Medi-Cal to Covered California –
Manual Auto Plan Selection (Manual
APS) Guide for Certified Enrollers
Covered California
Outreach and Sales Division
OutreachandSales@covered.ca.gov Page 1 of 22 March 15, 2024
Overview
This document explains new CalHEERS functionality to help certain consumers transitioning
from Medi-Cal change their tax filing status from “No” or “Null” to “Yes” to gain eligibility for a
Covered California plan with financial help.
Background
Automatic plan selection is currently only triggered from the consumer’s initial transition from
Medi-Cal to Covered California transaction. Consumers transitioning from Medi-Cal to Covered
California with a tax filing status of “no” or “null”:
• Are not eligible for a Covered California plan with financial help,
• Do not have a Covered California plan automatically selected for them,
• May not understand why they are not eligible for financial help, and
• May be willing to attest that they plan to file taxes to get a Covered California plan with
financial help.
On February 26, 2024, CalHEERS was updated to help single member household
consumers update their “planning to file taxes” question after their initial transition from Medi-
Cal to unsubsidized Covered California eligibility.
This new process:
• Only applies to single member household cases transitioning from Medi-Cal that are
not eligible for financial help due to tax filing status.
• Places consumers into one of three manual APS populations (Population 1, Population
2, or Population 3).
o Consumer notices/educational flyers and the consumer’s navigation path in
CalHEERS are based on their assigned population. (See Manual APS Basics
below for more details; sample Manual APS Consumer Notices/Flyers
provided.)
• For all three populations, CalHEERS provides a new Confirm Account Information
page for transitioning consumers to update their tax filing status.
o Consumers who confirm their tax filing status as “yes” on this page and meet all
other financial help eligibility criteria are redetermined eligible for a Covered
California plan with financial help.
o Once affected consumers, confirm their tax filing status as “yes”, (and they meet
all other eligibility criteria), CalHEERS will allow them to complete plan selection.
They must then complete plan selection within 90 days after their loss of Medi-
Cal. (See Confirm Account Information Page Basics below for more details.)
• For only Population 3 consumers, CalHEERS provides a new Manual APS MCT
Dashboard for transitioning consumers. (See Manual APS MCT Dashboard Basics
below for more details.)
Medi-Cal to Covered California –
Manual Auto Plan Selection (Manual
APS) Guide for Certified Enrollers
Covered California
Outreach and Sales Division
OutreachandSales@covered.ca.gov Page 2 of 22 March 15, 2024
Manual APS Basics
For affected consumers in all three populations, CalHEERS:
• Updates the Consumer Information Page to display that the consumer does not have
other health coverage and agrees to file taxes for the benefit year.
• Redetermines eligibility to show the consumer their APTC amount if their tax filing
status for the 2024 benefit year is updated to “yes” on the Confirm Account Information
page.
o All affected consumers must confirm or update the information on the Consumer
Information Page before they can complete plan selection.
• Generates eligibility notices based on the consumer’s assigned population.
For population 3 consumers only:
• CalHEERS determines the lowest cost Silver plan to be displayed on the consumer’s
Manual APS MCT Dashboard and in the consumer’s eligibility notice.
o This Covered California plan recommendation follows the same logic used for
automatic plan selection.
o The 834 with the consumer’s information is not generated or sent to the carrier at
the time of recommendation.
The 834 is generated and sent to the carrier when the consumer confirms
their information and chooses to keep the recommended plan (or selects a
different plan).
• The consumer’s coverage start date will be the first of the following month following
regular SEP plan selection logic. For example:
o Consumer discontinued from Medi-Cal on February 13.
o Does not select a plan in February.
o Selects a plan in March.
o Effective date is April 1.
Updated eligibility notices and educational fliers are generated based on the consumer’s
assigned population.
• Notices and educational flyers are viewable in the consumer’s CalHEERS Secure
Mailbox Documents and Correspondence page.
• The Educational Flyer is not saved as an individual document. It is included at the end
of the eligibility notice pdf file.
Medi-Cal to Covered California –
Manual Auto Plan Selection (Manual
APS) Guide for Certified Enrollers
Covered California
Outreach and Sales Division
OutreachandSales@covered.ca.gov Page 3 of 22 March 15, 2024
Population Group Notices and Flyers Provided
Population 1 Covered California Eligibility Determination Notice (NOD01)
Population 2 Modified Covered California Eligibility Determination Notice
(NOD01)
New Educational Flyer
• Note the following regarding the flyer:
○ A recommended lowest cost Silver plan is not listed on the
flyer.
