The People's Guide

35th Edition 2013-2014

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The People's Guide 2013-2014 42 Medi-Cal 6. Provide needed papers • 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. 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 ways for 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 office for help if you are not contacted within 45 days about your Medi-Cal. If Medi-Cal says that you are not eligible, you can ap- peal 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 un- der Fee-for-Service or "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, child is found no longer eligible for Medi- Cal, as long as you turn in your paperwork every year. If DPSS determines that your child is not eligible for no-cost Medi-Cal, your child's accelerated enrollment will end on the last day of the month in which DPSS makes that decision. CHDP "Gateway" Children who receive a CHDP visit are screened for temporary eligibility for Medi-Cal. If a child is eligible, he/she is pre-enrolled in temporary, full-scope Medi- Cal at no cost for up to 60 days (for the month of the visit and the month after). See pg. 49 for a full description. 4. Deemed Eligibility for Infants Infants who were born to a woman on Medi-Cal at the time of birth should receive Medi-Cal ongoing until the age of one, regardless of any increase in income. At age one, an annual redetermination form must be filled out. However, you must contact DPSS when your baby is born or use a "Newborn Referral Form" to start the baby's benefits (see #11 "If you are pregnant", right column this page). For questions or problems with this, call MCH Access (213) 749-4261 or the Health Consumer Center (800) 896-3203. 5. Fill out and turn in the form You can get help filling out the application if you need help. The Medi-Cal office must provide translation and assist you if you have a disability that makes it hard for you to complete the application. If the worker needs more information, you will be given a list of what is needed and a deadline to mail back. A "return appointment" is not necessary. If you do not have all the necessary docu- ments, you or someone you know may sign a statement explaining why not. You may be able to receive benefits while you con- tinue to gather the required information. The eligibility worker should help you get some of your missing papers. Give DPSS copies, not originals, of any documents. Make a copy of the application for yourself! Then hand in or mail in the form. Get a receipt if you hand in the form. If you mail the form it is a good idea to send it by certified mail.

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