Article 3 Section 1 County of Responsibility Table of Contents TITLE MPG CITE Overview 030101 Family Composition Persons With a Family Persons Without a Family 030102 OutofHome Placement Public AgencyGovernment Representative Private AgencyState Employed Person Persons Placed in State Hospitals Placement in Long Term Care after Release from a State Hospital LongTerm Care IncompetentIncapacitated Individuals 030103 General Situations Public Assistance Deceased Persons Persons Absent from the State Courtesy Applications Persons Under 21 Years of Age 030104 030101County of Responsibility A Overview The procedures contained in this section are administrative guidelines provided by the Department of Health Care Services DHCS to county staff to process MediCal applications and to ensure that benefits and services remain accessible to applicants beneficiaries and representatives acting on behalf of the applicantsbeneficiaries The objective of these procedures is to provide counties with information to administer the MediCal program in a coordinated and efficient manner within the state and grant benefits promptly MEM PROC 3B In resolving County of Responsibility issues staff shall consider criteria such as The age of the applicantbeneficiary and hisher representative The physical and mental condition of the applicantbeneficiary The travel distance of the applicantbeneficiary and hisher representative The possible delay in the processing of the application and eligibility determination that may create an undue hardship for the applicantbeneficiary andor hisher representative 030102 Family Composition A Persons with a Family B Persons without a Family For individuals whose eligibility is determined as part of a family or MEM PROC 3C based on family income the County of Responsibility is one of the following The county of physical presence if the familys residence is unclear or The county in which the familys principal residence is located Example An individual is involved in an automobile accident and hospitalized in County A The individual is expected to remain hospitalized for less than 30 days The individual has an intact family consisting of a spouse and two children living in County B The County of Responsibility shall be County B For individuals in Long Term Care that have a public guardianconservator or are incompetent the County of Responsibility is determined in accordance with MPG 030103 Items D and E For persons whose eligibility is not determined as part of a family nor based on family income the County of Responsibility is the county where the person lives and maintains residence Example The Joneses have a home in County A Mr and Mrs Jones decide to end their marriage Mr Jones lives in County B and Mrs Jones and the children remain in the home in County A County A is responsible for Mrs Jones and the children County B is responsible for Mr Jones because Mr and Mrs Jones are no longer living together In this situation there is no marital tie and Mr Jones income is not used to determine Mrs Jones or the childrens share of cost When a persons residence or identification is unclear the County of Responsibility is determined by the physical presence of the individual The person shall be treated as a person without a family 030103 OutofHome Placement A A government representative is an employee of an administrative Public Agency agency of a local state or federal government The employee may be Government Representative a public guardianconservator or social worker who has placement responsibility of the person If Then the County ofResponsibility is where the a person is placed by a government agencyrepresentative into a foster care home board and care home or a facility placement agency is located if the public agency is the appointed guardian conservator of the person the county where the foster care home board and care home or a treatment facility is located accepts a transfer of guardianship conservatorship beneficiary is living The County of Responsibility remains with the placement county until the county agencies work out the transfer jurisdiction agreement B Private AgencyState Employed Person When a person is placed into a board and care home group home or treatment facility by a guardian person employed by a private agency or the state to act as guardianconservator for the person The County of Responsibility shall be where the board and care home or treatment facility is located unless a persons eligibility is based on the familys income or is determined as member of an MFBU which includes the family C Persons Placed in State Hospitals Persons placed in state hospitals by a county mental health agency or a Regional Center for the developmentally disabled shall have their MediCal eligibility determined by the county in which the state hospital is located unless the persons eligibility is determined as part of a family or based on family income In this case the County of Responsibility is determined in accordance with MPG 030102 item A D Persons released from a state hospital and placed in a longterm care Placement in facility will have their MediCal eligibility determined by the county in LongTerm which the longterm care facility is located with the following Care after exceptions Release from a State Hospital If Then the persons has a public guardian or conservator in the county that originally placed the person into the state hospital that county remains the County of Responsibility unless the county in which the longterm care facility is located agrees to accept guardianship or conservatorship of the person The persons eligibility is determined as part of a family or based upon family income the County of Responsibility is determined in accordance with MPG 030102 item A E LongTermCare IncompetentIncapacitated Individuals If the applicantbeneficiarys community spouse family member or representative lives in another county within the State of California staff is expected to work with the applicantbeneficiary or hisher representative to expedite the applicationredetermination process Assistance for the applicantbeneficiary andor hisher representative shall include but not limited to Reviewing the Statement of Facts Gathering Information Determining eligibility Issuing benefits Refer to Article 4 Section 2 for procedures dealing with Authorized Representatives and Representatives for incompetent individuals key persons The county where the