MEDI-CAL
What It Means
To You
CALIFORNIA
DEPARTMENT OF HEALTH SERVICES
English/Spanish
Inglés/Español
Table of ConTenTs
1. MEDI-CAL–WHATITMEANSTOYOU.............................................................................. 1
2. WHOCANGETMEDI-CAL?.................................................................................................. 1
3. WHATDOESITMEANTOBE“DISABLED”FORMEDI-CAL?....................................... 4
4. HOWMUCHMONEYCANIGETANDSTILLGETMEDI-CAL?................................... 5
5. WHATPROPERTY/ASSETSAREALLOWABLEFORMEDI-CAL?................................. 5
6. MUSTILIVEINCALIFORNIATOGETMEDI-CAL?.......................................................... 5
7. WHEREDOIAPPLYFORMEDI-CAL?................................................................................ 6
8. HOWDOIAPPLYFORMEDI-CAL?.................................................................................... 6
9. WHATDOINEEDFORVERIFICATION(PROOF)?........................................................... 8
10. WILLIHAVEASHAREOFCOSTANDHOWMUCHWILLITBE?............................... 9
11. HOWDOIMEETMYSHAREOFCOST?..........................................................................10
12. WHATIFIHAVEPRIVATEHEALTHINSURANCECOVERAGE?..................................11
13. WILLMEDI-CALPAYMYPRIVATEHEALTHINSURANCEPREMIUMSIFI
CANNOLONGERAFFORDTOMAKEPAYMENTS?.....................................................13
14. ISTHEREANEWMEDI-CALCARD?.................................................................................13
15. WHATDOESTHEBENEFITSIDENTIFICATIONCARD(BIC)LOOKLIKE?...............14
16. WILLIGETAPAPERMEDI-CALCARD?..........................................................................14
17. WHATINFORMATIONISONTHEPAPERMEDI-CALCARD?........................................14
18. HOWDOIUSETHEBENEFITSIDENTIFICATIONCARD(BIC)?.................................14
19. WHATADDITIONALBENEFITSAREAVAILABLETOPERSONSUNDERTHECHILD
HEALTHANDDISABILITYPREVENTION(CHDP)PROGRAMANDEARLYAND
PERIODICSCREENING,DIAGNOSISANDTREATMENT(EPSDT)?..............................16
20. WHATIFILOSEMYBIC,ITISSTOLEN,ORIDONOTGETIT?..................................17
21. HOWDOIGETMEDI-CALSERVICES?............................................................................17
22. WILLMEDI-CALPAYFORALLMYMEDICAL/DENTALEXPENSES?.......................18
23. HOWCANIGETHELPFROMMEDI-CALIFIAMOUTOFSTATE?.........................18
24. ISMEDI-CALMANAGEDCARETHESAMEASAHEALTH/DENTAL
CAREPLAN?............................................................................................................................19
25. CANIGOTOANYPROVIDERIFIENROLLINAHEALTH/DENTAL
CAREPLAN?............................................................................................................................19
26. HOWDOIJOINAMANAGEDCAREPLAN?..................................................................19
27. HOWDOIGETOUTOFAMANAGEDCAREPLAN?...................................................19
28. WHATCANIDOIFIDISAGREEWITHANYDECISIONABOUTMY
MEDI-CALELIGIBILITYORBENEFITS?............................................................................20
29. WHATIFIHAVEBEENHURTBYANOTHERPERSONORHURTATWORK?................21
30. WILLMEDI-CALBILLADECEASEDMEDI-CALBENEFICIARY’SESTATE?................21
31. WHATISMEDI-CALFRAUD?..............................................................................................22
32. WHATDOTHEWORDSMEAN?........................................................................................22
SPANISHTRANSLATIONOFPAMPHLET..................................................................................25
COUNTYWELFAREDEPARTMENTSLISTING..........................................................................55
TRaDUCCIon al esPaÑol Del folleTo ........................................... Página 25
1. MeDI-Cal – WHaT IT Means To YoU
MEDI-CALpaysforhealthcareforcertainneedyresidentsofCalifornia.MEDI-CAL
issupportedbyfederalandstatetaxes.Thispamphlettellsaboutwhocan
getMEDI-CAL,thehealthcareservicesavailabletothosedeterminedeligible
forbenefits,thechoicesforgettingservices,howtousethepermanent
plasticCaliforniaBenefitsIdentificationCard(BIC)orthepaperMEDI-CAL
card,andyourappealrightsifyoufeelyouaretreatedunfairlyordonotget
whatyouareentitledtogetbylaw.
YoumaybeeligibleforMEDI-CALbenefitsregardlessofsex,race,religion,
color,nationalorigin,sexualorientation,maritalstatus,age,disability,or
veteranstatus.
YourlocalCountyWelfareDepartment(CWD)managesMEDI-CALeligibility
determinations.Ifyouhavequestions,youcanfindtheaddressesand
telephonenumberoftheCWDinthebackofthispamphlet.
IfyoudonotknowsomeoftheMEDI-CALtermsorwords,youcanturntothe
backpagesofthispamphletforthemeaningsofthosewords.
ASpanishtranslationofthepamphletfollowstheEnglish.
2. WHo Can GeT MeDI-Cal?
Evenifyouareworking,ownahouse,oraremarried,youmaybeeligiblefor
MEDI-CAL.TogetMEDI-CAL,youmustfallintooneofthefollowingMEDI-CAL
programcategories.
A.PUBLICASSISTANCE(PA):Ifyouareaged(65yearsoldorolder),blind,or
disabledandyougetSupplementalSecurityIncome/StateSupplementary
Paymentprograms(SSI/SSP),youareautomaticallyeligibleforMEDI-CAL
andwillbesentaCaliforniaBenefitsIdentificationCard(BIC).CallyourSocial
Securitydistrictofficeformoreinformation.
IfyougetCaliforniaWorkOpportunityandResponsibilitytoKids(CalWORKS),
youmayalsobeentitledtogetMEDI-CALbenefits.Ifyougetotherkindsof
PublicAssistance,youmaybeentitledtoalltheservicescoveredbyMEDI-CAL.
Callyourcountyeligibilityworkerformoreinformation.
Ifyouarenotinoneoftheseassistancegroups,youstillmaybeabletoget
MEDI-CALbenefitsinadifferentcategory.Somearelistedbelow,suchas
MedicallyNeedy(MN)orMedicallyIndigent(MI).MNandMIprogramsare
forpeoplewhocannotpayalltheirmedicalexpenses.Evenifyouhaveother
privatehealthinsurancecoverage,youmaystillbeeligible.
B.MEDICALLYNEEDY(MN):YouareMedicallyNeedyifyouareage65or
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older,blind,disabled,oryoumeetthefamilycircumstancesrequiredfor
CalWORKS(youhavechildrenunderage21whoareneedyanddonot
havethesupportorcareofoneparentbecauseofhis/herabsence,death,
incapacity,orunemployment).MNpeopledonotgetacashgrantbecause
theyhavetoomuchincomeorpropertyordonotwantacashgrant.You
maybecomeeligibleforMEDI-CALandgetaCaliforniaBenefitsIdentification
Card(BIC)bypayingorpromisingtopaymedicalexpenseswhichequalyour
“shareofcost”(SOC)forthemonth.(SeeSections10and11.)
C.MEDICALLYINDIGENT(MI):YouareMedicallyIndigentifyouarea
pregnantwomanwithnolinkage(connection)toaPAprogram(CalWORKS);
arefugeeinthecountry8monthsorless;orapersonage21to65ina
skillednursingfacilityorintermediatecarefacility.Personsunder21years
ofage,includingthoseinfostercarewhoseneedsaremetbypublicfunds,
childrenwhoqualifyfortheState-onlyAidforAdoptionAssistanceProgram
andcertainotherchildrennotlivingwithaparentorrelativemayalsobe
includedintheMIgroup.
D.SPECIALPROGRAMS:
• PREGNANTWOMEN
Ifyouarepregnantandcannotaffordtopayforhealthcareandsome
dentalcare,MEDI-CALcanhelppayformedicalexpensesforyouandyour
unborn.ManytimesyoucangetMEDI-CALatnocosttoyou,evenifyou
haveincome.OnceyougetMEDI-CAL,increasesinyourfamily’sincome
willnotbecounted:
•duringyourpregnancy,andpostpartumperiod,
•foryourbaby’sfirstyearoflife.
ParticipatingperinatalprovidersthroughoutCaliforniacanofferpregnant
womenimmediate,temporaryMEDI-CALcoveragependingtheformal
MEDI-CALapplicationunderthePresumptiveEligibilityprogram.Ifyouare
pregnantandinterestedinthisservice,askifyourproviderparticipatesin
thisprogram.
• CHILDREN
YourchildmaygetMEDI-CALatnocost,ifyourchildis:
•aninfant,or
•betweenages1and6,or
•betweenages6and18.
• REFUGEES
IfyouarearefugeeorentrantnotqualifiedfortheMNorMIprograms,ask
yourcountyeligibilityworkerforrefugee/entrantmedicalassistance.
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• CONFIDENTIALMEDICALSERVICESAVAILABLETOPERSONSUNDERAGE21
Ifyouareunder21yearsofage,unmarried,andlivingwithyourparents,
youmaygetcertainconfidentialmedicalservices.UndertheMinor
Consentprogram,youdonotneedparentalconsenttodetermine
eligibility.Medicalservicesincludedunderthisspecialprogramarethose
whichrelatetofamilyplanning,pregnancy,drug/alcoholabuse,sexually
transmitteddiseases,sexualassault,andmentalhealth.
