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Medi-Cal > Ch. 4- Medi-Cal Citizenship > Flashcards

Ch. 4- Medi-Cal Citizenship Flashcards

1
Q

When working with Medi-Cal why is it important to differentiate between citizen and non-citizen status when determining benefits?

A

The level of benefits offered to an applicant depends on their citizen or non-citizen status

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2
Q

What are the levels of eligibility for Medi-Cal benefits?

A

An applicant can potentially be eligible for full scope, limited scope, or restricted scope benefits

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3
Q

When working with Medi-Cal who are US citizens?

A

US citizens are defined by persons born in the USA
Naturalized citizens
Nationals
Collectively naturalized
Acquired citizenship, meaning child adopted outside of country
Derived citizenship, meaning a US parent head child while out of the country

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4
Q

What is a lawful permanent resident when discussing medical?

A

Lawful permanent residents are permanent resident
resident permit holder
Green card holder

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5
Q

What is a qualified non-citizen?

A

Lawful permanent resident
Asalee
Refugee
Paroled for at least one year
Withholding deportation
Conditional entrant
Cuban Haitian entrant
Battered non-citizens

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6
Q

What are PRUCOL?

A

Non-citizens
16 categories -categories will be found on MC 13 form

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7
Q

What is SIS?

A

SIS stands for satisfactory immigration status customers who claim SIS are required to verify their immigration status. A non-citizen who has complied with and received approval approval from US CIS.

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8
Q

What is an I551 card?

A

It is a legal permanent resident card, otherwise known as a green card for legally permanent residence. LPR.

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9
Q

What are fullscope benefits?

A

Full scope benefits include all medical services covered by the medical program.
Restricted scope benefits cover pregnancy care and emergency medical care only
Limited scope benefits covers only emergency medical conditions, pregnancy related services and long-term care services

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10
Q

What are limited scope benefits?

A

This level of benefits are for individuals who claim to be a US citizen/national, and who fails to meet the citizenship and identify verification requirements.

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11
Q

What are exceptions to the levels of benefits with medical?

A

The exception are children and young adults under 26 and adults 50 and over must be granted full scope benefits, meaning undocumented children under the age of 19 will be issued issued full scope.
undocumented children under 26 will be issued full scope, and
full scope will be offered to individuals 50 years and older

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12
Q

What is a DRA?

A

A DRA stands for deficit reduction act. It requires documentation of US citizenship and identity must be obtained for all medical applicants and beneficiaries who declare that their citizens or nationals of the US.

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13
Q

Who does the DRA?

A

It does not affect US citizens who are not requesting for themselves
Or all non-citizens, undocumented citizens, legal permanent residence, PRUCOL non-citizens

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14
Q

Who has exemptions from the DRA requirement?

A

Children who are recipients of foster care, FFCR,adoption assistance, KIN-GAP, minor consent, applicant/beneficiaries
Current recipients of SSI, SSDI, Medicare parts, A, B, C, or D, Social Security, retirement, or survivors insurance or SSI
Individuals receiving Medi-Cal dialysis only and dialysis supplement program, total Parenteral nutrition, Energen, long-term care
in CalWorks recipients would have met the citizenship and identity verification requirements from the beginning date of their aid, and will not be required to provide documentation for ongoing Medi-Cal eligibility

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15
Q

Who has temporary exemption from DRA?

A

Presumptive eligibility/accelerated enrollment recipients
PE for pregnant
CHDP Gateway
AE at the SPE
School lunch program
Presumptive MC eligibility under the BCCTP this exemption ends when eligibility for the ongoing Medi-Cal is determined unless other exemption exist
Exempted indefinitely, abandoned, baby program infants are born in the US and have no documentation
Deemed eligible infants who are born in the US

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16
Q

What do medical applicants who qualify for DRA receive?

A

If they follow the DRA guidelines and declare they are US citizens/national status and meet all eligibility requirements are eligible for full scope benefits until acceptable verification of citizenship and identity is provided

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17
Q

Are medical customers who are citizens of the US required to verify their citizenship and identity?

A

Yes, they are required to verify their citizenship and identity once provided it may not be requested again

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18
Q

What are acceptable evidence of identity that a US citizen provide evidence?

A

Photograph of the customer
name,
age,
gender,
height,
weight,
eyecolor

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19
Q

What if a person requests full scope Medi-Cal benefits, but has yet to show proof of citizenship?

A

Recipient will receive full scope, and if they failed to provide proof, then their benefits will be reduced to limited scope

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20
Q

What internal systems must be checked to verify documentation of applicants?

