & Enrollment Intake 6 3 7 Send NOAs & Benefit Card(s) (EW/FI) Run Eligibility (EW) Select Health Plan(HCO) 4 Additional Data Collection/Verification (EW) 5 Ineligible Post-Processing (EW) ** Changes from Health Only “As-Is” flow in Blue Italics EW = Eligibility Worker CW = Clerical Worker FI = Fiscal Intermediary MC = Medi-Cal SOF = Statement of Facts HCO = Health Care Options NOA = Notice of Action ACA = Affordable Care Act CalW = CalWORKs CalF = CalFresh IAP = Insurance Affordability Programs APTC/CSR = Advance Premium Tax Credit/Cost Sharing Reductions

  17. “As-Is” Health Plus (Before Oct 2013) Customer/Application Entry by Access Path("Level 1" Diagram - v3.0) Summary Only – Read Narrative for Important Detail Customers Mail–In & Faxed SAWS On-Line In-Person / In-Person Appt Phone-In 2 • Customer greeted; determine need. • Customers with Appts routed to EW • Customer directed to complete/ submit MC forms (e.g., SAWS1) to set App Date. Pend for MC SOF. • File clearance and case creation/ registration is completed. • Schedule Appt for same day/future assistance and CalF/CalW interview. • Additional forms provided to customer (e.g., MC SOF, SAWS 2, & local forms). • If interview not chosen, complete forms on paper or online at a self-service portal. Return forms by FAX, Mail, on-line, or in-person . • Customers needing assistance are supported by clerical or eligibility staff. • Apps are forwarded to EW for processing. • Mail-In applications requested by phone (case already created) are screened and forwarded to E&E Intake. • If incoming App is SAWS1 only then App is pended for SOF. • File clearance and case creation/ registration is completed for other Mail and FAX applications • Schedule Appt for same day/future assistance. • Apps are forwarded to EW for processing. • NOTE: Customer completes and submits On-Line Application. App Date set. • Staff check SAWS system queue for submitted Apps • File clearance and case creation/ registration is completed. • Set Appt for CalF/CalW after case created. • Forward to Customer Service to set CalF/CalW interview Appt. 1 1 1 1 • Customer greeted; determine need. • For Health Plus CalFresh w/ Pilot Program • County completes SAWS1 for MC and CalFresh on behalf of customerto set App Date. Pend for MC SOF. • File clearance and case creation/ registration is completed. • Apps are forwarded to EW for processing. • For other Health Plus Options • Info provided to customer on how to apply for CalF/CalW. • Schedule Appt for same day/future assistance and CalF/CalW interview. • Additional forms mailed to customer (e.g., MC SOF, SAWS2, & local forms). • Complete and return forms In-Person, by FAX, Mail, or on-line. • Customers needing assistance are supported by clerical or eligibility staff. Data Collection/Assistance (EW) Customer / Application Entry (CW) Customer / Application Entry (CW) Customer / Application Entry (CW) Customer / Application Entry (CW) E&E Intake ** Changes from Health Only “As-Is” flow in Blue Italics EW = Eligibility Worker CW = Clerical Worker FI = Fiscal Intermediary MC = Medi-Cal SOF = Statement of Facts HCO = Health Care Options NOA = Notice of Action ACA = Affordable Care Act CalW = CalWORKs CalF = CalFresh IAP = Insurance Affordability Programs APTC/CSR = Advance Premium Tax Credit/Cost Sharing Reductions

