Ch. 2-Application Process For Medi-Cal Flashcards
What ways are people able to apply for Medi-Cal?
SAWS1
SAWS2 plus
CalWIN SOF
Single streamline
Supplemental forms
Can another person apply for another person for medical?
Yes, however the person must sign the application
Is it important to have the tax filing information for the application to be completed?
Yes, tax information for each application and household is required for Medi-Cal
What is a Courtesy Application?
It is where an application is made in another County other than the County of responsibility. The County in which the individual applies must accept and process the application.
What action steps must be taken for the Courtesy Applications?
1.)Review application for completion. If complete go to step 2 and 3.
2.) Issue benefits promptly before case information and verifications are transferred to residence County
3.) follow procedures to process Internet-County Transfer
4.) If incomplete Forward application and all information collected within 15 days of application to County of Responsibility
How long does an applicant have to provide all necessary facts, changes and verifications to Worker?
Applicant has 10 days to report
Are interviews required for Medi-Cal?
No, however during Intake review we need to contact customer for clarification on any information provided. If additional information is needed we would mail 1st VCL (10 days to reply)
What is the minimum contact we are required to do with customer?
A minimum of 2
How many VCLs do we send out for additional information from customer and days needed to return information from customer?
We would send out 2-10 VCLs are required to be sent out before denying a case due to lack of infomation
What is an AR?
They are an Authorized Representative. Customer can appoint an AR to assist them in their MC application or redetermination process.
What forms can be acceptable AR forms?
MC 382-Appointment of Authorized Representative
The AR section of the single Steamlined Application
The AR section of the SAWS 2 Plus
The DPA 19 is acceptable for appointing AR during appeals process
Is an AR designation form required when an individual has legal authority to act on a customer’s behave?
No, not if they have legal authority
If applicant calls to request application for Medi-Cal what is the application date?
The phone call secures the request date.
Application sent out to customer.
Customer has 15 days to turn in paperwork
What if customer does not return paperwork within 15 days of calling for MC application?
The customer loses their Date of Application
What is date of application if paper application is the only form received requesting of MC?
Date received application is the the date of application we use.
How many days do we have to approve or deny a Medi-Cal application?
We have 45 days to approve or deny an application OR 90 days when eligibility depends on establishing disability or blindness
Can an application be denied before the 45 days?
Yes, when customer does not turn in verifications after 2-10 VCLs are sent out
When is Medi-Cal renewed?
It is renewed every 12 months. It does NOT have a 6 month review (SAR 7)
Is MEdi-Cal prorated?
No it is NEVER prorated
What is an IMN?
AN IMN s Immediate Medical Needs.
For customers who still need verification but have following conditions:
Pregnant
Hospital or nursing home admission within 10 workin days
Doctor, dentist, clinic other medical appt schedule within 10 working days.
Prescription to be filled in 10 working days
Referral from CMS case manager
Can applicant’s statement of IMN be accepted for purposes of determine Immediate Medical Needs exists?
Yes, with verbally or otherwise must be accepted
How many days does HSS have to determine eligibility for IMN-Immediate Medical Needs?
HHS has 10 days as long as all necessary verifications are submitted
What happens if applicant turns in requested verifications within 30 days of the case denial date?
HHS worker evaluates for ongoing eligibility and if appropriate , rescind the denial and approve ongoing benefits
What are additional reporting responsibilities customer is required to give?
They must disclose if they have other health coverage.
If applicant cannot provide paperwork for additional health coverage but need Med-Cal quickly, may provide care but detail case comments needed for specific reasons
What is MC 219 form?
MC 219 is the Rights and Responsibilities that we are required to give ALL Medi-Cal applicants even if they are denied coverage.
What is Craig vs Bonta refer to?
This is where a person with SSI loses their coverage they than have temp coverage and codes are put in place to let HHS workers know to have customer evaluated for Medi-Cal by the County
Do beneficiaries discontinued from SSI need to complete a statement of facts or request Medi-Cal benefits?
No, they do not.
What AID CODES do we look for regarding the Crag vs Bonta case regarding health care coverage?
WE look for:
1E-Aged
2E-Blind
6E-Disabled
What is RFTHI?
RFTHI stands for a request for tax household information. This request for Tax information is needed for each person. Text filer information is needed for determination for MAGI. It is permissible to contact the applicant by phone to get the information regarding the tax filing status of the household members. If you cannot reach the customer by phone mail out the RFTHI form to the customer to be completed for each household member including children.
