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