  18. “As-Is” Health Plus (Before Oct 2013) Eligibility & Enrollment Intake("Level 1" Diagram - v3.0) Summary Only – Read Narrative for Important Detail Customer/Application Entry 1 Eligibility & Enrollment Intake 2 Data Collection/Assistance (EW) • Refer Eligible Customers to HCO for Plan Selection for 2-Plan or GMC counties. • COHS counties enroll Eligible Customers into their county’s managed care plan. • EW Reviews Case & Comments if required. • NOAs Sent to Customer by SAWS. • Manual Mailing of NOA is optional. • Establish benefit payment types for CalF/CalW. • Benefit Cards Created & Mailed to Customerautomatically. • Submit to SAWS when sufficient for at least 1 benefit. • Eligible/Ineligible for MC/ CalF/ CalW. • Pended status until further data/verifications are provided. • Provide assistance with application forms, if needed. • Collect SOF to complete application. • Interview for SOF Info (CalW & CalF). • Verify Data, as required. • Enter data into SAWS, as required, and compare to known 3rd party info. 6 3 7 Send NOAs & Benefit Card(s) (EW) Run Eligibility (EW) Select Health Plan(HCO) • Process or refer for other county medical services (e.g., LIHP). • If Ineligible for CalW, evaluate for MC in P4. • May refer the customer to other community resources, if denied for CalWORKs and/or CalFresh. • Gather additional post-run Data if required, if provided on request. • Resolve Conditional or Pending States. • If Ineligible for CalW, evaluate for MC. • Enter data into SAWS, as required. • Re-Submit to Run Eligibility process. 4 Additional Data Collection/Verification (EW) 5 Ineligible Post-Processing (EW) ** Changes from Health Only “As-Is” flow in Blue Italics EW = Eligibility Worker CW = Clerical Worker FI = Fiscal Intermediary MC = Medi-Cal SOF = Statement of Facts HCO = Health Care Options NOA = Notice of Action ACA = Affordable Care Act CalW = CalWORKs CalF = CalFresh IAP = Insurance Affordability Programs APTC/CSR = Advance Premium Tax Credit/Cost Sharing Reductions

  19. “To-Be” Health Plus January 2014 DRAFT

  20. “To-Be” Health Plus (Jan 2014)Overview("Level 0" Context Diagram - v3.0) Summary Only – Read Narrative for Important Detail Customer / Application Entry • Customer Entry Paths • In-Person (walk-in & Appt) • Phone-In • Warm Hand-offs (Transfer from Covered CA) • SAWS On-Line Portal • Mail-in & Faxed Applications • SAWS On-Line Web Link to CalHEERS 2 1 Data Collection/Assistance (EW) • Customer / Application Entry • (CW/EW) • Tasks Include: • Complete Request for Aid / Benefits • Process flow dependent on type of entry • Perform File Clearance & Create Case • Advance ALL cases to process through ACA rules via SAWS • Supports CalFresh & CalWORKs Flows Eligibility & Enrollment Intake 6 3 7 Send NOAs & Benefit Card(s) (EW/FI) Run Eligibility (EW) Select Health Plan(HCO) 4 Additional Data Collection/Verification (EW) NOTE: Other “To-Be” changes exist in E&E Intake detail. See E&E Intake Level 1 Diagram 5 Ineligible Post-Processing (EW) ** Changes from Health Only “As-Is” flow in Blue Italics EW = Eligibility Worker CW = Clerical Worker FI = Fiscal Intermediary MC = Medi-Cal SOF = Statement of Facts HCO = Health Care Options NOA = Notice of Action ACA = Affordable Care Act CalW = CalWORKs CalF = CalFresh IAP = Insurance Affordability Programs APTC/CSR = Advance Premium Tax Credit/Cost Sharing Reductions

