Article 13 Section 1 Period of Eligibility Table of Contents TITLE MPG CITE General 130101 Beginning Date of Eligibility 130102 Period of Eligibility 130103 Final Date of Eligibility 130104 Retroactive Eligibility 130105 130101 Period of Eligibility MEM A This article provides staff with guidelines for determining the period of General time to which a person is eligible for MediCal including retroactive eligibility regulations MPG LTR 76 1189 130102 Beginning Date of Eligibility A MediCal OnlyApplicants The beginning date of eligibility is either MEM The first day of the month of application if all eligibility requirements of the appropriate MediCal program are met any time during that month The first day of the month after the month of application during which the eligibility requirements of the appropriate MediCal programs are met MPG LTR 76 1189 MEM B Inmates of a public or private institution as defined in MPG Article 6 50273 Inmates of an Section 1 are ineligible to MediCal from the day they enter through Institution the day they leave the institution MPG LTR 434 101 C Qualified Medicare Beneficiary QMB For Medicare Part A recipients the effective date of eligibility for QMB MEM 50258 benefits is the first day of the month following the date on which the worker makes the determination of eligibility For those applicants who are required to enroll in Medicare Part A during the general enrollment period of January through March July 1 is the effective date of eligibility for QMB benefits MPG LTR 76 1189 D CalWORKs SSISSP andOther PA Applicants For the purposes of this section applicants include MEM 50509 People who apply for MediCal under any Public Assistance program People who apply for CalWORKs and meet eligibility requirements in the month of application but whose CalWORKs is denied because they no longer meet CalWORKs eligibility requirements at the time CalWORKs granting action would be taken People who apply for SSISSP and meet the eligibility requirements but are denied because they die before the SSI application can be processed An application for MediCal must be filed on their behalf within 30 days of receipt of written notice of denial The beginning date of eligibility is established once the applicant meets the following requirements Citizenshipalien status Residence Linkage Property and income requirements of the appropriate program Once these requirements are met the beginning date of eligibility is either The first day of the month of application if eligibility requirements have been met any time in that month The first day of the month in which the requirements were met MPG LTR 76 1189 130103 Period of Eligibility A MEM Once the beginning date of eligibility is established the period of Introduction eligibility is determined as shown in this section MPG LTR 434 101 B PeopleEligible as MI or MN Eligibility begins the date specified in MPG 130102A above and MEM 50195 continues through each successive month during which the beneficiary meets the basic program requirements detailed in MPG Article 5 and meets all of the following conditions Has cooperated in providing the County with Social Security and health insurance claim numbers Has cooperated in meeting general responsibilities detailed in MPG Article 4 for example completed forms provided documents necessary to determine SOC reported changes that affect eligibility cooperated with State QC investigations and reported and utilized other health coverage Has met the property requirements specified in MPG Article 9 at some time during the month Has met the citizenship residence and institutional status requirements as specified in MPG Articles 6 and 7 at some time during the month MPG LTR 434 101 MEM C Eligibility begins with the date specified in MPG 130102D above 50195 People and continues through each successive month in which the person is Eligible to determined to be eligible to CalWORKs or SSISSP CalWORKs or SSISSP MPG LTR 76 1189 D Other PA Recipients The period of eligibility for MediCal for people eligible as Other PA MEM 50195 recipients begins with the date specified in MPG 130102D above Eligibility continues through each successive month during which the person meets all eligibility requirements of the appropriate Other PA category Other PA recipients include People receiving Four Month Continuing MediCal after CalWORKs discontinuance Persons receiving TMC E Minor Consent Services People eligible to MediCal under the Twenty Percent Social Security Increase regulation Pickle eligibles as defined in MPG Article 5 Section 10 MPG LTR 76 1189 The period of eligibility for MediCal for a child applying for Minor MEM Consent services MPG Article 4 Section 4 begins with the date specified in MPG 130102A above and may continue through each successive month during with the child meets both of the following conditions The conditions specified in B above Submits a completed and signed form MC 4026 to the County during the month in question which states that the child has a need of services related to sexual assault drug or alcohol abuse pregnancy family planning or venereal disease MPG LTR 76 1189 MEM F The period of eligibility shall be modified for any portion of a month in 50273 Institutional which a person is ineligible due to institutional status as described in Status MPG Article 6 Section 1 MPG LTR 76 1189 130104 Final Date of Eligibility A MEM When the person or family no longer meets all eligibility requirements Final Date of aid for that person or family shall be discontinued in accordance with Eligibility regulations regarding timely and adequate notice of action See MPG Article 4 Section 17 MPG LTR 76 1189 130105 Retroactive Eligibility A Introduction Applicants may apply for MediCal for any of the three months immediately preceding the month of application or reapplication MEM 50197 Exception There are no retroactive benefits for QMB MPG LTR 76 1189 B EligibilityCriteria All of the following criteria must be met in the months for which MediMEM 50197 Cal is requested to establish eligibility to retroactive coverage The applicant received health services in the retroactive month The applicant was not previously denied MediCal in the month in question unless the applicant was denied due to County error The applicants failure to cooperate when that failure was due to circumstances beyond the control of the applicant Had the application been made the applicant would have been eligible for one of the following programs CalWORKs SSISSP Other PA MediCal Special Treatment Programs Miscellaneous Special Programs MN see D below for people applying on the basis of disability MI see exceptions in C below for people 21 years of age or older MPG LTR 76 1189 C Exception forPeople Age 21Years of Ageor Older Applicants 21 years of age or older shall be retroactively eligible as a MEM 50197 medically indigent person only if one of the following conditions exists The person was residing in a skilled nursing intermediate care facility during any part of both The month of application The month for which retroactive eligibility is requested The woman has confirmation that she was pregnant in the retroactive month MPG LTR 76 1189 D MEM Applicants shall follow the retroactive MediCal application process Application outlined in MPG Article 4 Section 2 The application shall be treated Process as any other application A person applying on the basis of disability shall have the beginning date of their disability determined by DDSD prior to the worker determining retroactive eligibility MPG Article 5 Section 3 Applicants meeting all other eligibility criteria shall be entitled to MediCal benefits for the retroactive application period effective the month in which the disability began as established by DDSD MPG LTR 76 1189