Transitional Medi-Cal (TMC) Program
E080-0586 | Issued Date: 6/3/2026

Overview

The Transitional Medi-Cal (TMC) program provides Medi-Cal benefits to children/youth or Nonminor Dependents (NMD) who leave out-of-home placement due to returning Home of Parent (HOP) or aging out of care and are eighteen (18) through twenty-one (21) years old Eligibility is evaluated when child/youth/NMD are not eligible for ongoing Medi-Cal through the Continuing Eligibility for Children (CEC) Program. Additionally, this procedural guide directs the Department of Children and Family Services (DCFS) on the processes necessary to initiate a Medi-Cal application to the Department of Public Social Services (DPSS) while ensuring continuation of Medi-Cal benefits.

 

 

Table of Contents

Version Summary

This Policy Guide has been revised from the 03/09/2010 version to reflect current procedures to align with the implementation of the California Statewide Automated Welfare System (CalSAWS). The title has also been updated to Transitional Medi-Cal (TMC) Program.

POLICY

Medi-Cal Program

The Medi-Cal program is a program administered by the State Department of Health Services, under which qualified low-income persons are provided with health care services. See Medi-Cal Benefits for more information.

Continuing Eligibility for Children (CEC) Program

Children/Youth or NMDs under the age of nineteen (19) who are losing ongoing medi-cal coverage due to exiting care are evaluated for CEC.

  • Youth ages nineteen (19) and older are evaluated for ongoing medi-cal benefits by the DPSS under the Extended Medi-Cal Eligibility for Former Foster Youth (FFY) program.

The evaluation for the CEC program is completed within the eligibility criteria timeframe (not to exceed twelve (12) months following initial ongoing eligibility). For general information on CEC, information regarding child/youth exiting care with Kinship Guardianship Assistance Payment (Kin-GAP) or Adoption Assistance Program (AAP), and reasons for ineligibility, refer to All County Welfare Directors Letter (ACWDL) 14-05, and the Continuing Eligibility for Children (CEC) Program procedural guide.

Medi-Cal for Infant Supplement

ACWDL 90-56 and ACWDL 90-69 address information regarding Medi-Cal benefits for children of minor parents who are in Foster Care (FC).

Transitional Medi-Cal (TMC) Program

Senate Bill No. 87 made changes in Medi-Cal eligibility criteria and procedures in instances when eligibility on one basis has terminated. The bill provides for the transfer of a Medi-Cal beneficiary’s benefits to an appropriate TMC program, under specified circumstances. Also see ACWDL 90-66 for more information. 

Appeals for Terminated Medi-Cal Benefits

If an appeal is filed on behalf of the youth, the Appeals Hearing Specialist will reach out to the TMC unit to assess if the Medi-Cal benefits will be reinstated or if the beneficiary will be referred to DPSS.

PROCEDURE

Transfer of Continuing Eligibility for Children (CEC) Case to the Transitional Medi-Cal (TMC) Unit

TMC Unit Clerk (UC) Responsibilities

  1. Receive the CEC case referral via email from CEC Unit Clerk (UC).
  2. Review to determine whether all documentation is included in the case with accurate information.
  3. Ensure the case information and CEC EW file number is added to the TMC Log.
  4. Confirm there is no duplicate case.
    1. If there is a duplicate case, notify the TMC Eligibility Supervisor (ES) for further research.
  5. Verify case assignment to TMC Eligibility Worker (EW) with TMC ES.
  6. Data enter the TMC EW’s file number in the TMC Log.
  7. Access case in CalSAWS and reassign it to the TMC EW on the Case Summary page. 
  8. Forward the case to the assigned TMC EW.

TMC Eligibility Supervisor (ES) Responsibilities

  1. Review the case information received via email from the CEC Unit to determine whether all documentation is included in the case with accurate information.
  2. Assign case to a TMC EW based on a rotation.
  3. Forward the case to the TMC UC.