• FORMERFOSTERCHILDPROGRAM
YoucangetMEDI-CALuntilyoureachage21undertheFormerFoster
ChildProgramregardlessofyourincomeifyouareinStatefostercareon
your18thbirthday.Youareeligibleevenifyoulivewithsomeoneelse,
movetoanothercountyorwereterminatedfromMEDI-CAL.
• ADDITIONALSERVICESAVAILABLETOPERSONSUNDERAGE21THROUGH
THECHILDHEALTHANDDISABILITYPREVENTION(CHDP)ANDEARLYAND
PERIODICSCREENING,DIAGNOSISANDTREATMENT(EPDST)PROGRAMS
Ifyouoryourchildareunderage21,youmaybeabletogetmoreor
differentservicesthroughtheChildHealthandDisabilityPrevention(CHDP)
orEarlyandPeriodicScreening,DiagnosisandTreatment(EPSDT)programs.
Thisissothatchildrenandyoungadultsunder21yearsofagecangetall
thehealthcareservicestheyneedtomakesurehealthproblemsarefound
andtreatedearly.Regularcheckupsareimportantsomedical,dentalor
mentalhealthproblemsarefoundandtreatedearly.(SeeSection19.)
• MEDICALSUPPORTENFORCEMENT
Allchildrenhavetherighttobesupportedbybothparents.Ifyouare
applyingforMEDI-CALbenefits,youmustcooperateinestablishing
paternityforachild(ren)bornoutofwedlockandobtainingmedical
supportforachild(ren)whohasanabsentparent.Youwillbeprovidedall
childsupportservicesunlessyounotifytheFamilySupportDivisionDistrict
Attorney(FSD/DA)thatyoudonotwanttoreceivethoseservicesthatare
unrelatedtoobtainingmedicalsupportandestablishingpaternity.Someof
theavailableservicesareasfollows:
•Locatingtheparent(s)forsupportenforcementpurposes;
•Establishingpaternity;
•Establishingachildand/ormedicalsupport(healthinsurance)order;
•Enforcingachildand/ormedicalsupportorder;
•Modifyinganexistingcourtorderforchildand/ormedicalsupport;
•Enforcingaspousalsupportorderinconjunctionwithachildsupportorder;
•Collectinganddistributingsupportpayments.
CUSTODYANDVISITATIONSERVICESARENOTPROVIDED
• OTHER
Youmightqualifyformedicalassistanceinoneofthemiscellaneous
categories.Askyourcountyeligibilityworkertohelpyou.
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E.SPECIALTREATMENTPROGRAMS:Ifyouneeddialysistreatmentor
parenteralhyperalimentationservices,youmaybeeligibleforservicesunder
theseprograms.
F.SPECIALMEDICAREPAYMENTPROGRAMS:SomeMEDI-CALprogramssuchas
theBUY-INProgramandtheQualifiedMedicareBeneficiary(QMB)Programwill
payforMedicarepremiums,andyouwillnotbebilledforyourco-insuranceand
deductibles.TheQualifiedDisabledWorkingIndividual(QDWI)Programpaysthe
MedicarePartApremiumandtheSpecialLow-IncomeBeneficiary(SLMB)and
QualifyingIndividual-1ProgramspaytheMedicarePartBpremium.
G.IMMIGRANTELIGIBILITYFORMEDI-CAL:ImmigrantswhomeetallMEDI-CAL
eligibilityrequirementscangetfullorrestrictedMEDI-CALdependingontheir
immigrationstatus.Immigrantswhoarenotinafullscopeeligibleimmigration
statuscanqualifyforrestrictedMEDI-CAL,whichcoversemergencyand
pregnancy-relatedservices,iftheymeetalleligibilityrequirements.
H.BREASTANDCERVICALCANCERTREATMENTPROGRAM(BCCTP):BCCTP
providesnecessaryno-costtreatmenttoeligiblepersonsdiagnosedwithbreast
orcervicalcancerwhoarescreenedbyCentersforDiseaseControldoctorsor
areFamilyPACT(Planning,Access,CareandTreatment)doctorsandarefound
inneedoftreatment.Formoreinformation,call1-800-824-0088(toll-free).
3. WHaT Does IT Mean To be “DIsableD” foR MeDI-Cal?
TogetMEDI-CALasadisabledperson,youmusthaveseverephysicaland/or
mentalproblem(s)whichwill:
•lastatleast12monthsinarowand,
•stopyoufromworkingduringthose12months,OR
•possiblyresultindeath.
Youmustproveyourdisablingphysicaland/ormentalproblem(s)with
medicalrecords,tests,andothermedicalfindings.Themedicalproblem
mustbethemainreasonwhyyoudonotwork.
TogetMEDI-CALforadisabledchild,thechildmusthaveseverephysical
and/ormentalproblem(s)which:
• areonalistofdisablingchildhoodconditionsOR
• aresoseverethathe/shewouldnotbeabletododailyactivitieswhich
ahealthychildwouldbeabletodo.
Ifyouhaveaseverephysicaland/ormentalproblemthatisonalistof
disablingconditions,youmaybeabletogetMEDI-CALbasedon
disabilitypriortothefinaldeterminationofdisability.(Thisalsoappliesto
children.)Askyourcountyeligibilityworkerformoreinformationabout
PresumptiveDisability.
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250PercentWorkingDisabledProgram–Eligibledisabledworking
individualscangetMEDI-CALfromthe250PercentWorkingDisabled
program.Youmusthavecountableincomebelow250percentofthe
federalpovertylevelandpayapremiumbasedonyourincome.Disability
incomeisnotcounted.Formoreinformation,contactyourCWDorcounty
eligibilityworker.
4. HoW MUCH MoneY Can I GeT anD sTIll GeT MeDI-Cal?
YoucangetMEDI-CALregardlessofhowmuchmoneyyouget.However,
themoremoneyyouget,themoreyouwillhavetopayorpromiseto
paytowardyourmedicalbillsbeforeMEDI-CALwillhelppayyourother
medicalbills.(SeeSections10and11.)
5. WHaT PRoPeRTY/asseTs aRe alloWable foR MeDI-Cal?
Thereareproperty/assetslimitsfortheMEDI-CALprogram.Ifyourproperty/
assetsareovertheMEDI-CALpropertylimit,youwillnotgetMEDI-CAL
unlessyoulowerthemaccordingtoprogramrules.Thecountylooksat
howmuchyouandyourfamilyhaveeachmonth.Ifyourproperty/assets
arebelowthelimitatanytimeduringthatmonth,youwillgetMEDI-CAL,
ifotherwiseeligible.Ifyouhavemorethanthelimitforawholemonth,
youwillbediscontinued.Thehomeyoulivein,furnishings,personal
items,andonemotorvehiclearenotcounted.Asinglepersonisallowed
tokeep$2000(or$3000insomesituations)inproperty/assets,moreif
youaremarriedand/orhaveafamily.Ifachildhasproperty/assetsorifa
stepparentwantsMEDI-CALforastepchild,otherrulesmayapply.
IMPORTANT:Ifyouoryourspouse(husbandorwife)wentintoamedical
institutionornursingfacilityonorafterSeptember30,1989,andwere
expectedtoremainfor30dayswhilethespousewasstillhome,thespouse
athomemaykeepupto$99,540insomecases.(Thisamountmaychange
inJanuaryofeachyear.)
FormoreinformationonMEDI-CALproperty/assetsrules,pleaseask
yourCWDforaformcalled“MEDI-CALGeneralPropertyLimitations”(MC
InformationNotice007).Ifyouoryourspousewereinanursingfacility
beforeSeptember30,1989,alsoaskforaformcalled“CommunityProperty
–PersoninLong-TermCare(LTC)”(MCInformationNotice005).
6. MUsT I lIVe In CalIfoRnIa To GeT MeDI-Cal?
Yes.YoumustbearesidentofCaliforniainordertogetMEDI-CAL.
YoumustalsogiveevidencethatyouarearesidentofCaliforniabefore
yourMEDI-CALcanbeapproved.Evidencemaybeoneofthefollowing:
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1.ArecentCaliforniarentormortgagereceiptorutilitybillinyourname,or
2.AcurrentandvalidCaliforniamotorvehicledriver’slicenseor
IdentificationCardissuedbytheCaliforniaDepartmentofMotor
Vehiclesinyourname,or
3.AcurrentandvalidCaliforniamotorvehicleregistrationinyourname,or
4.AdocumentshowingyouareemployedinCalifornia(suchasapay
stub),or
5.Adocumentshowingyouareregisteredwithapublicorprivate
employmentserviceinCalifornia,or
6.EvidencethatyouoryourchildrenareenrolledinschoolinCalifornia,or
7.Evidencethatyouarereceivingpublicassistance,otherthanMEDI-CAL,
inCalifornia,or
8.EvidencethatyouareregisteredtovoteinCalifornia,or
9.OtheracceptableevidenceofyourCaliforniaresidence,ifyoudeclare,
underpenaltyorperjury,thatyoudonothaveanyofthedocuments
orevidencelistedinnumbers1through8above.
However,youdonothavetogiveevidenceif:
1.YouareapplyingforMinorConsentservices,or
2.YouarethechildofaparentwhohasalsoappliedforMEDI-CALand
givenevidenceofCaliforniaresidence,or
3.YourwifeorhusbandhasappliedforMEDI-CALandgivenevidenceof
Californiaresidence,ifsheorhelivesatyoursameaddress.
