- Who is eligible?
- Do you have to be a citizen to receive benefits?
- Are there income or property restrictions?
- What if my property exceeds the requirement limit?
- What if my income exceeds the requirement limit?
- What if my information has changed since I applied?
- How do I receive CMSP benefits?
- What if I move from my county?
- What if I disagree with an action the county has taken?
- Can I get CMSP for services received before I applied?
- What else should I know?
Who is eligible?
Individuals ages 21 through 64 who reside in a participating county, have incomes at or below 200% of the federal poverty level (FPL), and who are not eligible for Medi-Cal benefits could be eligible for CMSP benefits.
If you are a single parent with minor children, have minor children and have become unemployed, receive Social Security Disability, are pregnant, or feel that you are disabled, you should apply for Medi-Cal benefits. The county will determine which programs you may qualify for.
Do you have to be a citizen to receive benefits?
To receive full benefits, you must be a United States citizen or have legal immigration status. CMSP county residents with undetermined immigration status may receive restricted emergency services only.
Are there income or property restrictions?
CMSP has property requirements that must be met to be eligible for program benefits. An individual may only have $2,000 in liquid assets (bank accounts, CD's, cash, etc.) during the month. (A home, one car, and personal effects are exempt). Two persons may have $3,000, three $3,150, four $3,300, etc.
What if my property exceeds the requirement limit?
If your property exceeds the limit, you will not be eligible for CMSP. Talk to your eligibility worker at the county social services department for more information about acceptable ways to bring down your excess property.
What if my income exceeds the requirement limit?
If your net countable income exceeds 200% of the federal poverty level (FPL), you will not be eligible for CMSP. If your net countable income is above the maintenance need level but below 200% FPL, you must pay a certain amount of your medical bills before CMSP will begin to pay. The CMSP has established "maintenance needs levels" depending on the size of your family. These maintenance need levels are specific income amounts that are allowed for your living expenses. Any amount counted over these limits is considered "excess" and is your Share-of-Cost - what you must pay or obligate to pay toward your medical expenses each month before CMSP will pay for services.
For example, the maintenance need for one person is $600. If, after certain, limited, amounts are deducted from your gross pay for the month, and your countable net income exceeds $600, that excess amount is your Share-of-Cost. Some of these deductions include health insurance premiums, court ordered child support or alimony, and a $90 standard work deduction. However, if your net countable income is above 200% of the federal poverty level (FPL) you are not eligible for CMSP.
The maintenance need level for two adults is $934. You will need to provide pay stubs or some other verification of income to the county. They will tell you what you need to provide.
What if my information has changed since I applied?
Any changes in your situation that may affect your eligibility must be reported to your eligibility worker. These changes include getting married/divorced, getting or losing a job, getting pregnant, changing your address, as well as any changes to income. If these or any other change occurs you must notify your worker within ten days.
How do I receive CMSP benefits?
When the county determines that you are eligible, you will receive an approval notice, and shortly after, a Benefits Identification Card (BIC). This is a plastic card with you name, identification number, and a magnetic strip on it. Beginning October 1, 2005, CMSP members will also receive a CMSP/Anthem Blue Cross identification (ID) card. In addition, beginning October 1, to receive CMSP benefits you will need to go to a CMSP/Anthem Blue Cross 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/Anthem Blue Cross provider network, you will be responsible for paying for those services. It is your responsibility to present your BIC and your CMSP/Anthem Blue Cross 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.
What if I move from my county?
You must tell your eligibility worker that you are moving. No matter where you move, you will have to reapply for benefits in that county. Only the participating 35 rural counties have CMSP. The other counties have their own "county" programs, which may be more restrictive in terms of eligibility criteria or where you may receive services. Some of these counties may also call their programs "CMSP" but they are not part of the state administered County Medical Services Program.
What if I disagree with an action the county has taken?
If you disagree with an action the county has taken, you may appeal that action. You should first discuss the action with your eligibility worker and the eligibility worker's supervisor. If you remain dissatisfied, you may request a hearing. If you currently have benefits and request a hearing before the date the action is to take place, your benefits will continue until your appeal has been resolved.
The county in which you received your benefits is responsible for conducting the hearing and ruling on the issues.
Can I get CMSP for services received before I applied?
No. Your eligibility for CMSP benefits starts with the first day of the month in which you apply for CMSP.
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, ask your eligibility worker at the county social services department.