TMC EW Responsibilities

  1. Receive case information from the UC.
  2. Access CalSAWs and review if the case is approved or denied for CEC.
    1. If CEC is approved, determine if a correction of the Medi-Cal termination date is necessary.
      1. Confirm the Non-MAGI Renewal packet (MC 210 RV) was generated in CalSAWs and mailed to the beneficiary two (2) months prior to the Redetermination (RE) due date. [The identifying information is auto populated on the top portion of the MC 210 RV].
        • It is the beneficiaries’ responsibility to answer the questions on the MC 210 RV and return it within the thirty (30) day requirement.
        • If the Medi-Cal Renewal packet was not automated, manually generate the issuance of the packet in CalSAWS to the beneficiary.
      2. Confirm the Aid Code (AC) reflects 7J in CalSAWs and Medi-Cal Eligibility Data System (MEDS).
    2. If CEC is denied, confirm the MAGI Renewal packet (MC 216) was generated in CalSAWs and mailed to the beneficiary two (2) months prior to the Re-evaluation (RE) due date.
      1. If the Medi-Cal Renewal packet was not automated, manually generate the issuance of the packet in CalSAWS to the beneficiary.
        • It is the beneficiary’s responsibility to return it within thirty (30) days.
      2. Confirm the Aid Code (AC) reflects 38 in CalSAWs and MEDS.
    3. If CEC is expired, determine if a correction of the Medi-Cal termination date is necessary.
      1. If a correction is required, set extension for an additional sixty (60) days from the month following the RE due date.
      2. Update the AC from 7J to 38 in CalSAWs and MEDS (if applicable).
      3. Review MEDS after two (2) to three (3) days to confirm the AC interfaced from CalSAWs.
      4. Confirm the Non-MAGI Renewal packet (Medi-Cal Annual Redetermination Form) MC 210 RV was generated in CalSAWs and mailed to the beneficiary two (2) months prior to the RE due date.  
        • If the Medi-Cal Renewal packet was not automated, manually generate the issuance of the packet to the beneficiary in CalSAWS.
  3. Compare case on information in CalSAWS to MEDS.
    1. Confirm there are no duplicate records for the child/youth or nonminor dependent (NMD).
      1. If CalSAWs or MEDS indicate the child/youth or NMD has existing benefits from Social Security Administration (SSA), DPSS, an active FC case, or is receiving aid from another county, termination of TMC case.
        • If a duplicate Client Index Numbers (CIN) record exists on MEDS, send a request to the Centralized Medi-Cal (CMC) Unit to combine the CINs. For more information see E080-0580 procedural guide.
    2. Confirm address in CalSAWS Summary Page and ensure Notice of Action (NOA) was sent to the correct address.
  4. Confirm that CalSAWS automatically set a thirty (30) day control for return of the completed Medi-Cal Renewal packet.
    1. If the Medi-Cal Renewal packet is not returned in the thirty (30) day period, a reminder notice is automatically mailed out from CalSAWS to the beneficiary for an additional fourteen (14) days for the return of the Medi-Cal Renewal packet.
      1. If the Medi-Cal Renewal packet is not returned in the fourteen (14) day extended period, complete the termination of TMC.
        • No transition to DPSS is required.
  5. Document all actions on CalSAWS Journal.

Termination of TMC

TMC EW Responsibilities

  1. Access case in CalSAWS to run a negative action to terminate the Medi-Cal block.
  2. Confirm Termination NOA (MC 239) is generated in CalSAWS and was sent to the beneficiary at least ten (10) Calendar days prior to the termination date.
    • The NOA advises the beneficiary that the Medi-Cal benefits will terminate effective the end date of the redetermination period and information on appeals rights.
  3. Document all actions on CalSAWS Journal.

TMC ES Responsibilities

  1. Review TMC Termination.
    1. If there is incorrect or missing information, send back to TMC EW for correction.
      • TMC ES will review again when the corrections are completed.
  2. Document all actions in CalSAWS Journal.

Medi-Cal Renewal Packet Returned as Undeliverable

TMC EW Responsibilities

  1. If the Medi-Cal Renewal packet is returned from the United States Post Office (USPS) to the TMC EW as undeliverable:
    1. Access case in CalSAWS to obtain contact information for the beneficiary.
    2. Contact the beneficiary to confirm address.
      1. If contact is unsuccessful, terminate the Medi-Cal benefits by following the termination process.
    3. Update the address in CalSAWS to regenerate the Medi-Cal Renewal packet.
      • The beneficiary may opt to have the renewal packet emailed to them in which they would be instructed to indicate their correct address on the Medi-Cal Renewal packet prior to returning it.
  2. Document all actions on CalSAWS Journal.