A

HUB-verify citizenship, identity, and Social Security card number
MEDS -verify citizenship, identity, and Social Security number
CERMS system to check to see what we already have that would be seen as acceptable documentation on file that the client has already provided
SAVE system that will be used for LPR status since DRA does not apply to LPRs

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21
Q

When working with MEDS what does a successful match mean?

A

A successful match means that the applicant citizenship and identity are verified through SSA if and will not be required to provide any other documentation to meet DRA CIT/ID verification requirements

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22
Q

What is SAVE?

A

SAVE is an intergovernmental (federal/state) information, sharing program, consisting of an automated (primary) and a manual (secondary) verification system. This is done through CalWIN.
The primary system is used to verify the immigration status of legal residence and naturalized citizens who have an a number
The second verification as it is required if the primary verification response does not state, there is a satisfactory immigration status, (SIS)

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23
Q

When do you request a SAVE?

A

Your request an SAVE for non-citizens with an a number
At Intake for each applicant
Any time a person requesting benefits is added to the case
Anytime a change in non-citizen status is reported
As the next redetermination for each current recipient

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24
Q

How can verification of US citizens be submitted?

A

They could be submitted by mail, in person, or by guardian, or authorized representative

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25
Q

What is HUB?

A

HUB is a federal verification system always check for verification.
Proof of acceptable citizenship, or identity documents to the applicant or beneficiary when there is a successful HUBCIT/ID verification match means that a worker is not required to issue a DHCS0011

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26
Q

What is PRUCOL

A

PRUCOL, stands for permanently, residing in the United States under color of law. This is defined by regulations and court decisions to describe categories of non-citizens who are potentially eligible for certain public benefits.

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27
Q

What is required with a PRUCOL?

A

The MC 13 form is required for all non-citizens, claiming one of the protocol categories

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28
Q

When is an MC 13 not needed for the applicant?

A

The MC 13 is not needed when a person says to be a US citizen
Have a SIS on one of the application forms
Citizenship immigration status is verified via electronic means federal data hub CA, birth match, assess a citizenship verification
They are secondary adults on a case. You did not sign the application in the primary applicant a test to the individual being a US citizen national.
And their citizenship immigration status is verified the electronic means including the federal data hub California birth match, or the Social Security ministration, SSA citizenship verification process

29
Q

What are acceptable documents for citizenship?

A

A photocopy, fax scanner other copy must be excepted to the same expenses as the original must show a US place of birth, or that the person is a US citizen, international and fall within identified mpg 7.2 appendix be for citizenship and appendix. See Fidelity.

30
Q

Can a photocopy, fax scanner other copy of a document be excepted to the same extent as an original unless questionable?

A

Yes, they can be

31
Q

What is hierarchy of evidence?

A

The federal government provides guidelines of a ranking of acceptable evidence, based on reliability clients
primary-primary establishes citizenship and identity. They are tier 1 and is the most reliable examples are US passport US naturalization certificate, US passport card.
Secondary to fourth tiers -two through four include successfully, less reliable groups of documentation of citizenship. Only an example would be US birth certificate.
The fourth tier is to be used in the first second and third level of evidence of citizenship is not available others and then elevate to program so it’ll be forwarded to the DHCS

32
Q

What evidence of citizenship for tiers two through four are provided for citizens are nationals?

A

These may be a drivers license and expired documents is also proof of identity for children under 16 and under 18 of years. Also have other documents I can use.

33
Q

What documents can children under 16 and under 18 use to to verify their identity?

A

If they are under the age of 16 clinic records, Dr. records or hospital
School nurse, your daycare records, including report cards. Such records must be verified by the work with the issuing school. A phone contact with the issuing school is a sufficient verification if a contact is not rated narrated in case file.
An affidavit signed under penalty of perjury by a parent, guardian or caretaker, stating the date place of birth of a child with no other identity documents are available the signature on the application, sign under penalty of perjury, stating place and date of birth of child under 16 can also serve as an affidavit if no other acceptable evidence of identity is provided at time of application or redetermination The national school lunch program NSLP is not equivalent to the MC 210 or the MC 321 and cannot be used as an affidavit to establish identity

For children under 18 an affidavit of identity DHCS009 may be used in instances where the child cannot obtain a school ID card and does not have a state ID drivers license

34
Q

Why do we need to know non-citizenship information?

A

We need to know their information to know the scope of benefits

35
Q

Should an HSS worker request for verification from customer to verify legal permanent resident status?

A

Yes, it will be used to make appropriate entries into CalWIN.

36
Q

For MAGI benefits the HUB will attempt to verify LPR status. What will happen if it’s a HUB is not successful?

A

If the HUB is not successful than the HSS worker will need to force a SAVE in CalWIN.

37
Q

How will verification be run if it is for a non-MAGI?

A

The information will not be run through HUB and it will be verified by ordering a SAVE.