7. WHeRe Do I aPPlY foR MeDI-Cal?
CallyourCWDtohaveaMEDI-CALapplicationsenttoyourhome.The
phonenumberandaddressofyourCWDareinthebackofthispamphlet.
Ifyouwanttoapplyinperson,askyourCWDwhereyoucanapply.
MEDI-CALcountyeligibilityworkersalsoarelocatedatsomehealthclinics
andhospitals.
IfyougetanSSI/SSPgrant,MEDI-CALeligibilityisautomaticallysetupbyyour
SocialSecuritydistrictoffice.
8. HoW Do I aPPlY foR MeDI-Cal?
Theusualapplicationprocedureis:
1.CallorgotoyourCWDtogetaMEDI-CALapplication(seepage55).If
youhaveanimmediateneedforhealthcareservices(suchassevereillness
orpregnancy),completetheMEDI-CALapplicationandtakeittoyourclosest
CWDoffice.TelltheCWDthatyouhaveanimmediateneedformedicalor
dentalcare.TheCWDwillprocessyourapplicationasfastaspossible.
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2.Fillouttheapplicationform(s)ascompletelyasyoucan.Section9called
“WhatDoINeedforVerification?”tellsyouwhatprooftogivetheCWDwhen
youapplyforMEDI-CAL.Youcanspeeduptheprocessbyprovidingthe
necessaryinformationandpaperworkquickly.
3.YoumayapplyforMEDI-CAL“retroactivebenefits”ifyouhadmedical/
dentalservicesinthethreemonthsbeforethemonthyouapplyforMEDI-CAL,
andneedhelpfromMEDI-CALtopaythebills.IfyouwereeligibleforMEDI-CAL
duringanyofthethreemonthsbeforethemonthyouapply,evenifyouhave
paidthebills,MEDI-CALmaypaythesebills.Youcanapplyfor“retroactive”
MEDI-CALwhenyouapplyforMEDI-CAL.IfyouaskforretroactiveMEDI-CAL
later,youhaveuptooneyearaftertheretroactiveMEDI-CALmonthtoask
MEDI-CALtopaythatmedicalbill.
4.WhenyouapplyforMEDI-CAL,youwillgetalistofyourrightsand
responsibilities.Forexample,youmustgiveanychangesinaddress,
property,income,familycomposition,othercircumstances,andprivate
healthinsurancecoveragetoyourcountyeligibilityworkerwithintendays.
NOTE:OnceyouapplyforMEDI-CAL,MEDI-CALwillonlypayforthecovered
servicesyougetfromanenrolledMEDI-CALprovider.Youmustconfirmthat
theproviderisanenrolledMEDI-CALproviderbeforeyougetservicesifyou
wantMEDI-CALtopayfortheservices.
5.Mailortakethecompletedapplicationandnecessaryverification(proof)tothe
CWD.Ifyouwantconfidentialminorconsentservices,gotothenearestCWD.
NOTE:Insomecounties,whenyouareaMEDI-CAL“beneficiary”(that’swhat
youarecalledwhenyougetMEDI-CAL)youmayberequiredtosignupfora
MEDI-CALhealthcareplanand/ordentalplan.Ifyouarerequiredtosignup
foramedicalordentalplan,youmaychooseapersonaldoctorand/ordentist
fromalistgiventoyoubythemedicalanddentalplans.
IfyouliveinoneofthosecountieswherethereareMEDI-CALmedicaland
dentalplans,youwillreceiveadditionalinformationaboutthechoicesyou
haveavailableforgettingyourMEDI-CALbenefitsandtheplansofferedto
you.Youwillreceivethisinformationatthetimeyouapplyforbenefits,or
whenthecountyredeterminesyourbenefits.Insomecases,youwillreceive
informationaboutthemedicalanddentalplansavailable,andinformation
abouttoenrollintheplansthroughthemail.
6.Itmaytakeupto45daystoprocessyourMEDI-CALapplication.Ifyouapply
forMEDI-CALbasedondisability,yourapplicationmaytake90days.
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7.YouwillgetaletterinthemailtellingyouifyourMEDI-CALapplicationis
approvedordenied.IfyouhaveaMEDI-CALhealthcareplan,youwillgeta
healthcareplanidentificationcardinadditiontotheState-issuedBIC.
8.IfyoudonotgetananswertoyourMEDI-CALapplicationwithinamonth
afteryouapply,callyourcountyeligibilityworker.
9. WHaT Do I neeD foR VeRIfICaTIon (PRoof)?
YoumustgivecertaininformationbeforeyourMEDI-CALcanbeapproved.
Yourcountyeligibilityworkerwilltellyouwhatproofisneeded.
Youmayapplywithouttheproof,butyouwillhavetogiveitlater.Ifyou
cannotgettheproofyourself,askyourcountyeligibilityworkertohelpyou.
ITEMSREQUIREDforfullMEDI-CALbenefits(ifapplicable):
1. SocialSecuritycard(s).
2. Medicarecard(s).
3. Naturalizationdocument(s).
4. Alienregistrationcard(s).
5. Pregnancyverification.
6. Incomeverification:
a. Employeepaystubsorastatementfromyouremployershowinggross
earningsanddeductions.
b.Awardletterorchecksshowingamountofpensionorbenefits,including
SocialSecurityandV.A.
c. StateUnemploymentorDisabilityawardletter.
d.StudentLoangrantawardletter(s)orloangrantpapers.
e. Statementfromprovidersofotherincome(contributions,refunds,child
support,etc)
f. Self-employmentinformation:Lastyear’staxreturnorcurrentledgers,
currentinventory,includingbusinessequipmentandsupplies.
g.Carecostsforchild/incapacitatedperson(s).
7. PropertyTaxstatementsforallproperty.
8. VehicleRegistration(s)forautomobiles,boats,campersandtrailers.
9. Allcheckingandsavingsaccountstatementsandtrustaccountdocuments.
10.Allstocks(brokeragestatements),bonds(includingU.S.Savingsbonds)and
mutualfunds.
11.Alldeedsoftrust,mortgages,otherpromissorynotesandcontractsofsale.
12.Alllifeinsurancepolicies,includingcashsurrendervalue.
13.Allannuitypolicies.
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14.Allburialtrusts/prepaidburialcontracts/informationonburialplots.
15.Documentationregardingthecurrentvalueofalltrusts.
16.Paymentbook(s)forallencumberedproperty.
17.Allpolicies/cardsforhealthinsuranceyoucurrentlyhaveorwhichare
availabletoyou.
18.Application(s)forpossibleavailableincome(i.e.unemploymentbenefits,
statedisabilitybenefits).
19.Courtordersrelatingtoincomeandproperty.
20.Leaseagreements.
21.Lifeestatedocuments.
22.Copiesofpatienttrustaccountledgers.
23.Rentreceipts,currentutilitybills,orhousingstatement.
24.Copiesofchildsupportordersordivorcedecree.
25.SocialSecuritydisabilityorSSIdenialordiscontinuancenotice(if
applyingfordisability-basedMEDI-CAL).
26.EvidenceofCaliforniaresidency.
10. WIll I HaVe a sHaRe of CosT anD HoW MUCH WIll IT be?
Dependinguponyourmonthlyincome,MEDI-CALmaydeterminethatyou
havetomeetashareofcost(SOC)beforeMEDI-CALwillpayforyour,oryour
family’s,medicalexpensesforthemonth.Thenextsectionexplains“meeting
ashareofcost.”
WhetheryouwillhaveaSOCforamonth,andthesizeofyourSOC,depends
onhowmuchmoneyorincomeyouandyourfamilygetforthemonth.
MEDI-CALallowsyoutokeepacertainamountofyourfamily’sincomefor
yourlivingexpenses(thisportioniscalledyourMaintenanceNeed).MEDI-CAL
mayalsoallowyoutokeepadditionalamountsofyourfamily’sincome.Any
incomeforthemonthwhichismorethantheamountyouareallowedto
keepbecomesyourSOCforthemonth.
Insomefamilies,theincomeofonepersoncannotbeusedtodecideif
anotherpersonhasaSOC.Forexample,incomeofachildcannotbeusedto
decidewhetherabrotherorsister,parent,stepparentorcaretakerrelativehas
aSOC.IncomeofastepparentcannotbeusedtoseeifastepchildhasaSOC.
Ifyoudon’thaveanymedicalexpensesduringamonth,youdonotneed
tomeetyourSOCforthatmonth.However,keepyourBICincaseyouneed
medicalservicesinupcomingmonths.
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11. HoW Do I MeeT MY sHaRe of CosT?
YoumaymeetyourSOCforthecurrentmonthbyshowingMEDI-CALthatyou
paid,orhavepromisedtopay,foryourmedicalexpensesanamountofmoney
thesameasyourSOC.TherearetwowaystoshowMEDI-CALthatyouhave
paidorpromisedtopayyourSOCforacertainmonth.Thesetwomethodsare:
1.IneverymonththatyouhaveaSOC,yourCWDwillnotifytheStateofthe
amountofSOCyoumustpay.Whenyougotoamedicalproviderandgive
theprovideryourBIC,yourproviderwillgetinformationfromacomputer
systemaboutyourSOC.Aftertheprovideracceptsyourpromisetopayfor
themedicalservices,oryoupayforthoseservices,theproviderwillforward
theamountofSOCpaid,orpromisedtobepaid,throughthecomputer
systemtotheState.TheStatewillimmediatelyupdatetheSOCsystemsothat
futureprovidersthatmonthwillknowtheamountofSOCthatremains,ifany.