TMC Reviews Medi-Cal Renewal Packet

TMC EW Responsibilities

  1. TMC EW checks “My Tasks” in CalSAWS daily or if email is received from DPSS that the Medi-Cal Renewal packet was received:
    1. Review the Medi-Cal Renewal packet and case information in CalSAWS.
      • Access CalSAWS Images to confirm the following information is completed by the beneficiary and is included in the Medi-Cal Renewal packet:
          • Household Status page
          • Income page
          • Signature page
      • If information is missing or the signature is not included, contact the beneficiary by telephone advising them that the form(s) are being returned for completion and provide them with the date that the form must be returned, not to exceed thirty (30) days from the date of the original termination date.
      • Generate and send MC 355 via United State Postal Service (USPS) or email along with the missing forms to the beneficiary to be completed.
  2. Download and email the completed Medi-Cal Renewal Packet to the TMC ES for review.
  3. Document all actions on CalSAWS Journal.
      •  

TMC ES Responsibilities

  1. Review the completed Medi-Cal Renewal Packet.
    1. If there is incorrect or missing information, send back to TMC EW for correction.
      1. TMC ES will review again when the corrections are completed.
    2. If correct, send back to TMC EW for submission to DPSS.
  2. Document all actions in CalSAWS Journal.

TMC EW Responsibilities

  1. Submit the Medi-Cal Renewal packet to DPSS via email inbox: MOD-DCFSReferrals@dpss.lacounty.gov.
  2. Access case in CalSAWS and terminate the Medi-cal block so DPSS can open a Medi-Cal block.
  3. Confirm CalSAWS Medi-Cal block and MEDS after one (1) day to confirm the termination.
  4. Upload QM MEDS screen into CalSAWS case.
  5. Document all actions on CalSAWS Journal.

 

Medi-Cal Renewal Packet Returned After Termination

TMC UC Responsibilities

  1. Receive the Medi-Cal Renewal packet.
  2. Scan and email the Medi-Cal Renewal packet to the TMC ES.
  3. File the hardcopy and store for three (3) months.

TMC ES Responsibilities

  1. Receive the Medi-Cal Renewal packet.
  2. Forward the email with the Medi-Cal Renewal packet to the previously assigned TMC EW.

TMC EW Responsibilities

  1. Review the Medi-Cal Renewal packet that has been terminated.
    1. Upon of the Medi-Cal Renewal packet, complete the following actions:
      1. Review the Medi-Cal Renewal packet to ensure completeness and that signatures are intact.
        • If Medi-Cal Renewal packet was received within thirty (30) days of the termination, submit the Medi-Cal Renewal packet to DPSS via email inbox: MOD-DCFSReferrals@dpss.lacounty.gov.
  2. Document all actions on CalSAWS Journal.

TMC ES Responsibilities

  1. Review the Medi-Cal Renewal packet for completeness.
    1. If there is missing or inaccurate information, return the packet to the EW for correction.
    2. Return to the assigned Transition EW.
  2. Document all actions on CalSAWS Journal.
APPROVALS

Eligibility Supervisor (ES) Approval

  • CalSAWS Eligibility Determination and Benefit Calculation (EDBC) Authorization
HELPFUL LINKS

Forms

MC 210 RV, Medi-Cal Annual Redetermination Form (Non-MAGI)
MC 216, Medi-Cal Annual Redetermination Form (MAGI)
MC 239, Notice of Verification
MC 355, Medi-Cal Request for Information

REFERENCED POLICY GUIDES

E080-0580, Medi-Cal Benefits
E080-0585, Continuing Eligibility for Children (CEC) Program

STATUTES AND OTHER MANDATES

All County Welfare Directors Letter (ACWDL) 14-05 – Instruct counties on the application of CEC based on recent federal guidance and the transition of the Healthy Families Program (HFP) children to Medi-Cal.

ACWDL 90-56 – Discusses the changes made in the Aid to Families with Dependent Children-Foster Care (AFDC-FC) program as a result of the Omnibus Budget Reconciliation Act (OBRA) of 1987. 

ACWDL 90-66 –  Clarifies several areas that caused confusion during the implementation of the new Transitional Medi-Cal (TMC) provisions of the federal Family Support Act of 1988, including questions and answers for various scenarios.

ACWDL 90-69 –  Discusses benefits for child(ren) living with a minor parent who is an Aid to Families with Dependent Children-Foster Care (AFDC-FC) recipient.

Senate Bill (SB) 87, Medi-Cal: Eligibility – Chapter 1088 (1999-2000) –  Outlines law for the Medi-Cal program, administered by the State Department of Health Services, under which qualified low-income persons are provided with health care services.