38
Q

What can a legal permanent residence’s LPRs do when they have lost or expired documents?

A

Non-citizens who claim legal permanent resident status, and who have lost or have expired documentation are not to be considered undocumented workers will follow primary and secondary SAVE procedures

Non-citizens who have lost their documentation will be given 30 days to provide a receipt for replacement documentation CIS request that holders of expired cards, the urge to contact the nearest CIS office to apply for a new card

39
Q

Will all qualified non-citizens, have an I – 551 card?

A

No, not all qualified noncitizens will have an I– 551 card also known as a legal permanent resident card also known as a green card

40
Q

Do we need to see the actual Social Security card?

A

No, we do not, nor do we need to see proof that they had applied for one

41
Q

What is the requirement for the Social Security card number at time of application for Medi-Cal?

A

Every person requesting medical who has a Social Security card number at time of application is asked provided regardless of immigration status
As a condition of eligibility for full scope, Medi-Cal benefits, each applicant/beneficiary must either provide an acceptable verification of Social Security card number or cooperate in obtaining a Social S
Following applicants beneficiary/beneficiaries would be except this regulation infants under the Damned eligibility program and refugees under refugee medical assistant/entrance medical assistant program

42
Q

How long does an applicant have to provide Social Security card number?

A

They have within 60 days of the date of application, but not necessarily prior to the approval of eligibility HHHSSMS attempt to verify Social Security card number via all available systems

43
Q

What are acceptable Social Security card number verifications include?

A

Social security card
SSA form series, 08–70
SSA award letter
SSN notification letters for IRCA aliens
Medicare card
SSA check, showing the applicants name and Social Security card number with the letters, A, HA, J, T, M, following the Social Security card number
Income eligibility verification system (IEVS) applicant report with a code A or W in the SSN Dash VER field

44
Q

Who receives restricted benefits?

A

Non-citizens eligible only for restricted benefits, are not required to provide a Social Security card number as a condition of eligibility the worker will leave the Social Security card field blank in CalWIN. MEDS will issue a pseudo-Social Security card number for the MEDS record.

45
Q

How should documents be handled by HSS workers?

A

Workers should make sure to check CERMS to see your forms and documents are already on file so they are not requested or completed
If submitted documents are acceptable, a DHCS 0005 will be completed and imaged we received in the FRC
Client will be given a copy of the DHCS 0011 and it will serve as proof of meeting the requirements as indicated on the form

46
Q

What action steps need to be taken when handling documents?

A

1.determine the what the document is
2. Photo copy of the document.
3. Stamped copy as received.
4. Date and print name in stamped image. Include worker number, if applicable.
5. Provide customers with a receipt if requested.
6. Return the document to the customer.
7. Document should be imaged in CERMS.

47
Q

What happens if a customer has a DHCS 0005 DHCS 0011 from another county or state?

A

Worker should contact state and request a fax copy
Did the worker check the HUB & MEDS?

Check HUB and if not successfully verified then check MEDS INQE screen
Have acceptable documents been provided
Check case record, CERMS

48
Q

Should reasonable assistance be provided?

A

Yes
Explain and review acceptable
Use SAVE to verify citizenship for naturalized
Provide any resource information, examples name, address, telephone number of the vital statistics agency for the state of birth
Submit, a birth record data, match for applicants/beneficiaries born in California
Perform an exparte review
Explain how to provide evidence of good faith, effort to obtain documents

49
Q

What are heightened assistance?

A

Heightened assistance, will be given to the following:
Homeless, amnesia victims, mentally impaired, physically incapacitated, lacking representation
Heightened assistance, includes contacting any non-family members who may have documents for the individual
Contact any known current or past healthcare provider, such as an LTC to see him if they have any acceptable evidence
Contact other social services agencies that are known to provided assistance to the individual
Follow the diligent search procedures and mpg article 4, section 9, if applicable

50
Q

What is good faith, effort?

A

The customer is making a good faith effort in getting documents needed by worker. The effort set an alert for follow up DHCS0034 may be completed by the customer worker via telephone contact.
HSS completes a reasonable opportunity to provide ROP screen in CalWIN

51
Q

Good faith, effort

A

It is showing that there’s timely gives time for the client to Dean Bella documentation it is based on the individual circumstances and ability to obtain documentation and they’re good faith effort to provide
Compliance as long as they are making a good faith effort, the recipient who did not provide, except evidence, continues to receive full scope. Applicants will be granted, full scope, benefits, as long as they continue to make a good faith effort

52
Q

What happens to customers who are not making a good faith effort to acquire verification for Medi-Cal application?

A

For applicants, their benefits will be changed to limited.
For recipients, the benefits will be changed to limited.

