Issue link: https://digital.copcomm.com/i/398224
45 The People's Guide 2013-2014 Medi-Cal 9. If You Move If you move within California you should have no interruption of Medi-Cal eligibility. Be sure to report your change of address to your eligibility worker. Keep using your Medi-Cal card. If you move to a new county, report the change if you can to DPSS and also to the welfare office in the new county. The counties should manage the transfer of your case. If you move to another county you may also have to change your managed care plan. To change your plan call Health Care Options at 1-800-430-4263. 10. If You Were Billed Twice The doctor or health service provider cannot bill both you and Medi-Cal for the same care. If you think your doctor has billed you unfairly, you should contact the Health Consumer Center at (800) 896-3203 or Legal Aid. 11. Lost or Stolen Cards Notify your worker and a replacement card will be sent to you. If there is a medical emergency, you may receive a written notice of eligibility at your welfare office. HOW DO I CHOOSE MY CARE? There are two ways to receive your medical care under Medi-Cal: • "Fee for service" (regular Medi-Cal), • or Managed Care (Health Plan). These are also called HMOs (Health Main- tenance Organizations). Most Medi-Cal participants must enroll in a Health Plan. Medi-Cal recipients who may, but do not have to, enroll in an Health Plan include: • Children in foster care or the Adoption Assistance Program • People who get health care from an Indian Health Service Program. • In January, 2014, people with both Medi-Cal and Medi-Care in Los Ange- les County (and some other counties) will have to enroll in a Managed Care Health Plan for their Medi-Cal. They can choose to enroll in a health plan for their Medicare or not. Medi-Cal recipients who cannot enroll in a Medi-Cal Managed Care Health Plan • People who get Medi-Cal only for emer- gency and pregnancy related services (restricted Medi-Cal) 3. 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 house 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. 4. 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 the Health Consumer Center at (800) 896- 3203 or Legal Aid for help and advice. 5. 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 QR-7 for cash aid, but on a different form. Income Limit for Transitional Medi-Cal # in Family Gross Income Limit 1 $1,772 2 $2,392 3 $2,3011 4 $3,631 5 $4,251 6 $4,871 7 $5,491 8 $6,111 9 $6,731 (Accurate as of 2013) 6. Four Month Continuing Medi-Cal If you lose CalWORKs or Section 1931(b) because you start getting more child or spousal support, an adult can get free Continuing Medi-Cal, regardless of income, but just for four months. It is important that you turn in a QR-7 or any other change reporting form explaining why you are leaving CalWORKs or Section 1931(b), to help make sure you get Transitional or Continuing Medi-Cal. The children's free Medi-Cal continues until their next scheduled annual redetermination. 7. 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. 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. 8. 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. The notice explains the action and your right to ask for a fair hearing. (See pg. 66 Hearings and Complaints). If a change occurs affecting your Medi-Cal eligibility, DPSS must determine whether 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 they already have 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 the form. If you do not send in a completed form, DPSS will send you a written notice of action that you will lose 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 cuts your benefits. If you send in your form within 30 days of being cut from Medi-Cal, and that infor- mation show you were still eligible, DPSS must restore Medi-Cal benefits without making you reapply.