Secondary Payer Information

CMSP and Eligibility for Other Programs

When CMSP applicants are eligible for other publicly funded benefit programs CMSP is the secondary payer to these other programs. This means that if another program covers a benefit that is also covered by CMSP, the other program will be expected to be the primary payer for the benefit.

Expanded Medi-Cal Eligibility

The federal Affordable Care Act (ACA) authorizes States to expand their Medicaid programs to serve low income uninsured adults with incomes up to 138% of the federal poverty level (FPL). California enacted law to expand the Medi-Cal program under this authority. Beginning January 1, 2014 individuals that are otherwise eligible for Medi-Cal under these new rules or under current Medi-Cal requirements shall be required to participate in Medi-Cal instead of CMSP.

Covered California

The ACA provides expanded health insurance coverage options to low income individuals and families with incomes up to 400% of the federal poverty level (FPL). California enacted law to establish Covered California, a state-based health insurance exchange, to provide subsidized health insurance coverage to low income individuals and families in California. Beginning January 1, 2014 individuals that are otherwise eligible for Covered California and eligible to apply for coverage shall be expected to participate in Covered California instead of CMSP.

California AIDS Drug Assistance Program (ADAP)

CMSP members must apply for the California AIDS Drug Assistance Program (ADAP) to receive all HIV medications. A one-time, 30-day supply of the medication will be provided to assure continuity of care. Following the one-time supply, CMSP will consider payment for HIV medications only if the CMSP member provides a document showing eligibility for ADAP has been denied. Information about ADAP is available by calling (844) 421-7050. Information about ADAP is available on the California Department of Public Health website.

California Family Planning, Access, Care and Treatment Program (Family PACT)

CMSP members must apply for Family Planning, Access, Care and Treatment Program (Family PACT) to receive contraceptives. A one-time, 30-day supply of the medication will be provided to assure continuity of care. Following the one-time supply, CMSP will consider payment for contraceptives only if the CMSP member provides a document showing eligibility for Family PACT has been denied. Information about Family PACT is available by calling (800) 942-1054.

Breast and Cervical Cancer Treatment Program (BCCTP)

CMSP members must apply for benefits under the Breast and Cervical Cancer Treatment Program when breast or cervical cancer treatment is determined medically necessary. CMSP will continue to cover all appropriate diagnostic services associated with these conditions. Benefit coverage under BCCTP provides full scope Medi-Cal.

Drug Company Patient Assistance Programs (PAPs) for Hepatitis-C Medications

CMSP members must apply for Drug Company Patient Assistance Programs (PAPs) to receive Hepatitis-C medications. CMSP will consider payment for Hepatitis-C medications only if the CMSP member provides a document showing eligibility for available PAPs has been denied by the manufacturers. Information about drug company PAPs is available on the Pharmaceutical Research and Manufacturers of America’s Medicine Assistance Tool (MAT) Medical providers may also be able to provide information.

If the programs listed above do not provide a document showing eligibility has been denied, CMSP clients may use the Record of Denied Program Eligibility Form provided by MedImpact or Advanced Medical Management. This completed form must be submitted to CMSP via fax at (916) 848-3349. A formal document from the program showing eligibility has been denied will also be accepted.