County of San Diego Health and Human Services Agency HHSAMediCal Program Guide Conditions of Eligibility Number Page 0401 1 of 3 Effective Date 812021 BackgroundMediCal applicants must meet several conditions of eligibility The eligibility and linkage factors to be evaluated are identified in this section Although there are no income limits for NonMAGI MediCal some applicable conditions of eligibility must be met before an application for MediCal can be approved while some must not delay approval Purpose This section provides a brief description of each condition of eligibility if the conditions must be met prior to granting and refers to the appropriate MPG sections in which the specific requirements for each condition are addressed This section was updated to note that verification of specific conditions of eligibility must not delay approval PolicyA Residence An applicant must be a California resident to be eligible for MediCal Refer to MPG Article 7 Section 5 for residence requirements B Citizenship United States US CitizenshipNational or legal resident status is not required for eligibility for MediCal benefits However the citizenshipimmigration status of the applicant determines the level of benefits full scope or restricted for which the applicant is potentially eligible depending on their age MPG Article 7 Sections 1 2 and 3 define US citizen and noncitizen categories and specify the level of benefits for which the customer is potentially eligible MPG Article 040713 contains guidance for the reasonable opportunity period to provide citizenship verification C Property Limits As a condition of eligibility for NonMAGI MediCal the total net nonexempt property of the applicants MediCal Family Budget Unit MFBU must not exceed the property limit established by the MediCal program MPG Article 9 specifies what property is included in the property reserve and assists the Human Services Specialist HSS with the determination of total net nonexempt property Factors to be considered include the evaluation of ownership availability spend down transfer or conversion of property D Social Security Number SSN All applicants who are eligible for full scope benefits are required to provide a SSN within 60 days of application as a condition of eligibility for MediCal MPG Article 4 Section 11 lists acceptable verification of SSNs and describes referral procedures when the applicant does not have or is unable to verify their SSN Do not delay approval of the application pending verification of the SSN if the customer is otherwise eligible County of San Diego Health and Human Services Agency HHSAMediCal Program Guide Conditions of Eligibility Number Page 0401 2 of 3 E Unconditionally Available Income UAI All applicants are required to apply for any UAI to which they appear eligible MPG Article 4 Section 12 defines UAI and describes application cooperation and verification requirements for applicants who must apply for such income Do not delay approval of the application pending verification of application for UAI if the customer is otherwise eligible F Linkage to Public Cash Assistance People who receive a cash grant in certain public assistance cash programs are automatically eligible for MediCal MPG Article 5 Section 1 identifies public assistance programs that automatically qualify recipients for MediCal benefits G Linkage AFDC ABD or MI Persons who have linkage to Aid to Families with Dependent Children AFDC Aged Blind or Disabled ABD or Medically Indigent MI are eligible for MediCal if all other conditions of eligibility are met MPG Article 5 Sections 2 3 and 5 define linkage to these programs These sections also provide eligibility and verification requirements for applicants who qualify under one or more of these categories H Institutional Status The determination of eligibility and the period of eligibility are affected by the institutional status of certain MediCal applicants MPG Article 6 clarifies situations in which the applicants MediCal eligibility is affected by their institutional status I Medical Support Referral Medically Needy Only MNO applicants requesting MediCal for a child born out of wedlock or with an absent parent must cooperate with the Department of Child Support Services DCSS by assigning and locating the absent parent and provide information about possible medical support and payments available through a third party Referral procedures are outlined in Article 4 Section 18 Applicants who refuse to cooperate with the Medical Support Enforcement Program without good cause will be ineligible members of the MFBU Do not delay approval of the application for completion of the support packet if the customer is otherwise eligible J Application for Medicare Customers must apply for Medicare if they have potential eligibility and have 60 days from the date they are informed of the requirement to apply to provide proof of approval or denial Allow good cause for the verification if the customer has not received a response from the Social Security Administration SSA Do not delay approval of the application pending verification of their application status More information about Medicare can be found in MPG Article 15 section 4 K Other Health Coverage Customers must supply Other Health Coverage OHC information at application and redetermination and report changes to the county within ten days Most OHC information is obtained and entered in the MediCal Eligibility Data System MEDS through data match see MPG 1501 for more information Do not delay approval pending OHC if the customer is otherwise eligible County of San Diego Health and Human Services Agency HHSAMediCal Program Guide Conditions of Eligibility Number Page 0401 3 of 3 L Veterans Information Customers who indicate that they are veterans must apply for veterans benefits through the Department of Veterans Affairs VA The referral process is in MPG article 4 section 12 Do not delay approval pending Veterans Information if the customer is otherwise eligible M Third Party Liability Customers who have a lawsuit due to accident or injury must provide third party liability information More information is in MPG 150301 Do not delay approval pending third party liability information if the customer is otherwise eligible Procedure Do not delay MediCal approval for verification of SSN OHC veterans information third party liability application for UAI Citizenship Satisfactory Immigration Status SIS and Medicare if the customer is otherwise eligible Follow up with the customer after granting requesting verifications using the redetermination timeframes and contact rules and allow 30 days for response 60 days for Medicare and SSN If there is no response discontinue only the individuals in the case that were required to provide and failed to comply References MEM 50074 50168a1 50175 50185 50186 50207 50404 50408a 50409 50141 ACWDL 9627 0712 1913 Sunset Date This policy will be reviewed for continuance on or by 8312024 Approval for Release Rick Wanne Director SelfSufficiency Services