community spouse or applicantbeneficiarys representative resides shall be the County of Responsibility The responsible county is not determined by the county residencelocation of the Authorized Representative appointed by a competent community spouse responsible relative or other knowledgeable representative If Then a noninstitutionalized community spouse resides and maintains a County A shall home in County A and heshe applies in County A for the incompetent institutionalized spouse who is in an LTC facility in County B accept the application assist the community spouse in gathering information determine eligibility for the institutionalized spouse County A where the noninstitutionalized community spouse lives shall retain the case for continued eligibility since the institutionalized spouse is unable to provide information the individual is in a hospital in County A and is being released to an LTC facility in County A The individual is incompetent and unable to apply for MediCal on hisher own The individuals adult child who lives in County B applies for benefits in County B on behalf of the LTC parent County B shall accept and process the application assist the adult child in gathering information determine eligibility for the individual in LTC County B shall retain the case because the adult child is the beneficiarys representative acting on the beneficiarys behalf for continued eligibility in reporting changes the individual is in a hospital in County A and is being released to an LTC facility in County A The individual is competent but incapacitated The individuals adult child who lives in County B applies for benefits in County B on behalf of the LTC parent County B shall accept the application contact County A and forward the application information to County A County A shall accept and process the application assist the LTC applicant in gathering information determine eligibility for the individual in LTC 030104 General Situations A For people eligible for MediCal under CalWORKs or SSISSP the Public County of Responsibility is established by the regulations of the specific Assistance public assistance program B Deceased Persons The County of Responsibility for a deceased person is the county where the person was living at the time of death Example A person was admitted to a hospital in County A to receive emergency medical treatment The person died in the hospital The person was living in County B at the time of death County B is the county responsible for taking the application determining eligibility and issuing benefits for the deceased person If the deceased persons family or representative applies in any county within the state the county in which the applicants representative applies in shall accept the application and process the application under the courtesy application procedures C Persons who are absent from the state but retain California Persons Absent residence in accordance with MPG Article 7 Section 5 have their from the State MediCal eligibility determined by the county which would have been the County of Responsibility prior to the persons absence from the state D Courtesy Application A courtesy application is an application made in a county other than the County of Responsibility The county in which an applicant or hisher representative applies for benefits is the county responsible for making the initial eligibility determination even if it is not the applicants county of residence The county in which the individual or hisher representative applies must accept and process the application If all of the information required for making the eligibility determination is available the county shall Step Action 1 Review application for completion If Then complete complete Step 2 and 3 incomplete complete Step 4 2 Issue benefits promptly before the case information and verifications are transferred to the beneficiarys residence county the County of Responsibility 3 Follow the procedures outlined in Article 3 Section 2 to process an Intercounty Transfer via an eICT 4 Forward the application and all information collected within 15 days from the date of application to the County of Responsibility for followup and completion of the initial eligibility determination E Persons Under 21 Years of Age Example An individual lives in County A and becomes ill in County B The individual is immediately admitted to a hospital in County B County B has an outstationed eligibility worker at the hospital who receives a MediCal referral from the hospital staff The individual with the workers assistance can complete the Application SAWS1 Statement of Facts MC 210 and provide County B with the sufficient information to determine initial eligibility County B shall grant the individuals benefits before transferring the continued eligibility case responsibility to County A the beneficiarys county of residence When determining the County of Responsibility for a person under 21 years of age parental control and the persons tax dependent status shall be evaluated Parental control for the purposes of determining the County of Responsibility is the authority of the parents to make decision on the childs behalf whether or not the control is actually exercised A child who is away at school but returns home on some weekends holidays or vacations and is subject to parental control is considered temporarily absent from the parents household regardless of the duration of the absence When Then a person who is under age 21 is living away from home and claimed by hisher parents as the County of Responsibility is where the claiming parents live except for Minor Consent dependent for tax purposes applications if the parents live in the State a person is between age 18 and the County of Responsibility is 21 living in California but hisher where the child lives but the parents who claim the child as a parents must complete the MC tax dependent live outofstate 210 provide the county with informationverification and cooperate with county staff in the childs eligibility determination process The county where the child is physically present shall contact the childs parents and ask the parents to complete the application and grant benefits to the child if eligibility conditions are met The applicant is under age 21 the application for MediCal living away from home and does shall be accepted in the county not have information on hisher where the applicant lives tax dependent status