WhenyouhavemetyourSOCforthemonth,allfutureproviderswillreceive
informationthatyouhavemetyourSOCforthemonthandwhetherornot
youareeligibleforcoveredMEDI-CALservices.
2.AnotherwaytoshowyouhavepaidorpromisedtopayyourSOCistogive
yourmedicalbillsdirectlytoyourcountyeligibilityworker.Youmaygiveyour
billsformedicalservicesyougotduringthecurrentmonthtoyourcounty
eligibilityworkertoapplytowardyourSOC.Youmustgiveoldmedicalbills
frompreviousmonths(forwhichyoustillowemoneyandwhichyouwant
toapplytowardyourSOC)toyourcountyeligibilityworker.Yourprovider
cannotusetheSOCcomputersystemforyouroldmedicalbills.
Medicalbillsgiventoyourcountyeligibilityworkermustcontaincertain
kindsofinformationbeforeyourcountyeligibilityworkercanapplythese
billstowardyourSOC.
Yourmedicalbillsmustshowthisinformation:
1.Provider’snameandaddress.
2.Nameofpersonwhogotthemedicalservice.
3.Descriptionofthemedicalservicereceived.
4.ProcedureCode(amedical/dentalreferencenumber)formedical/dental
servicesreceived–yourproviderwillknowwhatthisnumberis.
5.Provider’sMEDI-CALprovidernumber,orifnotaMEDI-CALprovider,the
providerlicensenumber,orfederaltaxidentificationnumber.
6.Date(s)medicalservicewasreceived.
7.Dateonwhichbillwasissued.Foroldmedicalbills,thisdatemustbewithin
90daysofthedateyougivetheoldmedicalbillstoyourcountyworker.
8.Amountbilledtopersongettingtheservice.
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Ifanyofthisinformationismissingfromamedicalbill,youmusttrytogetit
fromyourprovider.Ifyouareunabletogetit,yourcountyeligibilityworker
willtrytohelpyou.Billingstatementsfromcollectionagenciesandcredit
cardstatementssometimesmaybeusedasevidenceofmedicalexpenses.
Undercertainconditions,youmaygivethemissinginformationbymakinga
swornstatement.
Ifyourcountyeligibilityworkerisunabletoacceptamedicalbill,youwillget
alettergivingthereasonforthedisapprovalofthebill.Youwillhavetendays
tofixtheproblemandbring/sendthebillagain.Ifyoudonotdothis,youwill
receiveadenialletterwithinthenext30dayswhichwillgivethereasonfor
thedenialandtellyouwhatyoumustdobeforeyoumaybring/sendyour
medicalbillagain.Youwillgetaseparateletterformedicalbillswhichhave
beenacceptedandappliedtowardyourSOC.
12. WHaT If I HaVe PRIVaTe HealTH InsURanCe CoVeRaGe?
YoucanhaveMEDI-CALeventhoughyouhaveprivatehealthcoverage.If
youareaMEDI-CALbeneficiaryandhaveindividualorgroupprivatehealth
insurancecoverage,youarerequiredbyfederalandstatelawtoreportit.
ThisinformationmustbegiventoyourCWD,toyourhealthcareprovider,
and/ortotheFamilySupportDivisionDistrictAttorney(FSD/DA),whenthere
isanabsentparentwhomayberesponsibleforyourchild(ren)’smedicalcare,
orinapaternityestablishmentwhenachildisbornoutofwedlock.Ifyou
failtoreportanyprivatehealthinsurancecoveragethatyouhave,youare
committingamisdemeanor.
Underfederallaw,healthinsurancebelongingtoaMEDI-CALrecipientina
childormedicalsupportenforcementcaseisusedasfollows:
TheproviderofservicewillbillMEDI-CAL.MEDI-CALwillpaytheprovider
ofservice.ThenMEDI-CALwillseekrepaymentfromtheotherhealth
coverage.Youwillnotbeliableforanyinsurancecost-sharingamount
(coinsuranceordeductible)unlessaMEDI-CALSOCmustbemet.Ifyourother
healthinsuranceisa PrepaidHealthPlan(PHP)oraHealthMaintenance
Organization(HMO),youmustusetheplanfacilitiesforregularmedicalcare.
OutofareaservicesoremergencycareshouldalsobebilledtothePHP/HMO.
Therefore,youmusttellyourcountyeligibilityworkerand/ortheFSD/DA:
• ifyou,yourchild(ren),ortheotherparentofyourchild(ren)hasprivate
healthinsurancecoverage.
• whentheprivatehealthinsurancecoverageisthroughyouremployer,
yourunion,oragroupororganization.
• withintendays,whenyourprivatehealthinsurancecoveragechanges
- ­
orstops.
• aboutanycourtorder(suchasdivorcejudgmentortemporary
supportorder)whichmakestheotherparentresponsiblefor
providinghealthinsurance.
Youmust:
• giveyourmedicalprovideranyinformationneededtobillyourprivate
healthinsurancecoverage,
• sendtotheCaliforniaDepartmentofHealthServices’(CDHS’)Third
PartyLiabilityBranchanypaymentyougetdirectlyfromaninsurance
carrierforservicespaidbyMEDI-CAL.Theaddressis:
CaliforniaDept.ofHealthServices
ThirdPartyLiabilityBranch
HealthInsurance
P.O.Box997424,MS4719
Sacramento,CA95899-7424
Youmust:
• sendtotheCHDS’ThirdPartyLiabilityBranchanymedicalsupport
paymentyougetfromtheabsentparent.Theaddressis:
CaliforniaDept.ofHealthServices
ThirdPartyLiabilityBranch
HealthInsurance
P.OBox997422,MS4719
Sacramento,CA95899-7425
• useyourhealthmaintenanceorganization(HMO),and/orprepaid
healthplan(PHP),suchasKaiserHealthPlan,CHAMPUS,ormilitary
coverage,forregularmedicalcare.Outofareaservicesforemergency
careshouldalsobebilledtotheHMO/PHP.
• useyourBIConlyforMEDI-CALcoveredservicesthatyourprepaidor
healthmaintenanceplanormilitaryinsurancedoesnotcover.
Ifyouhaveotherhealthinsurancecoverage,thecomputersystemwillbecoded
toshowotherhealthinsurance.
Aprovider(doctororpharmacy)maynotrefusetoprovideserviceorfillyour
prescriptionsolelybecauseyouhaveotherhealthinsurancecoverage(in
additiontoMEDI-CAL).Ifyoudonothaveotherhealthinsurancecoverage
andthecomputersystemiscodedthatyoudo,askyourcountyeligibility
workertocorrectthecodingonthecomputersystem.IfyouhaveSSI/SSP
andthecomputersystemisincorrectlycodedtoshowotherhealthinsurance
coverage,andyoudonothaveit,pleasecalltheCDHS’HealthInsurance
Sectionat1-800-952-5294(toll-free)tocorrectthecodingonthecomputer
system.
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Ifyouarehavingaclaimspaymentproblemwithaprovider,youmaycallthe
ElectronicDataSystemsBeneficiaryInquiryUnitat(916)636-1980.
NOTE:BeginningJanuary1,2006,ifyouareeligibleforMedicare,Medicare
(notMEDI-CAL)willpayformostprescriptiondrugsforMEDI-CALbeneficiaries
whoareeligiblleforMedicarePartA(hospital)orPartB(outpatient).For
informationonthisnewdrugcoverage,pleasecontact1-800-MEDICARE.
13. WIll MeDI-Cal PaY MY PRIVaTe HealTH InsURanCe
PReMIUMs If I Can no lonGeR affoRD To MaKe PaYMenTs?
IfyouareaMEDI-CALbeneficiaryandyouhaveaveryhigh-costmedical
conditionwhichrequiresaphysician’scare,theCDHSmaypayyourprivate
healthinsurancepremiums,ifitiscosteffective,undertheHealthInsurance
PremiumPayment(HIPP)program.Therearespecificrequirementstoqualifyfor
theprogramandnotallapplicantsareapprovedforHIPP.Formoreinformation
onHIPP:
•askyourcountyeligibilityworkertoreferyou,or
•calltheCDHS’HIPPProgramat1-866-298-8443
(toll-free).
AHIPPrepresentativeinSacramentowillexplaintheprocessandrequirements
fortheprogram.Ifitappearsthatyoumaymeettheeligibilityrequirements,an
applicationwillbesenttoyou.
14. Is THeRe a neW MeDI-Cal CaRD?
FromJanuary2005throughJune2005,MEDI-CALissuednewplastic
BenefitsIdentificationCards(BICs)toallbeneficiaries.YourBIChasanew
identificationnumbermadeupof14numbersandletters.Yourhealthcare
providersneedyournewBICtoprovideservicesandtobillMEDI-CAL.
NOTE:YOURBICDOESNOTGUARANTEEMEDI-CALELIGIBILITY.Takeyour
BICtoyourdoctor,pharmacy,hospitalorothermedicalprovider.The
providerwillusethiscardtoobtaininformationtodetermineifyouare
eligibleforMEDI-CAL.
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15. WHaT Does THe benefITs IDenTIfICaTIon CaRD (bIC)
looK lIKe?
ABIClookslikethis:
Actualcardsize=31/8x23/8inches;whitecardwithbluelettersonfront,
blacklettersonback.
1
2
3
4
5
Recipient Information on face of card:
1. Your ID Number (a 14 character
identification number).
2. Your name
3. Gender Code (male or female)
4. Date of Birth
5. Date card was issued to you
16. WIll I GeT a PaPeR MeDI-Cal CaRD?
YourcountywillgiveyouapaperMEDI-CALcardifyouhavean“Immediate
Need”orgetConfidentialMedicalServices(MinorConsent)asdescribedin
Section2D.
