Your Medi-Cal case has been affected by a lawsuit called Sneede v. Kizer. This lawsuit limits which family members may use medical expenses that are not billed to Medi-Cal to meet their family’s Share of Cost. If you are a spouse or a parent, you have the choice of listing your medical expenses in any case number on the reverse side of this form in which your name appears. You may list all your medical expenses in a single case number, or you may divide up the expense and list it in two or more case numbers in which your name appears. However, the total being reported for the single service cannot be more than the original bill.
If you are a caretaker relative such as a grandparent, aunt, uncle, etc., your medical expenses may only be listed in the case number in which your name appears. If you are a minor mother, a mother under the age of 21 years who lives in the home with her parent(s), you may list your medical expenses in both the case number with your parent(s) and again in the case number where you are in an aid code “IE” with your child. The same medical expense for minor mothers should be listed TWICE IN FULL. The medical expense is never divided up. IMPORTANT: A person listed as “IE” or “RR” in the aid code section on the reverse side of this form will not receive Medi-Cal benefits when the Share of Cost for that case number has been met. In order to receive Medi-Cal benefits, this person must meet the Share of Cost for a case number where the person is not listed as an “IE” or “RR.” This summary does not guarantee Medi-Cal eligibility. This summary only shows which members of the family have a Share of Cost for Medi-Cal. Note: “IE” means ineligible and “RR” means Responsible Relative.
According to the Sneede v. Kizer lawsuit, a subscriber’s eligibility and SOC must be determined using his/her own property. Children and spouses within the same family may have varying SOCs and, therefore, multiple case numbers listed on the Share of Cost Case Summary form. Sneede v. Kizer cases may result in the following scenarios: 1. A mother has medical expenses totaling $75 that have not been billed to Medi-Cal. The mother has a Share of Cost Case Summary form that lists her in two separate cases. She is listed with an “RR” code with her child and she is listed by herself with aid code 37. She may do one of the following: • Apply the entire $75 to her own $100 SOC. • Apply the entire $75 to her child’s $125 SOC. • Apply any amount less than $75 to her SOC and the balance of the $75 to her child’s SOC. The total amount reported cannot exceed the original $75. 2.
The Smith family consists of a stepfather (husband), a mother (wife) and the mother’s separate child. The wife and her husband are listed together on the Share of Cost Case Summary form as eligible subscribers with a $100 SOC. The mother is listed as an “RR” with her child in the second case with a $125 SOC. The mother has medical expenses totaling $100 that have not been billed to Medi-Cal. She may do one of the following: • Apply the entire $100 to her own $100 SOC. • Apply the entire $100 to her child’s $125 SOC. • Apply any amount less than $100 to her SOC and the balance of the $100 to her child’s SOC. The total amount reported cannot exceed the original $100. In all other cases that do not involve a natural or adoptive parent, Share of Cost can be cleared only for a person’s own medical expenses. Examples: • Caretaker relatives (such as a grandparent, aunt or uncle) can use their medical expenses to clear only their own Share of Cost. • Children can use their medical expenses to clear only their own Share of Cost.
A minor mother is listed on the Share of Cost Case Summary form with an “IE” (ineligible) or “RR” aid code in the same case with her child. In addition, the minor mother also may be in a second case, either listed with her parent(s) or in her own case. In this situation only, full medical expenses may be used to clear SOC in both cases. Two separate transactions are required. A minor mother is defined as a mother under the age of 21 who resides in the home of her parent(s).