Population 3 New Covered California Eligibility Determination Notice (NOD01X)
• Delegated enroller will get an alert in their Daily Summary when
this notice is generated.
New Educational Flyer
• A recommended lowest cost Silver plan is listed on the flyer.
Confirm Account Information Page Basics
The Consumer Account Information page is pre-populated to indicate the consumer:
• Does not have other health coverage, and
• Agrees to file taxes for the benefit year, and
• Is American Indian or Alaska Native (AI/AN).
Consumers in all three populations must confirm the information on the Confirm Account
Information page is correct before they can complete their enrollment.
Note the following:
• Confirming account information is different than the automatic plan selection process
to opt-in (keep) or opt-out (cancel). Due to its complex rules, it is only available
through the logged-in CalHEERS account and not available through IVR or CiCi.
• If the consumer indicates the information on the Confirm Account Information page is
not correct, clicking No, I need to change my information navigates the consumer to
the existing report a change flow.
The navigation path to the Confirm Account Information page depends on the consumer’s
assigned population.
Medi-Cal to Covered California –
Manual Auto Plan Selection (Manual
APS) Guide for Certified Enrollers
Covered California
Outreach and Sales Division
OutreachandSales@covered.ca.gov Page 4 of 22 March 15, 2024
Upon Log In, consumers in:
• Populations 1 and 2 go directly to the Confirm Account Information page.
• Population 3 are directed to the Confirm Account Information page by clicking the
Start Now button on their Manual APS MCT Dashboard.
The Confirm Account Information page looks like this:
The MEC question Do you have other health coverage through a job, your family’s job, or
other source? is first and guides next steps.
Additional account information displays for confirmation.
Medi-Cal to Covered California –
Manual Auto Plan Selection (Manual
APS) Guide for Certified Enrollers
Covered California
Outreach and Sales Division
OutreachandSales@covered.ca.gov Page 5 of 22 March 15, 2024
The following application information is updated to evaluate the consumer for financial help:
• The consumer will file taxes
• The consumer will file taxes as Single
• The consumer is not a tax dependent of someone else
• The consumer is not AI/AN
Clicking Yes, my information is correct, navigates to the next step based on their assigned
population.
• Population 1 and Population 2 consumers proceed to the existing Enrollment
Dashboard to shop for a plan and complete enrollment.
• Population 3 consumers proceed to the new Manual APS MCT Dashboard to
complete plan selection. Note: They also have the option to shop for a different plan, if
applicable.
Manual APS MCT Dashboard Basics
The Manual APS MCT Dashboard only displays for Population 3 consumers.
• It has slight differences from the Auto Plan Selection Dashboard that displays for
consumers transitioning from Medi-Cal to Covered California outside of this
population.
For Population 3 consumers only:
• A Start Now button displays instead of the Keep or Switch button.
• The Start Now button navigates directly to the Confirm Account Information page.
From the Account Home page, click the “You are now eligible for Covered California.
Please review your options” Account Alert link.
Medi-Cal to Covered California –
Manual Auto Plan Selection (Manual
APS) Guide for Certified Enrollers
Covered California
Outreach and Sales Division
OutreachandSales@covered.ca.gov Page 6 of 22 March 15, 2024
The Manual APS MCT Dashboard displays with the Start Now button.
Click Start Now to open the Confirm Account Information page.
Medi-Cal to Covered California –
Manual Auto Plan Selection (Manual
APS) Guide for Certified Enrollers
Covered California
Outreach and Sales Division
OutreachandSales@covered.ca.gov Page 7 of 22 March 15, 2024
If the consumer’s information is correct (they do not have other health coverage and they
agree to file taxes), click Continue to open the Choose Your Plan page.
• Note: if consumer indicates they need to make changes, CalHEERS will move to
report a change.
The Choose Your Plan page displays the consumer’s recommended plan.
Medi-Cal to Covered California –
Manual Auto Plan Selection (Manual
APS) Guide for Certified Enrollers
Covered California
Outreach and Sales Division
OutreachandSales@covered.ca.gov Page 8 of 22 March 15, 2024
Click I want to keep this plan to navigate to the Sign and Submit page and complete
enrollment.
Click I want to look at other plans to navigate to the Enrollment Dashboard to shop for a
different plan.
