Issue link: http://digital.copcomm.com/i/431369
The People's Guide 2015 42 Medi-Cal If you do not cooperate with DCSS you are denied Medi-Cal, but your children do not lose coverage. Cooperation is not required if applying only for the children. Pregnant women do not have to give information to DCSS until after the birth of the baby. Under some circumstances you have good cause for not cooperating. For example: • You don't know where the absent parent is, or have no other information about the other parent • You are afraid of the absent parent, you or your children may be in danger, or you are a victim of domestic violence • Rape or incest has occurred • You are planning to place the child for adoption 8. Wait for Approval Normally, the Medi-Cal office will approve or deny your application within 45 days of receiving it, except for the faster processes for infants and children, described above. If the state must evaluate a disability, the approval or denial can be delayed up to 90 days. Call (877) 597-4777 or a legal aid of- fice for help if you are not contacted within 45 days about your Medi-Cal application. If Medi-Cal states that you are not eligible, you can appeal the denial of benefits (see pg. 66 Hearings and Complaints). 9. The Medi-Cal Card Once you have been "approved," your permanent white plastic Medi-Cal card is mailed to your address. It is called a "Benefits Identification Card" or BIC. Each person listed on your application will get one, even if they aren't eligible for Medi-Cal, because if the family must pay a monthly Share of Cost, the medical expenses of every person listed on the ap- plication can be used to meet the Share of Cost. If you don't get your plastic card by the end of the month, or if you lose your card, contact the Medi-Cal office. 10. Authorization for Service under "Regular" Medi-Cal When you are not in a health plan, before some medical services can be performed for you the state has to give an authoriza- tion for the service. This does NOT apply to emergency care, office visits, and most drugs. It is the job of the doctor, pharmacist, or other service provider, not the patient, to get this authorization from the state. However, if the state denies or changes the authorization, the state will notify you and your doctor. You can appeal any unreasonable delay, denial, reduction, or termination of care. (See pg. 66 "Hearings and Complaints") for information about grievances and complaints. 11. If You Are Pregnant Any pregnant woman can be "presumed eligible" at certain clinics and given limited pregnancy-related Medi-Cal immediately called "PE", without proving pregnancy or providing information on property, car, or resources. PE will help you get early prenatal care, lab tests and medication. You still have to apply for Medi-Cal if you want to continue your Medi-Cal benefits. Even to get full Medi-Cal you have 60 days to provide proof of pregnancy. When you apply for Medi-Cal during preg- nancy, you should add your spouse or any other eligible children to your case. If a woman is not more than 30 weeks pregnant and has too much income to be eligible for free Medi-Cal, she may be eli- gible for a program called Medical Acccess Program (MAP). MAP used to be called Access for Infants and Mothers (AIM). Call MAP at (800) 433-2611. As soon as the baby is born call your worker to report the name and birthdate to add the new baby to your family case record. The baby needs his or her own card by the end of the month after birth. But, you should not have to fill out a new Medi-Cal application for your baby. If you have trouble reaching your worker to tell the worker about the birth of your baby, some WIC offices and clinics have "Newborn Referral Forms" you can fax to DPSS. Or you can get one yourself on the computer at http://dhcs.ca.gov/formsandpubs/forms/ Forms/mc330.pdf and download the form called, "Newborn Referral". It is number MC 330. You don't have to provide a birth certificate or Social Security number until the baby's first birthday. If you take your baby to a CHDP provider, your baby can also get a card issued through the "CHDP Gateway"(see pg. 48 CHDP). 12. If You Are Disabled If you are disabled you may apply for regular Medi-Cal as an adult with income below 138% of the Federal Poverty Level. If you want to be evaluated for the Aged and Disabled Medi-Cal program you will need a disability determination. To find 6. Provide Documentation DPSS Medi-Cal offices are now able to electronically verify required information to determine if you can get Medi-Cal. If they are not able to verify some or all of the required information, then you will have to provide physical documentation to them. The following items are requred to determine if you are eligible. You may not have to show documentation of cars, property or bank accounts if you are under the age of 64. • Identification with your name and cur- rent address on it. If you lack ID, you can also fill out a form called "PA 853" and swear that you are who you say you are, or documents to verify income or disability status may also serve as proof of identity. • Social Security Number or Card (or proof of application for the card) only for those requesting "full-scope" benefits. • Proof of income (like check stubs, a copy of your tax return, or monthly bank statements if you have direct deposit or a self-affidavit (statement of income if you are paid in cash or do not have any other way to prove income) • Proof that you live in Los Angeles County (a document that has your name and an address on it) for each adult on the application. • Proof of citizenship or acceptable im- migration status for each person on the application who has declared acceptable immigration status. If you are a parent applying for children only, you do not need to submit proof of your immigration status. • Vehicle registration if ownership of more than one vehicle is declared. • Verification of child or dependent care, educational expenses and/or health insurance premiums or court ordered child support payments can be used as deductions, but are not needed to determine eligibility. 7. Cooperate with Child Support Services If one parent is absent, most people will have to cooperate with DPSS and a county agency called the Department of Child Support Services (DCSS.) You must provide information you have about the other parent such as an address or Social Security Number, to establish who your child's absent father or mother is and whether that parent can provide the child with medical insurance.