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1. What property/assets are allowable for Medi-Cal? The Medi-Cal program determines eligibility for benefits on a “means” tested basis. If a Medi-Cal applicant’s property/assets are over the Medi-Cal property limit, the applicant will not be eligible for Medi-Cal unless they lower their property/assets according to the program rules. The Medi-Cal eligibility worker looks at how much an applicant and their family has […]...
2. Can a facility transfer or discharge a resident out of the facility because of a change in the resident’s method of payment from private or long-term care insurance payment to Medi-Cal payment? Generally, no. The only exception is if the facility is not certified to accept payment from the Medi-Cal program. In that case, the facility would be allowed to transfer or discharge the resident if the resident’s stay is no longer covered by long-term care insurance and he/she is unable to continue to pay privately. However, […]...
3. What are the community spousal resource limits for 2002 when qualifying for the Medi-Cal nursing home benefit? The 2002 community spouse resource allowances are $89,280 in assets and $2,232 in monthly income. For a married couple with one spouse in a nursing home and the other spouse at home, the spouse at home may keep up to $89,280 in resources (property and other assets) while the spouse in a nursing home may […]...
4. Medi-Cal Claims: A frequent cause of claim denials by Medi-Cal is due to incorrect recipient admission A frequent cause of claim denials by Medi-Cal is due to incorrect recipient admission and discharge dates and/or incorrect patient status codes submitted by providers. Erroneous “from-through” dates or patient status billed by one provider and paid by Medi-Cal can result in the denial of correct claims billed by another provider. This often occurs between […]...
5. Share of Cost, Share of Cost Issues Share of Cost, Share of Cost Issues...
6. Share of Cost Issues Question: What can I do if I have a problem with my share of cost? Reply: You can complain if you think that you have a problem with your share of cost: Share on Facebook...
7. Where can I get more information on Medi-Cal Eligibility? You can find more information by downloading a copy of “Before You Buy,” found on the Partnership’s web site. This document, which provides an explanation of asset protection and Medi-Cal Eligibility rules, must be provided to consumers when long-term care presentations are made, in compliance with Partnership regulations. “Before You Buy” is updated annually with […]...
8. County Welfare Department Generally Determines SOC Amount Generally, a subscriber’s SOC is determined by the county welfare department and is based on the amount of income a subscriber receives in excess of “maintenance need” levels.  Medi-Cal rules require that subscribers pay income in excess of their “maintenance need” level toward their own medical bills before Medi-Cal begins to pay. Share on Facebook...
9. Share of Cost, What Does “Share of Cost” Mean? Share of Cost, What Does “Share of Cost” Mean?...
10. What Does “Share of Cost” Mean? “Share of Cost” is the amount you agree to pay for health care before Medi-Cal starts to pay. This is called “meeting your share of cost.” Your Share of Cost is a set amount based on how much money you make. You only need to meet your Share on Facebook...
11. Share of Cost is calculated independently for CMSP and Medi-Cal SOC policy also applies to County Medical Services Program (CMSP) providers and subscribers. Share of Cost is calculated independently for CMSP and Medi-Cal, however, the same subscriber income is included in both calculations. Therefore, the same medical expenses may be used to clear SOC for both programs.  Providers may apply the same services used to […]...
12. Medi-Cal Hotlines Medi-Cal Hotlines   Border Providers (916) 636-1200 DHCS Medi-Cal Fraud Hotline 1-800-822-6222 Telephone Service Center (TSC) 1-800-541-5555 Provider Telecommunications Network (PTN) 1-800-786-4346 Share on Facebook...
13. Share of Cost, Medicare Beneficiaries With Advanced Lung Cancer Share of Cost, Medicare Beneficiaries With Advanced Lung Cancer...
14. Share of Cost, How Medically Needy Programs Work Share of Cost, How Medically Needy Programs Work...
15. Share of Cost, Part D Penalties What Are They and Can They Be Avoided? Share of Cost, Part D Penalties What Are They and Can They Be Avoided?...