  21. “To-Be” Health Plus (Jan 2014) Customer/Application Entry by Access Path("Level 1" Diagram - v3.0) Summary Only – Read Narrative for Important Detail • SAWS On-Line Web Link to CalHEERS Customers Mail–In & Faxed SAWS On-Line & e Referrals In-Person / In-Person Appt • Warm Handoff (Transfers) Phone-In • Customer greeted; determine need • For Health Plus CalF • County completes SAWS1 for MC on behalf of customer to set App Date. Pend for MC SOF. • File clearance and case creation/ registration is completed. • Complete SSApp. over phone, if possible by transfer to EW. • Schedule Appt for same day/future assistance and CalF interview. • Provide SSApp for MC need and assist customer understanding if needed. • Pend for MC SOF (e.g., SSApp) if EW cannot continue initial call. • Additional forms provided to customer, as needed (e.g., Non-MAGI request). • If assistance not chosen, customer completes paper forms or online at a self-service portal. Return forms by FAX, Mail, on-line, or in-person. • Customers needing assistance are directed to clerical or eligibility staff for support. • Apps are forwarded to EW for processing. • For Health Plus CalWor CalW& CalF • Refer to narrative. Customer cannot initiate a CalWORKs app over the phone. 2 • NOTE: Customers with SSApps will be processed as “Health Only” need. • Customer greeted; determine need. • Customers with Appts routed to EW. • Customer directed to complete/ submit SAWS1 to set App Date. • File clearance and case creation/ registration is completed. • Schedule Appt for same day/future assistance and CalF/CalW interview.Should be same day. • Additional forms provided to customer, as needed (e.g., Non-MAGI request). • If assistance not chosen, customer completes paper forms or online at a self-service portal. Return forms by FAX, Mail, on-line, or in-person. • Customers needing assistance are directed to clerical or eligibility staff for support. • Apps are forwarded to EW for processing. • NOTE: Customers through this door will be processed as “Health Only” need. Other benefits managed as referrals. • Customer greeted; determine need • County completes SAWS1 for MC on behalf of customer to set App Date. Pend for MC SOF. • File clearance and case creation/registration is completed. • Complete App. over phone, if possible (step to P2) • Schedule Appt for same day/future assistance. • Pend for MC SOF if SSApp cannot be completed with customer. • Additional forms provided to customer, as needed. • If assistance not chosen, customer completes paper forms or online at a self-service portal. Return forms by FAX, Mail, on-line, or in-person. • NOTE: Customer completes and submits On-Line Application. App Date set. Referral for a Non-MAGI, CalF, & CalW needs also sent by CalHEERS to SAWS work queue. • Staff check SAWS system queue for submitted Apps. & e-Referrals • County completes SAWS1 for Non-MAGI MC referral on behalf of customer to Set App Date. • Non-MAGI and SAWS Plus forms are mailed to the customer, as needed. • File clearance and case creation/ registration is completed. • Linked MC Apps are then forwarded to eligibility staff for completion. Non-MAGI Apps are pended for SOF. • NOTE: SSApps will be processed as “Health Only” need. • Applications requested by phone (case already created) are screened and forwarded to E&E Intake. • If incoming App is SAWS1 only then App is pended for SOF. • File clearance and case creation/ registration is completed for other Mail and FAX applications. • Schedule Appt for same day/future assistance. • Apps are forwarded to EW for processing. 1 1 1 1 1 Data Collection/Assistance (EW) Customer / Application Entry(CW) Customer / Application Entry(EW) Customer / Application Entry(CW) Customer / Application Entry(CW) Customer / Application Entry(CW) ** Changes from Health Only “As-Is” flow in Blue Italics E&E Intake EW = Eligibility Worker CW = Clerical Worker FI = Fiscal Intermediary MC = Medi-Cal SOF = Statement of Facts HCO = Health Care Options NOA = Notice of Action ACA = Affordable Care Act CalW = CalWORKs CalF = CalFresh IAP = Insurance Affordability Programs APTC/CSR = Advance Premium Tax Credit/Cost Sharing Reductions

