you want this. If you were eligible for Medi-Cal during those 3 months, Medi-Cal may pay those bills. If you’ve already paid the bills and Medi-Cal covers the services, your clinic, doctor, dentist, or pharmacist should provide the refund to you. If you have trouble getting a refund, call Legal Services at (916) 551-2150.
What Are The Income Limits? There are many ways to qualify for Medi-Cal. Each program has its own income limits. It is best to apply through the Covered California portal to receive a full screening for all available programs. Special Low-Cost Medi-Cal for Working Disabled Persons: If you are a disabled working person or are married and both of you are working and disabled, you can get lower cost Medi-Cal if if you meet certain employment and income requirements. If you qualify, you can eliminate your share of cost for a low monthly premium payment. Income deductions and exemptions apply, so apply even if you think your income may be too high; you can contact Legal Services of Northern California at (916) 551-2150 if you are denied.
What Are The Requirements? 1. Once a Year Eligibility Form Individuals receiving Medi-Cal must have their eligibility rechecked (or “redetermined”) every 12 months. You get a “redetermination packet” in the mail which you must fill out and send back. You do not have to send in copies of documents with your redetermination form. 2. Reporting Changes for Adults Adults must report to DHA any significant changes that may affect your eligibility within 10 days after the change. You must quickly report to your worker if you move, begin making more money (or less money), someone moves in or out of your house or you are pregnant. Even if you report a change that hurts your eligibility, you have important rights before the DHA cuts your Medi-Cal. 3. Losing Welfare Does Not Mean That You Lose Medi- Cal Leaving the CalWORKs program (for example because of a sanction, time-limit, or failure to comply with WTW rules) does not mean that you lose free Medi-Cal. If you lose your Medi-Cal after you leave welfare, contact Legal Services of Northern California at (916) 551-2150 for help and advice 4. Transitional Medi-Cal You might be eligible for up to 1 year of free (no Share of Cost) Medi-Cal (called transitional Medi-Cal or TMC) if you received CalWORKs or what is called “Section 1931(b) Medi-Cal” during at least 3 of the last 6 months, and you lost CalWORKs or Section 1931(b) Medi-Cal because you started making too much money. During the first six months of TMC, you and your family qualify for
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free Medi-Cal no matter how much income you have. After that, you remain eligible for TMC if you received TMC for the entire six months; you are still living in California;you remain employed; you have a child under 18 in the home; and you meet the income qualifications. Eligible families can receive TMC for up to one year. There is no lifetime limit on TMC. If your income goes down you can qualify again for regular Medi-Cal. If it then goes up again you can return to TMC with new time limits. There are no “resource” or property limits for TMC. TMC requires quarterly reports like a QR-7 for cash aid, but on a different form. 5. Four Month Continuing Medi-Cal If you lose CalWORKs or Section 1931(b) because you start getting more child or spousal support, a family can get free Continuing Medi-Cal, regardless of your income, but just for 4 months. It is important that you turn in an SAR-7 or any other change reporting form explaining why you are leaving CalWORKs or Section 1931(b), to help make sure you get Transitional or Continuing MediCal. The children’s free Medi-Cal continues until their next scheduled annual redetermination. 6. Former Foster Children If you were in Foster Care on or after your 18th birthday and you were “emancipated,” you are automatically eligible for free Medi-Cal until you turn 21 even if your income goes up. Chldren leaving foster care before their 18th birthday are not eligible for this program. 7. If You Get A Notice That Medi-Cal Will Be Cut Off DHA must send you a written notice of action at least 10 days before it cuts off, denies, delays or reduces your Medi- Cal benefits. The notice explains the reason for their action and your right to ask for a fair hearing. (See pg. 78 Hearings and Complaints). When a change occurs affecting your Medi-Cal eligibility, DHA must determine whether you are eligible for any other type of Medi-Cal, before sending you a notice of action cutting off your benefits. They have to look in your available records, including CalWORKs, CalFresh and other records for any missing necessary information. DHA can send you a form that only asks for the information it needs; it cannot ask for information it already has or does not need to determine whether you are still eligible for Medi-Cal. DHA must give you at least 30 days to complete the form. If you do not send in a completed form, DHA will send you a written notice of action that you will lose your Medi-Cal benefits. If your form is incomplete, DHA must first try to contact you by telephone and writing to get missing information before it cuts your benefits. If you send in your form within 30 days of being cut from Medi-Cal, and that information shows you were still eligible, DHA must restore Medi-Cal benefits without making you reapply.
The People’s Guide