H. CATEGORICALLY ELGIBLE MEDI-CAL

 

 

Policy

An assessment of San Diego County’s Medi-Cal case management process was conducted in order to evaluate the efficiency of the current process and to provide options to increase productivity.  As a result of this assessment, it was recommended that categorically eligible (CE) cases could be handled more efficiently by assigning responsibility for them to the associated CalWORKs Human Services Specialist (HSS).    

 

 

Definition of

Categorically Eligible

Medi-Cal

 

When some persons in the household are receiving CalWORKs, the remaining family members, who are ineligible for CalWORKs or choose not to receive CalWORKs, are considered to be eligible for 1931 (b) Medi-Cal without a separate determination, as long as there is AFDC deprivation.

 

 

Categorically Eligible Aid Codes

CE Medi-Cal cases have several aid codes:

 

·  3N (1931B Full Scope)

·   3V (illegal non-citizen Limited Scope)

 

Intake Responsibility and CE

Criteria

 

CalWORKs intake HSS’s are responsible for processing new applications for CE Medi-Cal applicants, in conjunction with a CalWORKs application, if the applicant meets the following criteria:

 

·       CalWORKs ineligibility is due to a non-financial reason such as undocumented non-citizen, felon, Welfare-to-Work sanctioned or those that have reached their CalWORKs time limit;

 

·       Deprivation (absent parent, death, incapacity, and unemployment) exists for a child in the assistance unit (AU);

 

·       Medi-Cal benefits are requested; and

 

·       Other family members are eligible for CalWORKs.

 

 

CalWORKs Granted Responsibility

CalWORKs granted HSS’s are responsible for processing CE Medi-Cal applications when there is an active CalWORKs case and a parent and/or sibling is ineligible to CalWORKs due to a non-financial reasons and:

 

·       A CalWORKs parent and/or sibling, who has requested Medi-Cal with the original CalWORKs application, now requests CE Medi-Cal benefits; or 

 

·       There is an addition to the CalWORKs household of a linked parent and/or sibling, and they request Medi-Cal only benefits.

 

 

CalWORKs Granted (38) Conversion

When the granted CalWORKs HSS discontinues an individual from the CalWORKs AU (i.e. sanctioned adult), a 38 FBU will auto generate for that individual.