  22. “To-Be” Health Plus (Jan 2014) Eligibility & Enrollment Intake ("Level 1" Diagram - v3.0) Summary Only – Read Narrative for Important Detail Customer/Application Entry 1 Eligibility & Enrollment Intake 2 Data Collection/Assistance (EW) • EW can assist with APTC plan choice for Exchange eligibles. • Customers choosing unsubsidized health coverage may be assisted by EW with plan selection via CalHEERS, if assistance is required. • MC Through March 2014... • Refer Eligible Customers to HCO for Plan Selection for counties with more than 1 plan choice. • MC April 2014 Forward... • Assist customers with plan selection, as requested or required via CalHEERS. • Advise customers to Pay Premium to Receive Benefit, if applicable • Refer Eligible Non-MAGI Customers to HCO for counties with more than 1 plan choice. • MAGI Notices are sent to SAWS to be mailed out once determination has been finalized by the county EW. • Non-MAGI MC & CalF/CalW Notices are generated by SAWS • APTC/CSR Notices are generated by CalHEERS • MC NOA Sent to Customer by SAWS. • Manual Mailing of NOA is optional. • Establish benefit payment types for CalF/CalW. • Benefit Cards Created & Mailed to Customer automatically. • NOTE: Support for adding comments to MAGI/APTC-CSR NOAs is not supported. • Submit to SAWS when sufficient for at least 1 benefit • Eligible / Ineligible for MAGI Medi-Cal • Eligible / Ineligible for APTC/CSR • Eligible / Ineligible for CalF/CalW • Eligible / Ineligible for Non-MAGI Medi-Cal • Provide assistance with application forms, if needed. • Collect IAP SOF to complete SSApp or Non-MAGI SOF, as required. • Interview for CalF/CalW SOF • Verify Data, as required. • Enter data into SAWS, as required. 6 3 7 Send NOAs & Benefit Card(s) (EW) Run Eligibility (EW) Select Health Plan(HCO) • Initiate Non-MAGI Medi-Cal App if Denied for MAGI and Qualifiers Exist or if requested by customer. • Process or refer for other county medical services (e.g., CMSP). • Offer customer unsubsidized health insurance coverage as an option. • May refer the customer to other community resources, if denied for CalWORKs and/or CalFresh. • Gather additional post-run Data if required for any benefit • Resolve Conditional or Pending States. • Enter data into SAWS, as required. • See Narrative for CalW/CalF processing rules. • Re-Submit to Run Eligibility process. 4 Additional Data Collection/Verification (EW) 5 Ineligible Post-Processing (EW) ** Changes from Health Only “As-Is” flow in Blue Italics EW = Eligibility Worker CW = Clerical Worker FI = Fiscal Intermediary MC = Medi-Cal SOF = Statement of Facts HCO = Health Care Options NOA = Notice of Action ACA = Affordable Care Act CalW = CalWORKs CalF = CalFresh IAP = Insurance Affordability Programs APTC/CSR = Advance Premium Tax Credit/Cost Sharing Reductions

  23. “To-Be” Health Plus Oct-Dec 2013

  24. “To-Be” Health Plus (Oct-Dec 2013) Overview("Level 0" Context Diagram - v3.0) Summary Only – Read Narrative for Important Detail Customer / Application Entry • Customer Entry • In-Person (walk-in & Appt) • Phone-In • Warm Hand-offs (Transfer from Covered CA) • SAWS On-Line Portal • Mail-in & Faxed Applications • SAWS On-Line Web Link to CalHEERS 2 2 1 Data Collection/Assistance (EW) Data Collection/Assistance (EW) Customer / Application Entry (CW/EW) • Tasks Include • Determine Customer Need & Choice of MC Now or Jan 1 • Complete Request for Aid / Benefits • Process flow dependent on type of entry • Advance “Now” health cases to process through Pre-ACA rules via SAWS • Advance “Later” health cases to process through ACA rules via CalHEERS • Supports CalFresh & CalWORKs Flows Eligibility & Enrollment Intake Medi-Cal “Now” Path 3 3 6 6 7 7 Run Eligibility (EW) Run Eligibility (EW) Send NOAs & Benefit Card(s) (EW/FI) Send NOAs & Benefit Card(s) (EW/FI) Select Health Plan(HCO) Select Health Plan(HCO) NOTE: Other “To-Be” changes exist in E&E Intake detail. See E&E Intake Level 1 Diagram 4 4 Additional Data Collection/Verification (EW) Additional Data Collection/Verification (EW) Medi-Cal “Later” (Jan 1) Path 5 5 Ineligible Post-Processing (EW) Ineligible Post-Processing (EW) ** Changes from Health Only “As-Is” flow in Blue Italics EW = Eligibility Worker CW = Clerical Worker FI = Fiscal Intermediary MC = Medi-Cal SOF = Statement of Facts HCO = Health Care Options NOA = Notice of Action ACA = Affordable Care Act CalW = CalWORKs CalF = CalFresh IAP = Insurance Affordability Programs APTC/CSR = Advance Premium Tax Credit/Cost Sharing Reductions

