County of San Diego Health and Human Services Agency HHSA County Medical Services CMS Program Guide Program Overview Number Page 0101 1 of 2 BackgroundCounty Medical Services CMS is a program for indigent adults CMS is a program of last resort and only covers certain medical services and is not considered health insurance CMS does not pay insurance premiums deductibles or copayments CMS does not meet the Minimum Essential Coverage MEC required by the Affordable Care Act ACA CMS is the Countys safety net program covering adults who are NOT Determined linked to MediCal eligibility Enrolled in MediCal Enrolled in Medicare Enrolled in a Covered California Health Care Plan or in any health care plan that meets the MEC requirement under ACA San Diego County does not provide direct services Services are provided by primary care clinics local hospitals and physicians that contract with San Diego County to provide medical care Policy A Eligibility Categories CMS An individual who meets the CMS eligibility criteria and whose family income does not exceed 165 of the annually adjusted Federal Poverty Level FPL receives services at zero cost CMS Hardship An individual who meets the CMS eligibility criteria and whose family income is over 165 up to and including 350 FPL will be evaluated for CMS Hardship The individual may be required to meet a Share of Cost SOC obligation for each month they receive CMS services Refer to 0602 for income limits and 1303 for CMS Hardship evaluations B Grant of Lien Requirement As a condition of eligibility all CMS applicants are required to complete and sign the CMS Lien information form and CMS Grant of Lien form naming the County of San Diego as grantee to secure any and all real estate property of the applicant as security for repayment of all claims paid by CMS on their behalf The lien will be filed against any real property that is currently owned or real property that may be acquired in the future However the applicant does not need to sell their current principal residence to qualify Refer to 0606 for additional information regarding liens C Reimbursement Agreement Requirement Effective with applications dated on or after 712008 as a condition of eligibility CMS Hardship applicants are required to sign the CMS Reimbursement Agreement form This repayment document requires the CMS applicant to reimburse San Diego County via the Office of Revenue Recovery ORR for CMS services provided Refer to 0607 for additional information regarding repayment requirements and procedures Impact No impact to other programs References None County of San Diego Health and Human Services Agency HHSA County Medical Services CMS Program Guide Program Overview Number Page 0101 2 of 2 Release Date December 23 2014 Sunset Date This policy will be reviewed for continuance by January 1 2017