17. WHaT InfoRMaTIon Is on THe PaPeR MeDI-Cal CaRD?
Yourpaperidentificationcardwillshowyourname,MEDI-CAL
identificationnumber,gender,dateofbirth,issuedateandgoodthrough
date.“ImmediateNeed”cardsareissuedforaonemonthperiodandMinor
Consentcardsareissuedforuptoayear.
NOTE:Ifyouareabeneficiary18yearsofageorolderwhoisnotinlong­
termcare,andnotgettingemergencyservices,youmustsignanddate
yourpaperMEDI-CALcardorBICwhenyougetitandbeforeyougivethe
paperMEDI-CALcardorBICtoaproviderforanycare.
18. HoW Do I Use THe benefITs IDenTIfICaTIon CaRD (bIC)?
YoushouldalwayscarryyourBICwithyou.
REMEMBER:FindoutiftheprovidertakesMEDI-CALpatientsbeforeyou
gofortreatment.Theproviderhasarighttorefusetotake
MEDI-CAL.Ifyouforgottotelltheproviderthatyouhave
MEDI-CAL,youmayhavetopayyourbill.
- ­
AskyourlocalmedicalsocietyforproviderswhotakeMEDI-CALpatients.
CalltheDeltaDentalofficefordentalreferralsat1-800-322-6384.
Foreachserviceyouget,givetheprovideryourBICsoMEDI-CALcanpay
theprovider(ifyouareeligibleforMEDI-CAL.)
SomeservicesmustbeapprovedbyMEDI-CALbeforeyoumaygetthem.
Theproviderwillknowwhenyouneedpriorapproval.
Someservicesarerestrictedtotwopermonth.Thereareafewexceptions,
butgenerallyyoucanonlygetatotaloftwoofthefollowingservices:
•Acupunctureservices
•Chiropracticservices •Podiatryservices(some)
•SpeechTherapy
•Audiologyservices
•OccupationalTherapy
•Psychologyservices
Ifyouneedanyoftheaboveservices,discussyourtreatmentplanand
appointmentswithyourdoctor.
Thefollowingservicesarenotautomaticallylimitedbutyourdoctor
mayneedtogetapprovalfromMEDI-CAL.Yourdoctorwilldecidewhich
servicesyouneedandwillaskforapprovalwhenitisneeded.Someofthe
serviceswhichrequirepriorapprovalare:
• Hemodialysisservices(kidneytreatment)
• Medicaltransportation
• Artificiallimbs,braces,andeyes
• Hearingaids
• Inpatienthospitalcare(SeeMEDI-CALterms)
• Physicaltherapy
• Crutches,wheelchairs,andotherdurablemedicalequipment
• Hospicecare
• PrescribeddrugsnotontheMEDI-CALdruglist
• Nursinghomecare
• MedicalsuppliesnotontheMEDI-CALmedicalsupplieslist
• Somedentalservices(e.g.gumtreatment,rootcanals,crowns,
dentures)
• Homehealth–HomeandCommunity-basedservicesasapossible
alternativetohospitalornursinghomecare
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Thefollowingservicesarenotautomaticallylimitedanddonotneed
priorapproval:
• Mostdoctor’sservicesandmostclinicvisits
• Manydentalservices(e.g.exams,x-rays,cleanings,preventiveservice,
fillings)
•Eyeglassesandeyeappliances
• Laboratory,X-ray,andradiationtreatment
•Bloodandbloodderivatives
• Medical/dentalscreeningsandreferralsareavailableforpersonsunder
21toidentifyandtreatmedical/dentalproblems(seeSection19)
• Ifyouarepregnant,youcangetprenatalcareguidancetohelpyouget
thecareyouneedtohaveahealthybaby,includingsomedentalcare
• PrescribeddrugsontheMEDI-CALdruglistifprescribedforthe
conditionsspecifiedonthelist(IfyougetMedicare,seeSection22)
• MedicalsuppliesontheMEDI-CALmedicalsupplieslistifprescribed
fortheconditionsspecifiedonthelist
FederallyQualifiedHealthCenter(FQHC)andRuralHealthClinic(RHC)services
donotrequirepriorapproval.However,theseservicesmaybelimited.
19. WHaT aDDITIonal benefITs aRe aVaIlable To PeRsons
UnDeR CHIlD HealTH anD DIsabIlITY PReVenTIon (CHDP)
anD THe eaRlY anD PeRIoDIC sCReenInG, DIaGnosIs anD
TReaTMenT (ePsDT) PRoGRaMs?
Ifyouoryourchildisunder21,theChildHealthandDisabilityPrevention
(CHDP)Programprovidesregularcheck-upsandneededimmunizations
tokeepyouhealthy.CHDPservicesincluderegularscreeningformedical,
dental,vision,hearingormentalhealthproblems.Ifyouneedhelpwithan
appointmentortransportation,theCHDPprograminyourcountycanhelp
you.Lookforthephonenumberundercountygovernmentinyourlocal
phonebook.
TheEarlyandPeriodicScreening,DiagnosisandTreatment(EPSDT)
programprovidesextraMEDI-CALservicesifyouareunder21andhave
fullscopeMEDI-CAL.EPSDTservicescorrectorimprovemedical,dental,
ormentalhealthproblems.Youmaygettheextraservicesifyouandyour
doctor,healthcareprovider,clinic,countyCHDPorcountymentalhealth
departmentagreeyouneedthem.Youcanaskforservicesasoftenasyou
thinkyouneedthem.
Ifyouhavesevereemotionalproblems,contactyourcountymental
healthdepartment.Lookinthegovernmentsectionofyourphonebook
underMentalHealthDepartment.Ifyoucannotreachthecountymental
healthdepartment,callthestatementalhealthombudsmantoll-freeat
1-800-896-4042.
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Ifyouoryourdoctorthinkthathealthserviceswhicharenotusually
coveredbyMEDI-CALmaybeneeded,youshouldtalkto:
•YourlocalcountyCHDPProgram
•YourManagedCarePlan
•YourCountyMentalHealthDepartment
Oraskyourdoctortocontact:
•YourlocalMEDI-CALFieldOffice,or
•TheCaliforniaChildren’sServicesprogram
20. WHaT If I lose MY bIC, IT Is sTolen, oR I Do noT GeT IT?
YoumayaskforaBICfromyourCWDwhenyouareeligibleforMEDI-CALbut
youhavenotgottenacard,youlostyourcard,yourcardwasstolen,orthe
cardyougotinthemailhaswronginformationonit.
IfyourBICisstolen,youmusttellyourlocalpoliceandyourCWD.You
shouldgiveasmuchinformationaboutthetheftaspossible.
IfyougetSSI/SSPorCalWORKS,youshouldautomaticallygetaBICinthe
mail.Ifyoudonotgetacard,youshouldcontactyourCWD.Eventhough
thecountydoesnotmakeSSI/SSPeligibilitydeterminationsorsendSSI/SSP
checks,theyhelpwithBICproblemsforpeoplewhogetSSI/SSP.Thecounty
canorderareplacementBICforyou.TheCWDwilltellyouifyoualsoneedto
contactaSocialSecurityofficetocorrecttheproblemwithyourBIC.
21. HoW Do I GeT MeDI-Cal seRVICes?
TherearetwowaystogetyourMEDI-CALservices.Howyougetyour
MEDI-CALserviceswilldependontheareayoulivein.Insomeareas,you
maychooseyourprovidersfromthosewhoacceptMEDI-CAL,oryoumay
choosetosignupforaMEDI-CALhealthand/ordentalcareplanifthere
areanyinyourarea.Inotherareas,someMEDI-CALbeneficiariesmust
signupforahealthand/ordentalcareplan.Intheareaswhereyoumust
signupforahealthcareplan,thereareexceptions.Theexceptionswill
beexplainedtoyouatthesametimeyourchoicesforgettingMEDI-CAL
servicesareexplainedtoyou.
Youwillgetinformationabouthealth/dentalcareplansatthetimeyouapply
orreapplyforbenefits.Youmayberequiredtogotoapresentationatthe
CWDwheretheytellyouaboutthehealthcareplansyoucansignupfor.You
mayalsogetinformationinthemailaboutthehealthcareplansinyourarea.
1.Inthoseareaswhereyoucanchooseyourownproviders,youshould
knowhowtousetheBICbeforeyouseeadoctororotherproviderof
healthservices.Pleasereadthesectionscalled“HowDoIUseTheBIC?”and
“WhatInformationIsOnThePaperMEDI-CAL?”(SeeSections17and18).If
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youarenotenrollinginahealthcareplanandchoosingyourownproviders,
youmusttellthehealthcareproviderthatyouhaveMEDI-CALbeforeyoufirst
getcare.IfyoudonottelltheproviderthatyouhaveMEDI-CAL,theprovider
maylegallybillyouforallservicesyouget.Providersofhealthcaredonothave
totakeMEDI-CALpatientsormayonlytakeafewMEDI-CALpatients.If you
don’t use your bIC correctly, you may have to pay for the services you get.
2.IfyousignupforaMEDI-CALhealth/dentalcareplan,youmaychoosea
providerfromaproviderlisttheplangivesyou.Asaplanmember,youcan
getalloftheservicescoveredbyregularMEDI-CAL.Someplansofferextra
serviceswhichyoucannotgetwithyourMEDI-CALcard.Inaddition,you
donothavetopaya“co-payment”whenyouareaplanmember.