  25. “To-Be” Health Plus (Oct-Dec 2013) Customer/Application Entry by Access Path("Level 1" Diagram - v3.0) Summary Only – Read Narrative for Important Detail Customers • SAWS On-Line Web Link to CalHEERS Mail–In & Faxed SAWS On-Line & Referrals In-Person / In-Person Appt Phone-In Transfers Phone-In • NOTE: Customer completes and submits On-Line Application. App Date set. . Referrals for a Non-MAGI need are in CalHEERS work queue. • NOTE: On-Line Apps are assumed to be Health “Now” Apps. CalHEERS link provided for “Later” Apps. • Staff check SAWS system queue for submitted Apps. • Staff check CalHEERS work queue for Non-MAGI referrals. • County completes SAWS1 for Non-MAGI MC referral on behalf of customer to Set App Date. • Non-MAGI forms are mailed to the customer. • File clearance and case creation/ registration is completed. • Linked Medi-Cal applications are then forwarded to eligibility staff for completion and pended for Non-MAGI SOF. • Set Appt for CalF/CalW interview after case created. • Customer greeted; determine need & Choice of MC Now or Later (Jan1). • Customers needing assistance are supported by clerical or eligibility staff. • If MC Now... • Customer directed to complete/ submit MC forms (e.g., SAWS1) to set App Date. • File clearance and case creation/ registration is completed. • Schedule Appt for same day/future assistanceand CalF/CalW interview. • Assist Client w/ MC210 or provide App Pkg, if appropriate. • Additional forms provided to customer (e.g., MC SOF & local forms). • If assistance not chosen, complete paper forms or online at a self-service portal. Return forms by FAX, Mail, on-line, or in-person. • Apps are forwarded to EW for processing. • If MC Later (Jan 1)... • Complete SSApp. over phone, if possible by transfer to designated eligibility staff for CalHEERS processing. • Schedule Appt for same day/future assistance, if necessary. • The customer is provided with SSApp to completeif phone assist not accepted or possible. • If CalF and MC and Jan 1 choice … • Jump to E&E Intake to follow “Jan 1” path with CalHEERS • Customer greeted; Choice of “Health Only” MC “Later” (Jan 1) is presumed. • County completes SAWS1 for MC on behalf of customer to Set App Date. • Assist client in CalHEERS with application and determination (jump to E&E Intake). • Schedule Appt for same day/future assistance, if required. • Pend for MC SOF if SSApp cannot be completed with customer. • If a Non-MAGI App is requested or indicated, that need is captured on the SSApp and managed as a referral • If assistance not chosen, customer completes paper forms or online at a self-service portal. Return forms by FAX, Mail, on-line, or in-person. • NOTE: SSApps will be processed as “Health Only” MC “Later” need. • Applications requested by phone (case already created) are screened and forwarded to E&E Intake. • If incoming App is SAWS1 only then App is pended for SOF • File clearance and case creation/ registration is completedfor other Mail and FAX applications. • Schedule Appt for same day/future assistance. • Apps are forwarded to EW for processing. • NOTE: Customers with SSApps will be processed as “Health Only - Later” need. • Customer greeted; determine need & Choice of MC Now or Later (Jan1). • Customers with Appts routed to EW • Customers needing assistance are supported by clerical or eligibility staff. • If MC Now... • Customer directed to complete/ submit MC forms (e.g., SAWS1) to set App Date. • File clearance and case creation/ registration is completed. • Schedule Appt for same day/future assistanceand CalF/CalW interview. • Assist Client w/ MC210 or provide App Pkg, if appropriate. • Additional forms provided to customer (e.g., MC SOF & local forms). • If assistance not chosen, complete paper forms or online at self-service portal. Return forms by FAX, Mail, on-line, or in-person. • Apps are forwarded to EW for processing. • If MC Later (Jan 1)... • The customer is provided SSApp to complete. • Schedule Appt for same day/future assistance. Should be same day. • The customer is routed to designated eligibility staff for CalHEERS processing. 2 1 1 1 1 1 Data Collection/Assistance (EW) • Customer / Application Entry(EW) • Customer / Application Entry(CW) • Customer / Application Entry(CW) • Customer / Application Entry(CW) • Customer / Application Entry(CW) ** Changes from Health Only “As-Is” flow in Blue Italics EW = Eligibility Worker CW = Clerical Worker FI = Fiscal Intermediary MC = Medi-Cal SOF = Statement of Facts HCO = Health Care Options NOA = Notice of Action ACA = Affordable Care Act CalW = CalWORKs CalF = CalFresh IAP = Insurance Affordability Programs APTC/CSR = Advance Premium Tax Credit/Cost Sharing Reductions E&E Intake

