E. MEDI-CAL CARD ISSUANCE

 

Policy

 

Medi-Cal cards are issued either by the California Department of Health Services (CDHS) in Sacramento or by the County in the Family Resource Center (FRC).  This section describes when cards are issued directly by the CDHS from Sacramento, and the responsibilities and procedures for issuing cards in the FRCs. 

 

 

Medi-Cal

Cards

Issued by

CDHS

CDHS issues a plastic Medi-Cal Benefits Issuance Card (BIC) to each eligible person who is a Medi-Cal Family Budget Unit (MFBU) member of an active Medi-Cal case, an Assistance Unit (AU) member receiving cash-based Medi-Cal and when there is a share of cost (SOC) to any ineligible member (IE) or responsible relative (RR) in the MFBU who is any of the following:

 

·   SSI/SSP eligible as reported by the Social Security Administration (SSA); or

 

·   Certified eligible by the County:

 

1.      CalWORKs;

2.      Refugee Assistance;

3.      Foster Care; or

4.      Medi-Cal-only.

 

 

CDHS
Medi-Cal Card Issuances

The CDHS issues BICs on a daily basis. The BIC will be generated and mailed within 5-10 days when a Medi-Cal beneficiary, IE or RR is added to MEDS or when HHSA requests a replacement. A new BIC is not needed when the beneficiary moves between programs or was previously discontinued and reapplies. Computer instructions can be submitted to MEDS by:

 

·       On-line entries by the  MEDS Clerk; or

 

·       CalWIN entries by a Human Services Specialist (HSS).

 

  

Medi-Cal Cards Issued by FRCs

 

County-issued Medi-Cal Paper ID cards are used as minor consent ID and Immediate Needs cards. In San Diego County, these Medi-Cal cards are generated through the use of form 14-1 HHSA, Request for Medi-Cal Paper ID Card.  Providers can use this card to verify eligibility and bill for services for up to one year for minor consent services and 30 days for Immediate Needs. This eliminates the need to issue additional cards for any subsequent months, unless the card is lost, stolen or damaged.

 

A 14-1 HHSA must still be completed for each month in which the beneficiary’s ongoing eligibility must be established on MEDS. If the beneficiary has a valid Paper ID card, the HSS will note on the 14-1 HHSA, “No Card Needed” (“NCN”) under “Reason Issued” or check the “Activate Only” box on the top of the 14-1 HHSA.

 

 

Immediate Need
Medi-Cal Card

·       When a person claiming SSI/SSP eligibility requests a FRC issued Medi-Cal card, the clerical section is responsible for processing the request.

 

·       An immediate need Medi-Cal card will be issued to any person who has completed the application process, been determined eligible and who has one of the following immediate medical needs:

 

o        Pregnancy; or

 

o       A hospital or nursing home admission is planned within the next ten working days; or

 

o       A doctor, dentist, clinic or other medical appointment is scheduled or necessary within the next ten working days and the provider refuses treatment without the Medi-Cal ID card; or

 

o       A prescription must be filled within the next ten working days. 

 

   

 

 

County Issuance Procedures

Mail Delivery of Medi-Cal Paper ID Cards

 

Form 14-1 HHSA – clerical or eligibility staff, as appropriate will complete and submit from 14-1 HHSA using instructions printed on the reverse side of the form.  The form is then submitted to the Immediate Need Clerk to have the Medi-Cal card produced and mailed to the beneficiary.

 

Office Delivery of Medi-Cal Paper ID Cards

 

County produced Medi-Cal Paper ID cards issued in the FRC are to be delivered to the beneficiary by clerical personnel. The “MEDI-CAL PAPER ID CARD RECIEPT FORM” section of form 14-1 HHSA will be used for the applicant’s signature.

 

Verification of Identity

 

The person completing the card request form will explain to the beneficiary that the clerk delivering the Medi-Cal Paper ID card will need to verify the beneficiary’s identity.  Beneficiary acceptable I.D. for receiving a card includes, but is not limited to the following:

 

·       Driver’s license;

·       DMV Identification Card

·       Military I.D. Card;

·       Bureau of Citizen and Immigration Status (BCIS) I.D. Card or Paper;

·       Social Security Card;     

·       Bank Card;                                                                                  

·       Student I.D.;

·       Food Stamp I.D.; or                                                     

·       Any other similar identification, which has the beneficiary’s picture   and/or signature. 

 

If the beneficiary has no identification, the HSS may either:

 

·       Identify the beneficiary to the clerk;

·       Provide the clerk with identifying information, (e.g., birth dates of children);or

·       Have the beneficiary sign form 14-1 HHSA on the “other information” line prior to the HSS submitting the 14-1 HHSA to the clerk for card issuance.  The clerical person can then have the beneficiary sign the 14-1 HHSA, and compare the signatures before releasing the Paper ID card.   

 

  

Out-of-County Eligible

A Paper ID card may be issued to a Medi-Cal Beneficiary from another county when an immediate need is indicated.

 

If a MEDS inquiry indicates eligibility for the month in question, the Medi-Cal card may be issued through MEDS.  If a MEDS inquiry indicates no eligibility, the county of responsibility must be contacted and the eligibility issuance information in the Medi-Cal Eligibility Manual (MEM) Article 14, Procedures 14-A, secured.

 

When a beneficiary from another county is a member of a Health Maintenance Organization (HMO) plan and needs medical services, the following procedures are to be followed:

 

·       The beneficiary may use his/her BIC card to obtain emergency medical services.

 

·        For treatment that is not of an emergency nature, there should be a number on the HMO I.D. card that the beneficiary or provider may call to obtain authorization for medical service.  Authorization will depend on the seriousness of the illness.

 

·        If the beneficiary has moved to San Diego (i.e., an appropriate incoming Inter County Transfer) and is enrolled in an HMO that is not active in San Diego County:

 

·       The HSS should have the beneficiary contact the Health Care Options (HCO) enrollment representative in the FRC, or if there is no representative in the FRC, call HCO at 858-492-2287 and supply the following information:

 

o       The beneficiary’s name;

o       The beneficiary’s Social Security number; and

o       The beneficiary’s phone number.

 

·       The HCO section will:

 

o       Assist the beneficiary in disenrolling from the other county HMO and enrolling in the San Diego County HMO and verify the beneficiary’s HMO disenrollment which is   effective within 15 to 45 days (if notified after MEDS cutoff); and

o      The HSS will document in the case narrative that the HCO section was contacted.

 

Between the date the HCO section is notified and the end of the month, the beneficiary is still a member of the HMO and must obtain medical services.