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.

Pending approval by the federal government, the CMSP Governing Board will operate a Low Income Health Program (LIHP) for CMSP counties beginning January 1, 2012. The program, made possible by California's Section 1115 Federal Medicaid Waiver, will operate as a 2-year pilot project with the name "Path2Health." The CMSP Eligiblity Manual has been revised to incorporate Path2Health, in accordance with federal rules.

The Governing Board approved the revised CMSP Eligiblity Manual on October 27, 2011. The CMSP Eligiblity Manual (effective 01/01/2012) is provided in "track changes" format to clearly show the changes to the current CMSP Eligibility Manual (06-30-11). The approved revised manual will take effect January 1, 2012. The current manual will be in effect through December 31, 2011.

When CMSP members are eligible for other benefit programs, including other health insurance coverage 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.