The Continuing Eligibility for Children (CEC) referral process applies for cases in which a child/youth or Nonminor Dependent (NMD) under age nineteen (19) exits care and does not qualify under the Extended Medi-Cal Eligibility for Former Foster Youth (FFY) program, or any other No Share of Cost (SOC) program, but may be eligible for the CEC Program.

This policy guide was updated from the 02/01/2010 version and reflects current procedures aligned with the implementation of the California Statewide Automated Welfare System (CalSAWS).

Medi-Cal Program

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

Transitional Medi-Cal (TMC) Program

Senate Bill No. 87 made changes to Medi-Cal eligibility criteria and procedures in instances when eligibility on one basis has terminated. The bill would provide for the transfer of a Medi-Cal beneficiary’s benefits to an appropriate transitional Medi-Cal program, under specified circumstances. Also see All County Welfare Directors’ Letter (ACWDL) 90-66 and the Transitional Medi-Cal (TMC) Program procedural guide for more information. 

Continuing Eligibility for Children (CEC) Program

The CEC Program was implemented on January 1, 2001.  Federal law (Section 1902(e)(12) of the Social Security Act) permits states to implement a CEC period for certain children under an age specified by the State, but not to exceed nineteen (19) years of age.  The Federal CEC ends either on the date that the individual exceeds the state-established age or the end of a period (not to exceed twelve (12) months) following initial ongoing eligibility. As stated in ACWDL 14-05, foster youth that are receiving Foster Care (FC) funds through Aid to Families with Dependent Children-Foster Care (AFDC-FC) will be eligible to receive Medi-Cal services under CEC when FC is discontinued. Whenever a child/youth under the age of nineteen (19) is no longer eligible for FC, Adoptions Assistance Payment (AAP) Program or Kinship Guardianship Assistance Program (Kin-GAP) and does not qualify under the Extended Medi-Cal Eligibility Program for Former Foster Youth (FFY), the CEC program may be applicable.  Therefore, the county must transition the youth to the CEC program after being terminated from FC/AAP/Kin-GAP, without requiring a new application. The child/youth is entitled to CEC until the next annual redetermination/reassessment, which shall be twelve (12) months from the initial determination. The AAP reassessment period is two (2) years; however, the CEC period may not extend past twelve (12) months. Per ACWDL 25-31, effective January 1, 2027, states must conduct Medi-Cal eligibility renewals every six (6) months for adult Medi-Cal members ages nineteen (19) and older enrolled in the Modified Adjusted Gross Income (MAGI) New Adult Group. If an FFY individual (who typically has a twelve-month renewal) resides in a household with individuals subject to the new six-month renewal requirements, ACWDL 25-31 governs how those renewals are coordinated. FFY eligibility is determined by DPSS.

Reasons for Ineligibility

A child/youth is not eligible to CEC (ACWDL 14-05) for the following reasons:  

• If child/youth is living with the Biological Parent/Adoptive Parent/Legal Guardian in another state.
• If child/youth is in receipt of Social Security (SS) benefits, CalWORKs, or other “No SOC” Medi-CAL program through Department of Public Social Services (DPSS).
• If child/youth is incarcerated at the time of a referral.
• If child/youth’s whereabouts are unknown at the time of a referral.
• If a CEC referral was received the same month or after the CEC period expired. However, the case should still be referred to the TMC program.
• If youth’s adoption is finalized after the age of eighteen (18) years old and coming from the Adoptions Assistance Program (AAP). However, the case should still be referred to FFY.
• If youth is over nineteen (19) years old and coming from the Kin-GAP or AAP programs, they are not eligible for CEC. However, the case should still be referred to the TMC program.
• Upon written request from the child/youth’s parent/legal guardian to opt out of Medi-Cal.

CEC Referral Process

CEC Unit Clerk (UC) Responsibilities

1. Receive a CEC Medi-Cal Referral for CEC from the CEC Intake email inbox: CECintake@dcfs.lacounty.gov. (Referral may come from a Case-Carrying Eligibility Worker (CCEW), Technical Assistant (TA) EW or FC Probation Unit).
   1. If referral is missing Case Name, Case Number, or PROB 667 (for FC Probation cases), it will be rejected back to the requestor via email.
2. Access child/youth case on CalSAWS to:
   1. Screen for duplicate referrals.
   2. Confirm placement termination.
3. Confirm the CEC EW assignment with the CEC Eligibility Supervisor (ES) based on rotation.
4. Reassign existing or open new Medi-Cal block on CalSAWS.
5. Update the Medi-Cal case assignment to the CEC on CalSAWS.
6. Data enter the referral information into CalSAWS Work Orders.
7. Forward CEC Referral to assigned CEC EW.