22. WIll MeDI-Cal PaY foR all MY MeDICal/DenTal eXPenses?
YourBICwillpayformanykindsofmedical/dentalexpenses.Whenyour
providerusesyourBICtoverifyyourMEDI-CALeligibility,yourproviderwill
knowifMEDI-CALwillpayforamedical/dentaltreatmentorifyouneedto
makea“co-payment”foranytreatment.Youmayhavetopay$1.00eachtime
yougetamedical/dentalserviceorprescribeddrugand$5.00ifyougotoa
hospitalemergencyroomwhenyoudonotneedanemergencyservice.You
donothavetopayifyouareenrolledinaMEDI-CALhealth/dentalcareplan.
NOTE:IfyouhaveMEDI-CALandMedicare,Medicare(notMEDI-CAL)paysfor
mostofyourprescribeddrugs.
23. HoW Can I GeT HelP fRoM MeDI-Cal If I aM oUT of sTaTe?
TakeyourBICorproofofenrollmentinaMEDI-CALhealthcareplanwithyou
whenyoutraveloutsideCalifornia.MEDI-CALcanhelpinlimitedsituations;
forexample,inanemergencyduetoaccident,injury,orsevereillness,or
whenyourhealthwouldbeendangeredbypostponingtreatmentuntilyou
returntoCalifornia.MEDI-CALmustfirstapproveanyout-of-statein-patient
medicalservicesbeforeyougettheservice.Youwillberesponsiblefor
medicalcostsforservicesyougotout-of-stateifthemedicalproviderisnota
MEDI-CALproviderordoesnotwishtobecomeaMEDI-CALprovider.
Theprovidershouldfirstverifyeligibilitybycontactingthefiscalintermediary
at(916)636-1960.Theprovidermaygetinformationoncoverage,
authorizationandbillingproceduresbycontactingthefollowing:
MEDICALSERVICES
CaliforniaDept.ofHealthServices
MEDI-CALFieldOffice
P.O.Box193704
SanFrancisco,CA94119-3704
(415)904-9600
DENTALSERVICES
DeltaDental
Denti-Cal
11155InternationalDrive,BuildingC
RanchoCordova,CA95670
1-800-541-5555
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IfyouliveneartheCaliforniastatelineandusedoctorsorotherproviders
ofmedicalserviceintheotherstate,someoftheserestrictionsdonot
apply.(However,medicalservicesinMexicoorCanadaarenotcovered
exceptforemergencyhospitalization.)
YouwillnotgetMEDI-CALifyoumoveoutofCalifornia.Youmayapplyfor
Medicaidinthestateinwhichyoulive.
24. Is MeDI-Cal ManaGeD CaRe THe saMe as a HealTH/
DenTal CaRe Plan?
Yes.MEDI-CALManagedCareisaprogramwherebytheStatecontracts
withvariousmedicalproviderstoprovideservicestoyouinanorganized
andcoordinatedmanner.Themanagedcareplansmustdirectlygive,or
arrangefor,allMEDI-CALservicestoyou.
25. Can I Go To anY PRoVIDeR If I enRoll In a HealTH/
DenTal CaRe Plan?
Ifyouenrollinahealth/dentalcareplan,youmustusetheplanproviders
andclinicsunlessemergencycareisneeded.
26. HoW Do I JoIn a ManaGeD CaRe Plan?
Youcanaskyourcountyeligibilityworkerifmanagedcareisavailableandhow
tocontacteitherthehealthcareplanorthelocalhealthcareoptionsworker.
27. HoW Do I GeT oUT of a ManaGeD CaRe Plan?
InsomeareasservedbyaCountyOrganizedHealthSystem(COHS),ifyou
arewithaprovider,eitherthroughvoluntaryenrollmentorthroughbeing
assigned,youwillhavetostaywiththatproviderforaperiodofsixmonths.
Ifyoujoinorareassignedtoaprovideryoudon’twant,youmaydisenroll
(cancel)foranyreasonanytimewithinthefirst30dayswiththatprovider,
orafteryouhavebeenwiththeprovidersixmonths.
IfyouareinaCOHScountywhereyouhavetostaywithaproviderforsix
monthsbeforedisenrolling,youwillgetmoreinformationaboutthiswhen
yousignupforthehealthcareplan.
IfyouliveinaTwo-PlanModelorGeographicManagedCarecounty,andthe
optiontojoinahealthcareplanisvoluntary,youmaydisenroll(cancel)at
anytime.(Youcontacttheplanmembershipstaffatthephonenumber
providedinthepapersyougotwhenyousignedup.)Itusuallytakes45days
tobecancelled.IfyouhavequestionsaboutyourenrollmentinaTwo-Plan
ModelorGeographicManagedCarehealthplan,youcancallHealthCare
- ­
Optionsat1-800-430-4263.Ifyouarenotdisenrolledin45days,contact
yourcountyeligibilityworkerforhelp.
28. WHaT Can I Do If I DIsaGRee WITH anY DeCIsIon aboUT
MY MeDI-Cal elIGIbIlITY oR benefITs?
STATEHEARING:YougetaNoticeofAction(NOA)inthemailfromthe
CWDwheneveryourMEDI-CALeligibilitychanges.Ifyoudisagreewith
adecision,youshouldtalktoyourcountyeligibilityworker.Ifyouare
stilldissatisfied,youmayaskforaStatehearingthroughtheCWDorthe
CaliforniaDepartmentofSocialServices.OnthebackoftheNOA,you
willfindouthowyoucanrequestaStatehearingandwheretosendyour
request.Ifyoudisagreewiththedenialofahealthbenefit,youcanalsoask
foraStatehearingby:
Writingto:
CaliforniaDept.ofSocialServices
StateHearingDivision
POBox944243,MailStation19-37
Sacramento,CA94244-2430
Orbycalling:
CaliforniaDept.ofSocialServices
PublicInquiryandResponseUnit
Toll-freeNumber:1-800-952-5253OR
Hearingimpaired(TTY)only:
1-800-952-8349
YoumustaskforaStatehearingwithin90daysfromthedateonwhich
youbelievethewrongactiontookplace.Ifyouaskforahearingbeforethe
effectivedateoftheactionwhichstoppedorloweredyourMEDI-CALbenefits,
youmaycontinuetogetthesameMEDI-CALbenefitsuntilthehearing.
YouoryourrepresentativecanreadtheregulationsabouttheMEDI-CAL
programandmostofthefactsinyourcase.Helpisalsoavailableinsome
languagesotherthanEnglish,includingSpanish.Atthehearing,an
AdministrativeLawJudgewillreviewtheCWD’sactionstoseeifsomeone
madeamistake.Youmusteithergotothehearingorgivewrittennotice
forsomeonetogoinyourplace.Youmaybringotherstorepresentyou
aswitnesses.Youmayaskquestionsofthecountyrepresentativeorany
CountyorStatewitnesses.
DISCRIMINATION:Ifyoubelieveadecisionaboutyourrighttoget
MEDI-CALbenefitswasunfairlymadebecauseofyoursex,race,religion,
color,nationalorigin,sexualorientation,maritalstatus,age,disability
orveteransstatus,youmayfileawrittenortelephonecomplaintwith
theCaliforniaDepartmentofHealthServices,OfficeofCivilRights,MS
0009,POBox997413,Sacramento,CA95899-7413,(916)440-7370.Your
complaintofdiscriminationwillbeinvestigated.
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29. WHaT If I HaVe been HURT bY anoTHeR PeRson oR HURT
aT WoRK?
Ifyouarehurtbyanotherpersonorhurtatwork,youmayuseyourBIC
togetservices.Youmustreporttheaccidentorinjurytoyourcounty
eligibilityworkersothattheMEDI-CALprogramcanbepaidbackbythe
responsibleparty.
Also,sendorfaxtheinformation
listedbelowto:
CaliforniaDept.ofHealthServices
RecoveryPersonalInjuryUnit
P.O.Box997425,MS4720
Sacramento,CA95899-7425
FAX(916)650-6581
OR
Youmaycall:
(916)650-0490
1.Yourname,address,andphonenumber.
2.YourBICnumber,andSocialSecurityNumber.
3.Thedateyouwerehurtandwhathappened.
4.Thename,address,andphonenumberofyourattorney,ifyouhiredone.
5.Thename,address,andphonenumberofthepersonwhohurtyou.
6.Thename,addressandphonenumberoftheliableinsurancecompany;
alsoaddthepolicynumber.
7.Ifyouwerehurtatwork,thename,addressandphonenumberofyour
employer.
30. WIll MeDI-Cal bIll a DeCeaseD MeDI-Cal benefICIaRY’s
esTaTe?
MEDI-CALmayclaimagainsttheestateofaMEDI-CALbeneficiarywhohas
diedafterOctober1,1993,onlyif:
• MEDI-CALpaidforcertainmedicalservicesafterthebeneficiary’s55th
birthday,andthedeceasedMEDI-CALbeneficiaryhadnosurviving
spouse,minor,ortotallydisabledchild(ren),and
• theMEDI-CALclaimagainsttheestatedoesnotcreateasubstantial
hardshipontheheirsofthedeceasedMEDI-CALbeneficiary.
MEDI-CALshallimposealienupontheequityinterestinthehomeorother
propertyofaninstitutionalizedMEDI-CALbeneficiaryifcertainconditions
aremet.Suchclaimsandliensmaybereducedifitcanbedemonstrated
thatasubstantialhardshipiscreatedonthesurvivorsorheirsofthe
deceasedMEDI-CALbeneficiary.
