Issue link: http://digital.copcomm.com/i/431369
The People's Guide 2015 44 Medi-Cal 2. Reporting Changes for Adults Adults must report to DPSS any significant changes that may affect their eligibility within 10 days after the change. You must quickly report to your worker if you move, begin making more money (or less money), someone moves in or out of your home or you are pregnant. Even if you report a change that hurts your eligibility, you have important rights before the DPSS cuts your Medi-Cal. 3. Losing Welfare Does Not Mean That You Lose Medi-Cal If you leave CalWorks due to a sanction, time limit, or make too much money, you do not lose Medi-Cal. If you lose your Medi-Cal after you leave welfare, contact your worker to find out how to get back on Medi-Cal. If you need further help, call the Health Consumer Center at (800) 896-3203 or Legal Aid for help and advice. 4. Transitional Medi-Cal (TMC) You might be eligible for up to one year of free (no Share of Cost) Medi-Cal (called Transitional Medi-Cal or TMC) if you lost CalWORKs or Section 1931(b) Medi-Cal because you started to work and are earn- ing too much money. if you are eligible, during the first six months of TMC you and your family qualify for free Medi-Cal no matter how much income you have. After that, you remain eligible for TMC if your income is not more than the limits in the chart on the next page. Adults and children can get TMC for up to one year. You can receive TMC more than once in your lifetime. If your income goes down you can qualify again for regular Medi-Cal. If it then goes up again you can return to TMC with new time limits. When children are no longer eligible for TMC they should be screened for the Medi- Cal Targeted Low-Income Health Program. There are no "resource" or property limits for TMC. TMC requires regular reports like a SAR-7 for cash aid, but on a different form. Income Limit for Transitional Medi-Cal # in Family Gross Income Limit 1 $1,800 2 $2,426 3 $3,051 4 $3,677 5 $4,303 6 $4,929 7 $5,555 (Accurate as of 2014) 5. Four Month Continuing Medi- Cal If an adult loses CalWORKs because he or she starts getting more child or spousal support, he or she can get free Continuing Medi-Cal, regardless of income, but just for four months. It is important that you turn in a change reporting form explaining why you are leaving CalWORK, to help make sure you get Transitional or Continuing Medi-Cal. The children's free Medi-Cal continues until their next scheduled annual redetermination. 6. Former Foster Children If you were in Foster Care on your 18th birthday, you may be automatically eligible for free Medi-Cal until you turn 26, even if your income goes up. To enroll, you can contact the Former Foster Care District at (626) 569-2968. If you lose Medi-Cal, call the Alliance for Children's Rights (213) 368-6010 or the Health Consumer Center at (800) 896-3203 for assistance. 7. Keep Medi-Cal until DPSS Proves You Are No Longer Eligible DPSS must send you a written Notice of Action at least 10 days before it cuts off, denies, delays or reduces your Medi- Cal benefits. (See pg. 66 Hearings and Complaints). If a change occurs that hurts your ability to get Medi-Cal, DPSS must determine if you are eligible for any other type of Medi- Cal, before sending you a notice of action cutting off your benefits. They have to look in your record for any missing necessary information. DPSS can send you a form that only asks for the information it needs; it cannot ask for information it already has or does not need to determine whether you are still eligible for Medi-Cal. DPSS must give you at least 20 days to complete and return the form. If you don't return the completed form, DPSS will send you a written notice of action that they will reduce or stop your Medi-Cal benefits. If your form is incomplete, DPSS must first try to contact you by telephone and writing to get missing information before it stops or reduces your benefits. If you send in your form within 30 days of being cut from Medi-Cal, and that information show you were still eligible, DPSS must restore Medi-Cal benefits without making you reapply. 2. Share of Cost if you are be- tween the ages of 19 and 65, not blind, not disabled To find out your monthly Share of Cost, start with your gross monthly income. Include spouse or parent income, but not other people living in your house. Then subtract the need level for your family size on the chart on page 40. The balance is your monthly Share of Cost. For more information contact Legal Aid (Pg. 68) 3. Share of Cost if you are over 65, blind or disabled To find out your monthly Share of Cost, start by adding your earned and unearned income, and subtract $20. Then subtract the need level amount for your family size in the chart on page 40.For more informa- tion contact Legal Aid (Pg. 68) Resource Limits The resource limit does not apply to people applying for a "MAGI" Medi-Cal program. For anyone else, your family's resources must be below the following limits to get Medi-Cal: # in Family Resource Limit 1 $2,000 2 $3,000 3 $3,150 4 $3,300 5 $3,450 6 $3,600 7 $3,750 8 $3,900 9 $4,050 10 or more $4,200 The home you live in, furnishings, personal items, and some non-term life insurance policies don't count. For "Non-MAGI" Medi-Cal, one car does not count. There are other exemptions if a vehicle is used as part of employment and for transporting a family member with a disability. Staying On Medi-Cal 1. Once a Year Eligibility Form People receiving Medi-Cal get a form in the mail every 12 months that needs to be completed to redetermine eligibility.