County Medical Services Program Guide
Special Notices
2021
SN 21-03 - CMS 2021 FPL and MAE Increases
(Published: 6/8/2021)
SN 21-02 - Suspected Unemployment Insurance Fraud and Identity Theft Information
(Published: 2/12/2021)
2022
SN_22-02_-_CMS_2022_FPL_and_MAE_Increases
(Published: 6/3/2022)
SN 22-01 Earned Income Tax Credit Outreach
(Published: 3/1/2022)
Policy Inquiries
Chapters and Sections
Number
Document Title
Published
Article 01
Program Overview
Section 01 - Program Overview
12/23/2014
Section 02 - Scope of Services
10/1/2015
Section 03 - Access to Eligibility
10/1/2015
Section 04 - Administrative Responsibilities
10/1/2015
Section 05 - Definition of Acronyms and Terms
12/23/2014
Section 06 - Case Record Retention
10/1/2015
Section 07 - Contracted Hospitals-Primary Care Clinics-PCC
10/1/2015
Article 02
Application Process
Section 01 - Application Process
10/25/2016
Section 02 - Statement of Facts
4/4/2016
Section 03 - Face to Face Interviews
4/4/2016
Section 04 - Processing Mail-in Applications
11/27/2019
Section 05 - Linkage to MediCal
12/23/2014
Section 06 - Verification - Documentation Procedures
4/4/2016
Section 07 - Responsible Relatives
4/4/2016
Section 08 - Clinic Assignment
4/4/2016
Section 09 - Case Handling
4/4/2016
Section 10 - Approvals
4/4/2016
Section 11 - Denials
4/4/2016
Section 12 - Notification
4/4/2016
Section 13 - Applicant in Facility Outside San Diego County
4/4/2016
Section 14 - Other Required Forms
4/4/2016
Section 15 - CMS Patient Handbook and CMS Benefit Card
4/4/2016
Section 16 - Coverage Information
4/4/2016
Section 17 - Credit Check Authorization
4/4/2016
Section 18 - Reimbursement Agreements
4/4/2016
Section 19 - Image Verification Checklist
4/4/2016
Section 20 - CMS Card
4/4/2016
Section 21 - Patient Handbook
4/4/2016
Section 22 - Notice of Privacy Practices
4/4/2016
Section 23 - Responsible Relatives
4/4/2016
Article 03
Confidentiality
Section 01 - Confidentiality
5/3/2016
Section 02 - Release of Information
5/3/2016
Section 03 - Request for Information
5/3/2016
Section 04 - Inspection of Case Records
5/3/2016
Section 05 - Court Appearances-Subpoenas
5/3/2016
Article 04
Eligible Individuals
Section 01 - Eligible Adults
12/23/2014
Section 02 - Eligible Individuals
12/23/2014
Section 03 - Sneede and Gamma FBU
5/2/2016
Section 04 - Limited Medi-Cal
12/23/2014
Article 05
Non-Financial Eligibility
Section 01 - Identity
8/24/2011
Section 02 - Residence
8/24/2011
Section 03 - Citizenship
8/24/2011
Section 04 - Non-Citizens
11/14/2022
Section 05 - Social Security Number
8/24/2011
Section 06 - Institutional Status
8/24/2011
Article 06
Financial Eligibility
Section 01 - Financial Eligibility
9/9/2011
Section 02 - Maintenance Need Level
4/25/2016
Section 03 - CMS Family Budget Unit (CFBU)
8/24/2011
Section 04 -Property Reserves
8/24/2011
Section 05 - Share of Cost
8/24/2011
Section 06 - CMS Grant of Lien
8/14/2015
Section 07 - Reimbursement
4/4/2016
Section 08 - Questions and Answers
12/23/2014
Article 07
Other Coverage
Section 01 - Other Coverage
8/19/2015
Article 08
Certification Process
Section 01 - Certification
8/24/2011
Section 02 - Erroneous Certification
8/24/2011
Section 03 - Recertificaton
8/24/2011
Section 04 - General Relief Recipients
7/17/2013
Section 05 - Parents Denied CalWORKS or Medi-Cal For No Linkage
8/24/2011
Section 06 - Applicants Referred to Another Resource
8/24/2011
Section 07 - Retroactive Coverage
8/24/2011
Section 08 - Hospital Admission During the Certification Period
8/24/2011
Section 09 - Changes and Information Reported During The Certfication Period
7/17/2013
Article 09
Automation Instructions
Section 01 - CMS IT System
5/14/2013
Section 02 - IDX System
5/14/2013
Section 03 - Indicator and Program Recovery Alert Process
5/14/2013
Article 10
Quality Control
Section 01 - Policy
3/12/2012
Section 02 - Case Sample Selection
3/12/2012
Section 03 - Case Review Process
3/12/2012
Section 04 - Results and Required Responses
3/12/2012
Section 05 - Challenge Procedure
3/12/2012
Section 06 Report of Findings
3/12/2012
Article 11
CMS Fraud Referrals
Section 01 - Definition
8/24/2011
Section 02 - Policy
2/15/2012
Section 03 - Referral Procedures
8/24/2011
Section 04 - Investigations, Overpayment Procedures
8/24/2011
Article 12
County Administrative Hearing Process
Section 01 - Policy
11/18/2013
Section 02 - County Administrative Hearings
10/16/2014
Section 03 - Monitoring Compliance
11/18/2013
Section 04 - Filing Deadline
8/24/2011
Section 05 - Good Cause
9/6/2011
Article 13
Hardship
Section 01 - Hardship Overview
8/24/2011
Section 02 - Income Eligibility Criteria
8/24/2011
Section 03 CMS Hardship for Individuals Over 165 FPL
4/25/2016
Section 04 - Changes in SOC
8/24/2011
Article 14
Mail-in Recertifications
Section 01 - Mail-in Recertification Process
11/27/2019
Article 15
Discontinuance
Section 01 - Discontinuance
12/23/2014