53
Q

Why are case comments important and what should be in them?

A

The document should have all the actions taken documented and Calwin,
such as contacting the applicant
advising the customer of the need to provide evidence.
Follow up, required
good faith, effort, made by the customer to obtain evidence
extensions of reasonably opportunity.
Receipt of evidence,
adverse actions,
good cause determination for applicants refusal to provide.
All of the documentation is important in the case, so that anyone looking at the case will know what has happened so far and what still needs to happen or why it was denied or approved

54
Q

Restoring full scope benefits

A

If documents are submitted within one year, they have good cause then the restored full benefits were going to affect the month limited benefits began.
If documents are submitted within one year of the requested date and does not have good cause full benefits, always be restored effective the first month in which the documents are submitted.
If documents are submitted more than one year from requested date, has good cause or not, the restored full benefits, go into affect the first month of when the documents were submitted.

55
Q

What is PRUCOL?

A

It is a person permanently residing in the US under color of law, with the knowledge and permission or consent of USCIS, and whose departure from the US agency does not consider enforcing.

56
Q

What does PRUCOL refer to?

A

It refers to an appearance of legal power to act, but which may operate in violation of the law. These non-citizens are entitled to full scope, Medi-Cal benefits, if otherwise
Citizens and immigration
Easy CIS does not recognize PRUCOL as a legal
noncitizens received no immigration benefits as a result of a CISPRUCOL determination
CIS will not deport noncitizens on the basis of the claim PRUCOL or apply for
These non-citizens may be deported for reasons, unrelated to medical such as win, a noncitizen fraudulently supplies, CIS, false information, or has an open warrant for his/her arrest
PRUCOL can be requested for a deceased person

57
Q

What form is required when a non-citizen is claiming one of the PRUCOL?

A

MC 13 form is required for it to be filled out

58
Q

There are 16 categories on the MC 13 form which categories require verification of SIS & SAVE in which does not?

A

Categories 1 through 15 require verification of SIS, and SAVE
Category number 16 does not require SIS or SAVE

59
Q

Let’s discuss category 16 on the MC 13

A

Category 16 does not require an SAVE or any documentation relating to immigration status for this situation Grant full scope, benefits, if otherwise, eligible
When a customer claims category number 16, the worker will explain the CISPRUCOL the termination process to the noncitizen applicant/
The deferred action of childhood arrivals (DACA) also known as the Dream Act is PRUCOL category number 12 found under question five of the MC
MC RRR recipients claiming category 16 on the MC 13 are not required to verify PRUCOL status at their annual redetermination

60
Q

What are follow-ups to category 16 on MC 13?

A

Worker becomes aware that an individual claim category 16 and has SIS a discrepancy exists, and the worker must contact the medical program specialist who shall receive the case to ensure the documented individuals are receiving the appropriate level of benefits

61
Q

What does a worker do if an applicant is claiming categories 1 through 15, but does not have SIS documentation at the time and meets all other conditions of eligibility?

A

Applicant is granted full scope of MC for 90 days from the date of notification of the ROP. Make sure to advise the applicant of the 90 day requirement at intake and document all actions in case comments.

62
Q

What should a worker do when an applicant claims one of the categories between one and 15 but does not have SIS documentation at the time, however, meets all the other conditions of eligibility?

A

The applicant is granted full scope, MC for 90 days from the date of notification of the ROP.

63
Q

What do we do in CalWIN when a applicant has been given a 90 day reprieve?

A

Change the due date, 90 days from the date of request to traffic verification, if not received benefits will be reduced to restricted

64
Q

If verification is not received, and the benefits are reduced to restricted, are there exceptions?

A

An exception would be a non-citizen, no matter the immigration status under 26 years of age or individuals 50 years or older will be eligible for full scope of benefits

65
Q

Will full scope benefits be granted to an applicant who replies or requests PRUCOL the next time around who failed to provide verification?

A

Full scope benefits may not be granted until the noncitizen provides documentation of SIS.

66
Q

What is CIS stand for?

A

Cis stands for citizen and immigration services

67
Q

Does CIS policy recognize PRUCOL as legal non-citizen status?

A

No, CIS does not recognize PRUCOL as a legal non-citizen status non-citizens receive no immigration benefits as a result of a CIS PRUCOL determination. CIS will not deport non-citizens on the basis that they claim PRUCOL or apply for or receive medical however, these non-citizens may be deported for reasons, unrelated to medical such as when a non-citizen, fraudulently supplies, CIS, false information, or has an open warrant for his or her arrest. PRUCOL can’t be requested for a deceased person.

68
Q

What does ROP stand for?

A

ROP stands for Reasonable Opportunity Period.

Medi-Cal (19 decks)

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