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IfthesurvivingspouseofadeceasedMEDI-CALbeneficiarydies,MEDI-CAL
maybilltheestateofthesurvivingspouseforeithertheamountpaidby
MEDI-CALformedicalassistance,orthevalueoftheestatereceivedbythe
survivingspouse,whicheverisless.
Theestateofindividualsofanyagemayalsobebilledifthatindividualhadbeen
aresidentofanursingfacility.
31. WHaT Is MeDI-Cal fRaUD?
Ifyouaregettingtreatmentfrommorethanonedoctor,youshouldtelleach
doctorabouttheotherdoctor(s)givingcaretoyou.Itisyourresponsibility
nottoabuseorimproperlyuseyourMEDI-CALbenefits.Itisacrimeto:
•allowotherstouseyourMEDI-CALbenefits,and
•getdrugsthroughfalsestatements
ItisacrimeforyoutosellorlendyourBICtoanypersonorfurnishyourBIC
toanyoneotherthanyourproviderofservicesasrequiredunderMEDI-CAL
guidelines.MisuseofBIC/MEDI-CALbenefitsisacrimethatcouldresultin
administrativeactionorcriminalprosecution.Ifyoususpectsomeoneof
misusingMEDI-CALbenefits,youmaymakeaconfidentialreportto:
1-800-822-6222(toll-free)
32. WHaT Do THe WoRDs Mean?
1.BENEFICIARY–ApersonwhohasbeendeterminedeligibleforMEDI-CAL.
2.COUNTYWELFAREDEPARTMENT(CWD)–SeetheCountySocialServices
Departmentlistingatthebackofthispamphlettocontactyourcounty
MEDI-CALoffice.
3.(MEDI-CAL)HEALTHCAREPLAN–TheCDHScontractswithprepaidhealth
plans,healthmaintenanceorganizations,andprimarycarecasemanagement
systemtogivecoveredMEDI-CALservicestoMEDI-CALbeneficiaries.MEDI­
CALbeneficiarieswhoenrollinaplanareguaranteedaccesstoafullrangeof
qualityhealthcare,includingpreventivemedicalservices.
4.HOMEANDCOMMUNITY-BASEDCARESERVICES–Healthcareservicesthat
cansometimebegivenathometopersonswhousuallywouldneedtostayin
ahospitalornursinghome.Theseservicesareonlyavailabletocertainpeople
gettingMEDI-CALwhomeetspecialrequirements.Askyoudoctororhospital
dischargeplannertocontactthelocalMEDI-CALFieldOfficeifyouthinkyou
mightneedtheseservices.
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5.INPATIENTHOSPITALCARE–Careyougetwhenyouareadmittedto
ahospital.InsomeareasoftheState,youcanonlygetinpatientcareat
hospitalscontractingwiththeState.Ifyouneedcare,youshouldcontact
yourdoctor,andifnecessary,yourdoctorwillmakearrangementsfor
hospitalization.Inalife-threateningemergency,orifyouareapregnant
womaninactivelabor,anyhospitalcangiveyoucare.
6.LINKAGE–Personswhomeetthefederaldefinitionofage(65yearsor
older),blindness,ordisability,orparentsandtheirchildrenwhoaredeprived
ofparentalsupportorcareareconsidered“linked”(orconnected)tooneof
thesecategories.
7.MAINTENANCENEED–TheamountofmonthlyincomeMEDI-CALhas
determinedthatapersonorfamilyneedforfood,clothing,housing,etc.The
amountwillchangewiththenumberofpeopleinthefamily.
8.MEDI-CAL–California’snameforMedicaid,thefederalandstateprogram
ofmedicalassistanceforneedyandlow-incomepersons.
9.MEDICARE–Afederalhealthinsuranceprogramadministratedbythe
SocialSecurityAdministrationwhichisavailableregardlessofincome.
Mostpersons65yearsofageorolderandcertaindisabledorblindpersons
regardlessofage,arecovered.MedicarePartAcovershospitalization.
MedicarePartBcoversdoctorbills.BeginningJanuary1,2006,Medicare
PartD(notMEDI-CAL)coversmostprescribeddrugs.AMedicarecardisred,
white,&andblue.
BUY-IN–Ifyouareaged,blind,disabled,gettingTitleIISocialSecurity
paymentsorRailroadRetirementdisabilitybenefits,ordialysis-related
healthcareservices,youmustapplyforMedicareattheSocialSecurity
officeinordertoqualifyforMEDI-CAL.IfyouqualifyforbothMedicare
andMEDI-CAL,MEDI-CALwillpayyourmonthlyMedicarePartBinsurance
premiumsandMEDI-CALmaypayyourmonthlyPartAinsurance
premiums.PleasetellyourdoctoryouhavebothMedicareandMEDI-CAL,
soyouwillnotbebilledfortheMedicareco-insurance.
10.OTHERHEALTHCARECOVERAGE–anyprivatehealthbenefitplanor
healthinsurancecoverage(whetherindividualorthroughaunion,group,
employer,ororganization)underwhichpaymentcanbemadeforhealth
careservicesprovidedtothepersonscoveredbythatpolicyorplan.
11.PERSONALPROPERTY–Allliquidandnon-liquidassets(otherthanreal
property)suchascash,savingsaccounts,checkingaccounts,stocks,bonds
jewelry,boats,lifeinsurancepolicies,recreationalvehicles,etc.
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12.PROPERTYRESERVE–Thetotalnetmarketvalueofcountableproperty
assetsofthosepersonsapplyingforMEDI-CAL.
13.REALPROPERTY–Landandimprovementswhichgenerallyinclude
anyimmovablepropertyattachedtothelandandanyoil,mineral,timber
orotherrightrelatedtotheland.
14.SHAREOFCOST(SOC)–Theamountyoumustpayorpromisetopay
eachmonthtowardthecostofyourhealthcarebeforeMEDI-CALwillpay.
YourSOCmaychangewhenyourmonthlyincomechanges.Youonlypaya
SOCinamonthwhenyougethealthcareservices.ASOCisnotamonthly
chargethatyoumustpaywhetherornotyouhavemedicalbills.
15.VERIFICATION–Acceptableevidence(documents)whichgivesproofof
statementsmadebyanapplicant/beneficiary.
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Butte County
State of California
Health and Human Services Agency Department of Employment and
Social Services
COUNTY SOCIAL SERVICES AGENCIES
Departamentos de Bienestar de los Condados 78 Table Mountain Blvd., Oroville
(530) 538-7711
Please contact your nearest County Social
2445 Carmichael Dr., Chico
Services Office for complete MEDI-CAL Eligibility
(530) 879-3479
information or other health-related services.
Mailing address:
Please verify the location and phone number
P.O. Box 1649
in your telephone book or at www.dhs.ca.gov/
mcs/medi-calhome/default.htm. Some county
Oroville, CA 95965
web sites may provide additional health-related
www.buttecounty.net/dess/Medical_
information.
Services.html
Por favor póngase en contacto con la
oficina del Departamento de Bienestar del
Condado más cercana a usted para obtener
la información completa sobre la Elegibilidad
de MEDI-CAL u otros servicios relacionados
a la salud. Por favor verifique la dirección y
el teléfono en su guía telefónico o en www.
dhs.ca.gov/mcs/medi-calhome/default.
htm. Algunos de los sitios web del condado
pueden darle más información sobre servicios
relacionados a la salud.
Alameda County
Health and Human Services
8477 Enterprise Way
Oakland, CA 94621
(510) 383-8523
Calaveras County
Calaveras Works and Human Services
509 East Saint Charles Street
San Andreas, CA 95249-9701
(209) 754-6444
www.co.calaveras.ca.us/departments/
welfare.asp
Colusa County
Department of Health and Human
Services
251 East Webster Street
Colusa, CA 95932
(530) 458-0250
www.alamedasocialservices.org/public/ No county website available
services/medical_care/
Contra Costa County
Employment and Human Service
1275A Hall Avenue
Richmond, 94804
(866) 663-3225
Alpine County
Department of Social Services
75A Diamond Valley Rd.
Markleeville, CA 96120
(530) 694-2235
www.cchealth.org
www.co.alpine.ca.us/dept/health/
ssmedical.html
Del Norte County
Department of Social Services
880 Northcrest Drive
Crescent City, CA 95531-3485
(707) 464-3191
Amador County
Department of Social Services
1003 Broadway
Jackson, CA 95642
(209) 223-6550
www.co.amador.ca.us/depts/social/
index.htm
www.co.del-norte.ca.us:82/cf/topic/
topic4.cfm?Topic=Social%20Services&
SiteLink=200012.html
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El Dorado County
Department of Human Service
3057 Briw Road
Placerville, CA 95667-1637
(530) 642-7300 Imperial County
Department of Social Services
2995 South Fourth Street, Suite 105
El Centro, CA 92243
(760) 337-6800
www.co.el-dorado.ca.us/
socialservices/
www.imperialcounty.net/
socialservices/
Fresno County
Department of Employment & Temporary Assistance
Call for nearest office (area code 559)
Regional Offices Heritage Center, Fresno 453-3544 or 453-4934 University Med Center 453-6447 Coalinga Regional Center 935-6300
Selma Regional Center 898-5100
Reedley Regional Center 637-7580 Inyo County
Department of Social Services
912 N. Main Street
Bishop, CA 93514
(760) 872-1394 www.fresnohumanservices.org/
MedicalCare.htm
www.inyocounty.us/Admin/vision_
statement.htm
Kern County
Department of Human Services
100 E. California Avenue
Bakersfield, CA 93307
(661) 631-6807
www.co.kern.ca.us/dhs/
Glenn County
Human Resources Agency
P.O. Box 611
420 East Laurel Street
Willows, CA 95988-0611
(530) 934-6514
Kings County
Human Services Agency
1200 South Drive
Hanford, CA 93230
(559) 582-3241
www.hra.co.glenn.ca.us/
www.co.kings.ca.us/HSA/best.htm
Humboldt County
Department of Health and Human Services Social Services 929 Koster Street
Eureka, CA 95501
(707) 269-3590
(800) 891-8851 (Limited Service Area)
Lake County
Department of Social Services
15975 Anderson Ranch Parkway
P.O. Box 9000
Lower Lake, CA 95457-9000
(707) 995-4200 www.co.humboldt.ca.us/portal/
health.asp
Lassen County
Lassen WORKS
Roosevelt Annex
720 Richmond Road
Susanville, CA 96130
(530) 251-8152
www.dss.co.lake.ca.us/
www.co.lassen.ca.us/welfare_mission.htm
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County of Los Angeles
Dept. of Public Social Services
(Apply at the nearest District office.
