ARTICLE 4

 

                                                              SECTION 1

                                                                                        

                                              CONDITIONS OF ELIGIBILITY

 

1.        GENERAL

 

Applicants who apply for Medi-Cal are required to meet several conditions of eligibility before their application can be approved and a Medi-Cal card issued.  The eligibility factors to be evaluated include:  residence, property limits, Social Security Number requirements, and apparent eligibility to unconditionally available income.  Linkage factors to be considered include linkage to AFDC, Aged Blind or Disabled (ABD), Medically Indigent (MI) and eligibility to other public assistance.  Although there are no income limits for Medi-Cal, all other applicable conditions of eligibility must be met before an application for Medi-Cal can be approved.  This section provides a brief description of each condition of eligibility for Medi-Cal and refers workers to the appropriate MPG and MEM sections in which the specific requirements for each condition of eligibility are addressed.

 

 

2.        RESIDENCE

 

To be eligible for Medi-Cal, an applicant must be a California resident.  Refer to Article 7, Section 5 for residence requirements.

 

3.        CITIZENSHIP/ALIEN STATUS

 

U.S. Citizenship or legal resident status is not required to be eligible for Medi-Cal benefits.  However, the citizenship/alien status of the applicant determines the level of benefits (full scope or restricted) for which the applicant is potentially eligible.  Article 7, Section 1 through 3 defines U.S. citizens and alien categories and specifies the level of benefits for which the applicant/beneficiary is potentially eligible.

 

4.        PROPERTY LIMITS

 

As a condition of eligibility for Medi-Cal, the total net nonexempt property of the applicant's MFBU must not exceed the property limit established by the Medi-Cal program.  MPG Article 9 specifies what property is included in the property reserve and assists the worker with the determination of the total net nonexempt property.  Factors to be considered include the evaluation of:  ownership, availability, utilization, spenddown, and transfer or conversion of property.

 

 


5.        NEW FOOTER - : 7/93; Letter #: 211SOCIAL SECURITY NUMBERS

 


 

All applicants who request full-scope benefits are required to provide a Social Security Number as a condition of eligibility for Medi-Cal.  MPG Article 4, Section 11 lists acceptable verification of Social Security Numbers and describes referral procedures when the applicant does not have or is unable to verify his/her Social Security Number.

 

 

6.        UNCONDITIONALLY AVAILABLE INCOME

 

 

All applicants are required to apply for any unconditionally available income to which they appear eligible.  MPG Article 4, Section 12 defines unconditionally available income and describes application, cooperation and verification requirements for applicants who must apply for unconditionally available income.

 

 

7.        LINKAGE TO PUBLIC ASSISTANCE CASH PROGRAMS

 

 

Persons who receive a cash grant in certain public assistance cash programs are automatically eligible for Medi-Cal.  MPG Article 5, Section 1 identifies public assistance programs that automatically qualify recipients for Medi-Cal benefits.

 

 

8.        LINKAGE TO AFDC, ABD OR MI

 

 

Persons who have linkage to AFDC, ABD or MI are eligible for the Medi-Cal program if all other conditions of eligibility are met.  MPG Article 5, Sections 2, 3, and 4 define linkage to these programs.  These sections also provide eligibility and verification requirements for applicants who qualify under one or more of these categories.

 

 

9.        INSTITUTIONAL STATUS

 

 

The determination of eligibility and the period of eligibility is affected by the institutional status of certain Medi-Cal applicants.  MPG Article 6 clarifies situations in which the applicant's Medi-Cal eligibility is affected by his/her institutional status.

 

 

10.      MEDICAL SUPPORT REFERRAL

 

 

 

Medically Needy Only (MNO) applicants, requesting Medi-Cal for a child born out of wedlock or with an absent parent, must cooperate with the Family Support Division of the District Attorney's office by assigning and/or obtaining medical support and payments, establishing paternity, identifying 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.

MEM

50185

 

 

Applicants who refuse to cooperate with the Medical Support Enforcement Program without "good cause" will be ineligible members of the MFBU.

MEM

50175