Eligibility Manual
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A Forest.Under the authority set forth in California law, the CMSP Governing Board sets the criteria for member participation in the County Medical Services Program. Eligibility for CMSP benefits is determined by the County Social Services Department in each participating CMSP county.

Eligibility requirements address such areas as: age limits, residency and citizenship, personal property limits, motor vehicle limits, real property limits, responsibility of family members/relatives, need standard, and share-of-cost. Other program requirements address such matters as use of the Beneficiary Identification Card (BIC), prior authorization for selected services, CMSP member copayments and monthly share-of-cost, liability for payment for health care services by other insurance, and fair hearings. Eligibility is determined in accordance with the CMSP Eligibility Manual.

For CMSP applications with beginning dates of aid on or after May 1, 2016, a revised CMSP Eligibility Manual is in effect. This revised manual reflects various changes to CMSP eligibility and the new CMSP Primary Care Benefit that took effect May 1, 2016. It also reflects changes approved by the Governing Board that take effect October 1, 2016.

NOTE: For CMSP applications with beginning dates of aid prior to May 1, 2016, please use the CMSP Eligibility Manual with the February 1, 2015 effective date.

When CMSP members are eligible for other benefit programs, including other publicly funded health coverage, such as Medi-Cal or Covered California, or programs like the AIDS Drug Assistance Program, or Family PACT, CMSP is the secondary payer to these programs. Click here for more information.

To submit corrections or suggestions for the eligibility manual, please e-mail info@cmspcounties.org.

The eligibility manual is in PDF format. PDF documents require Adobe Acrobat Reader to view. Click here to download the free Reader if your PC does not have this utility.

 

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