Refer to the White Pages under
COUNTY GOVERNMENT of your
phone book)
(877) 597-4777 Toll Free (Limited
Service Area)
(213) 639-6300 Merced County
Human Services Agency
2115 West Wardrobe Avenue
P.O. Box 112
Merced, CA 95341-0112
(209) 385-3000 ext. 5155
www.co.merced.ca.us/countyweb/
Modoc County
Department of Social Services
120 North Main Street
Alturas , CA 96101
(530) 233-6501
www.ladpss.org/
Madera County
Department of Social Services,
Eligibility
720 East Yosemite Avenue
P.O. Box 569
Madera, CA 93639
(559) 675-2300
www.modoccounty.us/
www.madera-county.com/
socialservices/
Marin County
Dept Health & Human Services (Public Assistance)
120 North Redwood Drive-West Wing
San Rafael, CA 94903
(415) 473-3400
www.co.marin.ca.us/depts/HH/main/
ss/public.cfm
Mariposa County
Department of Human Services
5186 Highway 49 North
Mariposa, CA 95338
Toll-free (800) 266-3609
(209) 966-3609
www.mariposacounty.org/
Mendocino County
Department of Social Services
737 South State Street
P.O. Box 8508
Ukiah, CA 95482
(707) 463-7700
Mono County
Department of Social Services
85 Emigrant Street
P.O. Box 576
Bridgeport, CA 93517
(760) 932-5600
www.monocounty.ca.gov/
departments.html
Monterey County
Department of Social Services
100 South Main Street- Suite 216
Salinas, CA 93902
(831) 755-8500
(831) 755-4650 www.co.monterey.ca.us/dss/
benefits/medi-cal.html
Napa County
Department of Social Services
2261 Elm Street
Napa, CA 94559
(707) 253-4511
Toll-free: (800) 464-4214 www.co.napa.ca.us/GOV/
Departments/DeptPage.
asp?DID=50100&LID=939
www.mcdss.org
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Nevada County
Human Services Agency
950 Maidu Avenue
P.O. Box 1210
Nevada City, CA 95959
(530) 265-1340
Toll Free: (888) 809-1340
www.mynevadacounty.com
Orange County
Social Services Agency (Call for nearest district office) Anaheim (714) 575-2400
Santa Ana (714) 435-5900
Laguna Hills (949) 587-8543
Garden Grove(714)741-7100 www.ssa.ocgov.com/Agency_
Services/Adult_Services_and_
Assistance_Programs/default.asp
Placer County
Health and Human Services
11519 B Avenue
Auburn, CA 95603
(530) 889-7610 Roseville Office (916) 784-6000
North Lake Tahoe (530) 546-1900 www.placer.ca.gov/welfare/welfare.
htm
Plumas County
Dept of Social Services
270 County Hospital Rd, Suite 207
Quincy, CA 95971
(530) 283-6350
www.countyofplumas.com/
Riverside County
Department of Public Social Services
(Call for nearest office)
(951) 358-3000 Mail only:
731 Palmyrita Avenue
Riverside, CA 92507
dpss.co.riverside.ca.us/
Sacramento County
Department of Human Assistance
2433 Marconi Ave
Sacramento, CA 95821-4807
(916) 874-2072
dhaweb.saccounty.net/Services/
Medical_Assistance/index.html
San Benito County
Human Services Agency
1111 San Felipe Rd, Ste 206
Hollister, CA 95023-3801
(831) 636-4180
www.sanbenitohhsa.org
San Bernardino County
Human Services System
Transitional Assistance Department
(Call for nearest district office)
(909) 388-0245
www.hss.co.san-bernardino.ca.us/HSS/
San Diego County
Dept of Health & Human Srvs Agency
(Call for the nearest district Office)
(858) 514-6885 www2.sdcounty.ca.gov/hhsa/
ServiceDetails.asp?ServiceID=680
City & County of San Francisco
Dept of Human Services
1440 Harrison Street
San Francisco, CA 94120
(415) 863-9892
www.sfgov.org/site/dhs_page.
asp?id=12885
San Joaquin County
Human Services Agency
333 E. Washington Street
Stockton, CA 95202
(209) 468-1000 www.co.san-joaquin.ca.us/hsa/MediCal/index.htm
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San Luis Obispo County
Department of Social Services
3433 S. Higuera Street
San Luis Obispo, CA 93403
(805) 781-1600
Shasta County
Department of Social Services
2460 Breslauer Way
P.O, Box 496005
Redding, CA 96001
(530) 225-5767 www.slodss.org
www.co.shasta.ca.us/Departments/
Social Services/TemporaryAssistance/
tempasst.shtml
San Mateo County
Human Services Agency
400 Harbor Boulevard, Building “C”
Belmont, CA 94002
(650) 802-7570
Sierra County
Social Services
202 Front Street
P.O. Box 1019
Loyalton, CA 96118
(530) 993-6720
Downieville Office (530) 289-3711
www.smchsa.org/smc/department/
home/ 0,,15587275_18158401_
19643107,00.html
Santa Barbara County
Department of Social Services
234 Camino Del Remedio
Santa Barbara, CA 93110
(805) 681-4401 www.sierracounty.ws/mod.php?mod
=userpage&menu=1704&page_id=15
www.countyofsb.org/social_services/
Santa Clara County
Social Services Agency
(Call for nearest district office)
(408) 271-5600
www.sccgov.org/site/
0,4760,sid=136775,00.html
Santa Cruz County
Health Services Agency
1020 Emeline Street
Santa Cruz, CA 95060
(831) 454-4134
Watsonville Office (831) 763-8500
www.santacruzhealth.org/admnstr/
2benefits.htm
Siskiyou County
Human Services
North County Office:
818 S. Main Street Yreka, CA 96097
(530) 841-2700 South County Office:
293 Main Street, Suite B
Weed, CA 96094
(530) 938-5100 www.co.siskiyou.ca.us/humsvc/etas.
htm
Solano County Health and Social Services
275 Beck Avenue
Fairfield, CA 94533 Toll Free: (800) 400-6001
www.co.solano.ca.us/
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Sonoma County
Human Services Department
2550 Paulin Drive
P.O. Box 1539
Santa Rosa, CA 95402-1539
(707) 565-5200
Toll Free: (800) 354-1277
www.sonoma-county.org/human/
med
Tulare County
Health & Human Services Agency
(Call for nearest Office)
In-Take Office
Dinuba (559) 591-5804
Lindsey (559) 562-1377
Porterville (559) 782-4750
Tulare (559) 685-2600
Visalia (559) 733-6111
Stanislaus County
Community Services Agency
251 East Hackett Road
P.O. Box 42 (95353)
Modesto, CA 95355
(209) 558-2777
Tuolumne County Department of Social Services
20075 Cedar Road North
Sonora, CA 95370
(209) 533-5711
www.co.tulare.ca.us/
www.stanworks.com/index.htm
www.tuolumnecounty.ca.gov
Sutter County
Department of Human Services
Welfare Social Services Division
190 Garden Highway
P.O. Box 1535
Yuba City, CA 95992-1535
(530) 822-7230
Ventura County
Human Services Agency
505 Poli Street Ventura, CA 93001
(805) 652-7693
Regional Offices:
Oxnard (805) 385-8654
Ventura (805) 658-4100
Santa Paula (805) 933-8300
Simi Valley (805) 584-4842
www.co.sutter.ca.us/index.
aspx?doc=/depts/hs/wss/wss.xml
Tehama County
Department of Social Services
22840 Antelope Blvd.
PO Box 1515
Red Bluff, CA 96080
(530) 527-1911
www.tcdss.org
Trinity County
Dept of Health and Human Services
#1 Industrial Parkway
Weaverville, CA 96093-1470
(530) 623-1265
Toll Free: (800) 851-5658
www.vchsa.org
Yolo County
Dept of Employment & Social Services
25 N. Cottonwood Street
Woodland, CA 95695
(530) 661-2750
West Sacramento Office
500-A Jefferson Blvd.
West Sacramento, CA 95605
(916) 375-6200 www.yolocounty.org/org/dess/
program/medical.htm
www.trinitycounty.org/
Departments/HHS/hhsinfo.htm
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Yuba County
Human Services Agency
6000 Linhurst Avenue, No. 504
P.O. Box 2320
Marysville, CA 95901-9987
(530) 749-6311
www.co.yuba.ca.us/content/
departments/hhsd/
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PUB 68 – NOV 2005
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