California Department of Social Services - State Hearings Division
Notes from the Training Bureau - March 11, 1998

References: Title 22, CCR§§ 50167, 50175, ACWDL 90-07 and Title 42 United States Code §1396(r)(2)

Counties must attempt to make two contacts with a Medi-Cal applicant or recipient before denying or discontinuing Medi-Cal for failure to provide information, failure to cooperate or because of loss of contact.

In the case of an application, the county worker meets the first contact requirement by providing the applicant with a written request for items needed at the face to face interview. If the first date passes with no response from the applicant, the county worker must make a second contact either by telephone or in writing. The county worker must notify the applicant of the items needed to establish eligibility and must give the applicant at least ten days to respond. If there is no response, then the county worker may issue a Notice of Action (NOA).

In the case of a Medi-Cal recipient, the county worker must notify the recipient what information is needed in order to continue Medi-Cal eligibility and must give the recipient a specific due date to respond. This contact may be made by telephone or in writing.

If the beneficiary fails to respond to the first contact by the due date, the county worker must make a second contact either by telephone or by written notice. The second written contact to a recipient may be the MC 239A Notice of Action (NOA), but such notice must advise the recipient what is needed to establish continuing eligibility and should state clearly that if the information is not received by the due date, the case will be discontinued on the last day of the month the notice is issued (assuming the county has issued notice at least ten days prior to the end of the month). If the information is received prior to the discontinuance date, the county must rescind the discontinuance.

For both applicants and recipients the county worker must not only make the required contact, but must also document that the contact was made and the results of such contact.

The two contact requirement also applies when the recipient fails to return the Quarterly Status Report (QSR) or returns an incomplete QSR. The county may satisfy the second contact requirement in such case by reissuing the incomplete QSR or issuing a new QSR with a NOA and advising the recipient that the discontinuance will be rescinded if the QSR is returned prior to the discontinuance date.