  26. “To-Be” Health Plus (Oct-Dec 2013) Eligibility & Enrollment Intake – 2 Paths("Level 1" Diagram - v3.0) Summary Only – Read Narrative for Important Detail Eligibility & Enrollment Intake – Medi-Cal “Now” Path (Uses SAWS) • Submit to SAWS for Pre-ACArules when sufficient for at least 1 benefit. • Eligible / Ineligible for Pre-ACA MC, CalF, & CalW. • Pended status until further verifications are provided. • Refer Eligible Customers to HCO for Plan Selection for counties with more than 1 plan choice. • COHS counties enroll Eligible Customers into their county’s managed care plan. • EW Reviews Case & Comments if required. • Pre-ACAMC & CalF/CalW NOAs Sent to Customer by SAWS. • Manual Mailing of NOA is optional. • Establish benefit payment types for CalF/CalW. • Benefit Cards Created & Mailed to Customer automatically. • If immediate medical attention is needed, print temporary BIC. • Provide assistance with application forms, if needed. • Collect MC SOF to complete application. Interview for CalF/CalW SOF. • Verify Data, as required. • Enter data into SAWS, as required, and compare to known 3rd party info. 2 2 Data Collection/Assistance (EW) Data Collection/Assistance (EW) • Process or refer for other county medical services (e.g., LIHP). • If Ineligible for Pre-ACA MC, route to “Later” Path using CalHEERS. • Gather additional post-run Data if required, if provided on request. • Resolve Conditional or Pending States. • Enter data into SAWS, as required. • Re-Submit to Run Eligibility process. Customer/Application Entry 1 Eligibility & Enrollment Intake - Medi-Cal “Later” (Jan 1st) Path (Uses CalHEERS & SAWS) 6 6 3 3 7 7 Send NOAs & Benefit Card(s) (EW) Send NOAs & Benefit Card(s) (EW) Run Eligibility (EW) Run Eligibility (EW) Select Health Plan(HCO) Select Health Plan(HCO) • EW Reviews Case & Comments if required NOTE: Support for adding comments to MAGI/APTC-CSR NOAs is not supported. • ACA Medi-Cal or APTC/CSR NOA sent by CalHEERS. • Manual Mailing of NOA is optional. • Establish benefit payment types for CalF/CalW. • Benefit Cards Created & Mailed to Customer automatically. • Submit to CalHEERS for ACA health rules; Submit to SAWS for CalF/CalW rules • Eligible / Ineligible for MAGI MC, APTC/CSR, CalF and/or CalW. • Pended status until further verifications are provided. • Provide assistance with application forms, if needed. • CollectIAP SOF (SSApp) to complete application. • Verify Data, as required. • Enter CalF/CalW request, if applicable (referral via CalHEERS). • Enter data into CalHEERS for Health and SAWS for CalF/CalW, as required. • Refer MC Eligible Customers to HCO for Plan Selection for counties with more than 1 plan choice. Others are auto enrolled. • Assist APTC/CSR eligibles with Plan Selection via CalHEERS. • Assist unsubsidized health insurance customers with Plan Selection via CalHEERS. 4 4 Additional Data Collection/Verification (EW) Additional Data Collection/Verification (EW) 5 5 Ineligible Post-Processing (EW) Ineligible Post-Processing (EW) • If denied for MAGI/APTC-CSR refer to “Now” Path if Qualifiers Exist or if requested by customer. • Process or refer for other county medical services (e.g., LIHP,CMSP). • Offer customer unsubsidized health insurance coverage as option. • Gather additional post-run Data if required, if provided on request. • Resolve Conditional or Pending States. • Enter data into SAWS, as required. • Re-Submit to Run Eligibility process. ** Changes from Health Only “As-Is” flow in Blue Italics EW = Eligibility Worker CW = Clerical Worker FI = Fiscal Intermediary MC = Medi-Cal SOF = Statement of Facts HCO = Health Care Options NOA = Notice of Action ACA = Affordable Care Act CalW = CalWORKs CalF = CalFresh IAP = Insurance Affordability Programs APTC/CSR = Advance Premium Tax Credit/Cost Sharing Reductions

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