- How do I apply for CMSP benefits?
- What information do I need to apply for CMSP benefits?
- How do I receive CMSP benefits?
- How do I find a doctor that will take CMSP?
- What if I need a service not covered by CMSP?
- Can I get CMSP for services received before I applied?
- What else should I know?
How do I apply for CMSP benefits?
To apply for CMSP benefits, you will need to submit an application for benefits with the county social services department. In some counties you may apply at other sites such as the hospital. To get more information about applying for CMSP in your county, see the list of Participating Counties.
What information do I need to apply for CMSP benefits?
When you apply for CMSP, you will be told what information to provide so that the county may determine your eligibility. You will be asked to provide a variety of information such as Social Security numbers for everyone you are applying for, three current pay stubs or some other form of earned income verification, award letters or other form of verification of income such as State Disability, Unemployment Insurance Benefits, Workman’s Compensation payments, etc. You will also be required to verify your resources with bank statements, verification of stocks, bonds, mutual funds, etc.
Depending on your circumstances you may be required to provide other items.
How do I receive CMSP benefits?
When the county determines that you are eligible, you will receive an approval notice, and shortly after, a State of California Benefits Identification Card (BIC). This is a plastic card with you name, identification number, and a magnetic strip on it. CMSP members will also receive a CMSP identification (ID) card for the CMSP Standard Benefit. In addition, some CMSP members will also received a Primary Care Benefit (PCB) card. All CMSP members receive a CMSP Member Guide that contains information about how to use CMSP benefit coverage. To receive CMSP benefits you will need to go to a CMSP network provider to receive all services, except emergency services. If you receive non-emergency services from a medical provider who is not a part of the CMSP provider network, you will be responsible for paying for those services. It is your responsibility to present your BIC and your CMSP ID cards to the provider when you get services.
When you go to the doctor, pharmacist, or other medical provider, they will verify your eligibility for CMSP, check if you have a Share-of-Cost and how much is remaining on the Share-of-Cost, and determine if there are other applicable restrictions or limitations.
How do I find a doctor that will take CMSP?
Advanced Medical Management administers CMSP. To find a primary care provider (PCP), specialist or other participating provider, you should contact the Advanced Medical Management at (877) 589-6807. You may also check the Advanced Medical Management website. When you call, they will advise you which PCP's are available in your geographic area and how to get connected with the care you need. The social services department where you applied for CMSP also has a list of participating PCP's in your county and nearby counties where you can receive care. You must get all services, except emergency services, from a healthcare provider participating in the CMSP provider network.
What if I need a service not covered by CMSP?
In some situations your doctor may want you to take a certain drug or receive a service that requires additional authorization. If this is the case, your doctor will need to submit the appropriate pre-service review form to Advanced Medical Management for medical services that require prior approval. Your doctor will need to submit a Medication Request Form (MRF) to MedImpact for medications that require prior authorization.
If you have any other questions, about the CMSP, ask your eligibility worker at the county social services department.
Can I get CMSP for services received before I applied?
Beginning June 1, 2016 applicants for CMSP may request one month of “retroactive” CMSP coverage. Applicants should talk with their eligibility worker about applying for this coverage.
What else should I know?
Your beginning and end date for your CMSP benefits will be provided to you as a part of the Notice of Action (NOA) you get regarding your eligibility for CMSP. You will NOT receive another notice regarding the end date for your benefits. It is your responsibility to reapply for CMSP during the last month of your eligibility term if you would like to continue your CMSP eligibility into another term.
If you have any other questions, about the CMSP benefits, you may call Advanced Medical Management at (877) 589-6807.