Ch. 3-Conditions Of Eligibilty For Medi-Cal Flashcards
Are there certain conditions Medi-Cal applicants must meet?
Yes, they must live and intend to stay in California. A PO Box will not meet the residence requirement if listed as a physical address
US citizenship or legal resident status is not required to be eligible for Medi-Cal benefits -however, based on criteria, there will be full scope, restricted scope, and limited scope benefits.
There are Property limits
Social Security card number, but do not need to actually see card.
Unconditionally available income
Linkage determining which program available based on certain criteria
Institutional status
Medical support
What are the residency conditions that must be met for Medi-Cal?
Applicant must live in intend to stay in California
They may not use a PO Box to meet the residency requirement, if listed as a physical address
Self attest station meaning verbal contact is a valid
It is OK to leave California as long as it is temporary less than 60 days
US citizenship or legal resident status is not required to be eligible for Medi-Cal benefits however what will decide the scope of benefits an applicant is entitled to?
Full scope would be a US citizen or legal permanent resident and certain other aliens, however, full scope will be offered to young adults between the ages of 19 to 25 and undocumented under the age of 26 will be offered full benefit scope benefits under MAGI and non-MAGI programs as well as undocumented older adults, age 50 or older will be eligible for full scope benefits, regardless of immigration status
Restricted scope, emergency and pregnancy only for undocumented aliens, then
we have a limited scope people who claim to be US citizens or nationals, but failed to meet the citizenship and identity verification requirements, and she’ll be referred to as a limited scope of benefits person until they provide the verification
What are property limits for Medi-Cal criteria?
Certain Medi-Cal programs have a property limit
Is a Social Security number card needed to be physically seen?
No
What are unconditionally available income?
This is income that is unconditionally available and the applicant/beneficiary only has to claim or accept the income.
Examples are:
Social Security benefits,
retirement benefits,
survivors insurance
Disability insurance
Unemployment benefits
UIB
State disability income (SDI)-must earn three minimum of 300 within 12 months, be Under doctors care and earn a minimum of $75 in a quarter.
Veterans benefits, if person refuses to apply, for it will be denied for benefits
What is linkage criteria in regards to Medi-Cal?
Linkage determines which program is available based on certain criteria
How does institutional status affect determining benefits?
These people may put in an application, and it will be on hold until they are no longer in the facility, due to having access to medical while in these institutions.
Examples:
Inmates
in a state or federal prison
Correctional facility
County city or tribal jails
Detention centers
California youth authority camps
Residential facilities located on the grounds of adjacent to any large public institution
Correctional or holding facilities for prisoners are individuals being held under court order as witnesses
Detention facilities, camps, training, schools, or any other facility for children, determined to be delinquent
Education or vocational training institutions that provide an accredited program for its residence
What medical conditions must be met to qualify for Medi-Cal?
If a child is born out of wedlock, or with an absent parent, even if the father is in the home, there is a condition of eligibility they must meet:
Assign the state of applicants rights to any
I meant cooperating of
Payments cooperate in establishing paternity of a child born out of wedlock for
Quested cooperate and identifying in a locating the
Provide information about possible entitlement to medical support and payments. Available through any third-party.
What forms are not included in the application for children born out of wedlock?
CW 2.1 and/or CW 2.1/2 IQ forms.
NMC355 should be sent with the forms to allow the customer 30 days to provide information
Can a case be denied for failure to complete the forms for out of wedlock children?
No, It can not be denied for that purpose.
What does MEC stand for?
MEC stands for Minimal Essential Coverage
