ARTICLE 4

 

                                                               SECTION 6

 


                                                             INTERVIEWS

 

1.        GENERAL

 

This section describes initial screening, intake and redetermination interview requirements specifically related to the Medi-Cal program. Clarification of when a face-to-face interview is required, who must attend the interview and what material is covered at the face-to-face interview is included in this section.

 

 

2.        FACE-TO-FACE INTERVIEW

 

A face-to-face interview is not required at application or annual redetermination. All Medi-Cal applicants/beneficiaries have the option of returning their forms and completing the application and/or redetermination process by mail except as noted below.

 

 


MEM 50159

MEM 50161

 

A.       Application

 

A face-to-face interview is not required at application, except for the following:

 

1)      The applicant requests a face-to-face interview.

 

2)      All applications for Minor Consent services must be made in person at Family Resource Centers (FRCs) or outstation sites.

 

3)      The ET determines good cause exists to require a face-to-face interview.

 

4)      Fraud is suspected.

 

 

 

 

 

 

 

 

 

 

 

5)      To complete the application process when:

 

a)        There is questionable information on the application form.

 

b)        There is questionable verification.

 

c)        An individual and/or family has no visible means of support, such as in-kind income, or the means of support is not reported for the individual and/or family.

 

d)        There are obvious discrepancies between asset and income information reported on the Income Eligibility Verification System (IEVS).

 

 

e)        A self-employed individual whose income and expenses do not match reported income.

 

When an ET requests that an applicant attend a face-to-face interview for any reason, the reason(s) must be narrated. The mail-in application process does not relieve the ET of the responsibility to assist the applicant in completing the application process. If the applicant contacts the ET to express difficulty in completing the application, and the situation cannot be resolved by phone, refer the applicant to available resources or suggest that he/she make an appointment with the ET (or schedule a home call, if appropriate) to review the application. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MEM 50159

MEM 50161

B.       Redeterminations

 

A face-to-face interview is not required at annual redetermination, except for the following:

 

1)      The beneficiary requests a face-to-face interview.

 

2)      If the ET determines good cause exists to require a face-to-face interview. Refer to Article 4, Section 15 for good cause criteria.

 

Redetermination processing requirements are addressed in MPG Article 4, Section 15.

ACWDL

99-36

 


3.        new footer:  1/97; mpg ltr 373INTERVIEW REQUIREMENTS

 

          MEM 50517 requires that applicants/beneficiaries are to be informed of specific information as part of the face-to-face interview.  In San Diego County, the application process consists of an initial screening and the intake interview.  An Orientation session is also included as part of the County's application process.

MEM 50157


          Applicants are informed of all information required by the State from the initial screening, Orientation and intake procedures.

 

 

A.       Initial Screening

 

The applicant/beneficiary will be provided with an initial screening package of forms that contains the Application for Aid (Form SAWS 1), the Coversheet to the Application for Aid (Form SAWS1 COVERSHEET), the Request for Basic Information Medical Services (Form 14-4), the Reception Referral (Form 16-2A), the Language Needs Determination (Form 20-46).  Upon presenting the completed Initial Screening Package, the client will be given the specific forms needed for the Medi-Cal application and an appointment for a face-to-face interview with an Intake Worker.

 

 

B.       Face-to-Face Intake Interview

 

                 Generally, the worker will:

 

1)      Review the Rights and Responsibilities (Form MC 219) with the applicant.  Both the applicant and the worker must sign the MC 219 to certify that the applicant has been advised of his/her rights and responsibilities as an applicant for Medi-Cal.

 

2)      Review Conditions of eligibility (using the Statement of Facts) and verification requirements for the Medi-Cal program under which the applicant's eligibility is to be determined.

 

 

3)      Explain to the applicant that IEVS is a cross match system that uses the Social Security Numbers of everyone in the case to access state and federal information on income and resources.  Applicants are to be informed that this information is used to ensure that the eligibility and share-of-cost determination are correct.  Applicants are further advised that the information may be verified through collateral contact when discrepancies are found.

 

4)      Insure that the Orientation Form 07-33 has been signed by the applicant and stamped off by the Orientation worker (PSS from the County Health Department).  The intake worker will make any appropriate CHDP or service referrals requested by the applicant and will certify that the applicant has been informed of the CHDP Program and available social services by signing the lower section of Form 07-33 DSS (EXCEPTION:  Use of the form 07-33 DSS is not required by HOS or perinatal outstationed workers when rights and responsibilities are explained individually.)

 

 

5)      Certify, by making a notation on the Statement of Facts Form MC210, that the applicant has been informed of the Special Supplemental Food Program for Women, Infants and Children (WIC) and other private resources if the applicant is pregnant, breastfeeding, or postpartum woman, or a parent/caretaker of a child under the age of five, and provide the client with a WIC brochure to inform them of the availability of benefits provided under WIC.

 

MEM 50157 &

50184

6)      An oral explanation of WIC benefits shall be given to those individuals who are unable to read.