CEC Eligibility Worker (EW) Responsibilities

1. Review the CEC Referral to confirm accuracy and completeness.
   1. Confirm the information matches the information on CWS/CMS, CalSAWS. If not, or if any information is missing, research on DCFS 280 via Foster Care Search System (FCSS) and contact the parent(s)/guardian(s) to obtain and confirm the following:
      1. Case name
      2. Case number
      3. Child/Youth’s name
      4. Name and address of parent/relative/guardian that the child/youth was returned to or remains living with
      5. The date that out-of-home placement was terminated
      6. The initial determination or the last redetermination/reassessment month of the FC/AAP/Kin-GAP case
      7. Confirm AAP/FC/Kin-GAP program block is terminated on CalSAWS.
2. Access MEDS, CalSAWS, and CWS/CMS to download current inquiry printouts.
   1. Access CWS/CMS to determine the date the child was returned to the home of the parent(s)/guardian.
   2. Confirm the last day the child is eligible for CEC matches on both MEDS and CalSAWS based on the date the child was returned to the home of the parent(s)/guardian, and the date of the last determination/redetermination.
      • CEC eligibility will begin the first day of the month following the month that the child/youth’s placement is terminated.
      • The end date for CEC will be the last day of the last month up to twelve (12) months after the placement termination date.
      • If the child/youth turns age nineteen (19) before the end of the CEC period, the CEC period will end the last day of the month that the child turns nineteen (19).
        • The child/youth is referred to the TMC program.
3. Determine and set up the time period for CEC eligibility by running an Eligibility Determination and Benefit Calculation (EDBC) in CalSAWS.
   1. If case summary shows inaccurate determination, run a “manual” EDBC to reflect accurate determination.
      • Aid Code 7J for Approved CEC
      • Aid Code 38 for Denied/Expired CEC
4. Confirm (update if applicable) the Medi-Cal Eligibility Data System (MEDS) system includes the following information:
   1. Parent(s)/Legal Guardian’s address
   2. CEC eligibility period including the termination date for CEC
      • For approved CEC, the termination reason code is 38 and the termination date is the end of the CEC period.
5. Create the digital CEC case on the CEC Unit Imaging shared drive.
   1. For approved or denied/expired CEC cases, complete the following:
      • Mail the appropriate Notice of Action (NOA) to the parent/relative/guardian.
      • Follow referral steps to refer the child/youth’s case to the TMC program.
   2. For denied/ineligible CEC cases, complete the following:
      • Run a “negative action” EDBC on CalSAWS to terminate the Medi-Cal block.
      • Mail the appropriate NOA to the parent/relative/guardian.
6. Annotate all actions taken and eligibility determination on CalSAWS Journal and Work Order.
7. Complete the CEC Check List and sign as validation of accuracy and completeness.
8. Refer the completed digital CEC case to the ES for review and approval.

CEC Eligibility Supervisor (ES) Responsibilities

1. Review the case for accuracy and completeness including documentation on CalSAWS Journal and Work Orders.
   1. If accurate, approve the digital CEC case by authorizing the EDBC on CalSAWS and signing the CEC Check List.
   2. If there are inaccuracies, or incomplete forms, return the CEC digital case to the assigned CEC EW for corrective action.
2. Upon approval, return the case to the assigned CEC EW for imaging.

Referral to Transitional Medi-Cal (TMC) Program

CEC EW Responsibilities

1. Ensure CEC digital case is complete and accurate (including child/youth’s current address and contact information) for referral to TMC.
2. Forward the CEC digital case to the CEC UC for transfer to the TMC Unit.

CEC UC Responsibilities

1. Receive the referral for the CEC digital case to the TMC Unit.
2. Create an e-case Transmittal Log for the CEC digital case.
3. Email the Transmittal and digital CEC case to the TMC UC and copy the TMC ES and the CEC ES.

ES Approval

• CEC Check List
• EDBC Authorization on CalSAWS

Forms

Hard Copy

Continuing Eligibility for Children Check List

NOA 290, Notice of Action (approval or denial-termination/denial-expired)

PROB 667

LAKids

Continuing Eligibility for Children (CEC) Referral

E080-0580, Medi-Cal Benefits
E080-0586, Transitional Medi-Cal (TMC) Program

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 25-31 – Updated the requirement for states to conduct Medi-Cal eligibility renewals every six months for adult Medi-Cal members ages nineteen (19) and older enrolled in the MAGI New Adult Group.

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.

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.