Do you qualify for Medi-Cal benefits? In California Department of Health Care Services.
CALIFORNIA MEDICAID
See attached sample template for a response to the below post. The sample is a totally different subject, it’s just provided as a sample for the type of feedback needed fot the below homework assighnment.
Home State: CALIFORNIA
Minimum Wage in California: $10.00 per hour2 (my friend is a waitress)
Part-time basis: 34 hours per week4 – part time is 1-34 hours per week. ($16,320 annual household salary)
Eligibility requirements for Medicaid/Medi-Cal:
Since my friend’s spouse is currently in a rehab hospital. My friend can apply for Hospital Presumptive Eligibility (HPE) Program. This program will provide “immediate access to temporary, no-cost Medi-Cal while applying for permanent Medi-Cal coverage.”1 The qualifications include:
· Have income below the monthly limit for household size.1
· Be a California resident.1
· Not already have Medi-Cal.1
· If not pregnant, have not received PE Enrollment benefits from any Medi-Cal PE Program up to the maximum limitation allowed within the past 12 months of applying. If pregnant, have not had a PE Enrollment during the current pregnancy of applying.1
And, be eligible in one of the following HPE groups below:
· Children under 19 years old1
· Parents and Caretaker Relatives1 (my friend will be the primary caretaker of her husband)
· Pregnant Women (benefits are limited to ambulatory prenatal services.)1
· Former Foster Youth between ages 18 to 26 years old, who were in foster care in any state on their 18th birthday or older. (No income limit)1
· Adults between ages 19-64 (my friend is only 62 years old), not pregnant, not in Medicare, and not eligible for any group stated above.1
This is a Medi-Cal benefit for up to 2 months.
They can also qualify based on income since their annual yearly earnings is less than $22,108 for a family size of 2.
To see if you qualify based on income, look at the chart below. Income numbers are based on your annual – or yearly – earnings.5
Family Size
138% Poverty Level
1
16,395
2
22,108
2 Adults
22,108
Medi-Cal qualifications may also include the following5:
· 65 or older
· Blind
· Disabled
· Under 21
· Pregnant
· In a skilled nursing or intermediate care home
· On refugee status for a limited time, depending how long you have been in the United States
· A parent or caretaker relative or a child under 21 if:
o The child’s parent is deceased or doesn’t live with the child, or
o The child’s parent is incapacitated, or
o The child’s parent is under employed or unemployed
· Have been screened for breast and/or cervical cancer
The Medi-Cal program governs eligibility for benefits on a “means” tested basis. “The 2002 community spouse resource allowances are $89,280 in assets and $2,232 in monthly income. For a married couple with one spouse in a nursing home and the other spouse at home, the spouse at home may keep up to $89,280 in resources (property and other assets) while the spouse in a nursing home may keep $2,000. The spouse at home may keep all of the income received in his or her name, regardless of the amount. If the amount is below $2,232 per month, the spouse in the nursing home may allocate income to bring the at-home spouse’s income up to the $2,232 per month limit. The spouse in the nursing home is permitted to keep $35 a month for personal needs.”8
Home care services – yes, they are eligible for In-Home Operations6
Adult day health program – yes, they are eligible for Community-Based Adult Services (CBAS) – formerly Adult Day Health Care (ADHC)7
Nursing home care – yes, they are eligible care in a skilled nursing facility6
The sites are not user friendly. There is quite a number of FAQs that are not really related to my inquiries. The search box is not helpful as I one would think. It took me several attempts to look for the information that I needed to get. If I had an age- related limitation such as poor vision and hypertension, then I would definitely get a headache and my blood pressure would increase out of frustration. I did take a long nap during the course of this assignment because it was a bit frustrating not to find the information that I wanted to get immediately and I was getting tired. Patience is definitely necessary to go over these CA.gov sites.
References:
1. Hospital Presumptive Eligibility (HPE) Program (2016). In California Department of Health Care Services. Retrieved fromhttp://www.dhcs.ca.gov/services/medi-cal/eligibility/Pages/HospitalPE.aspx
2. Minimum Wage (2016). In State of California Department of Industrial Relations. Retrieved fromhttp://www.dir.ca.gov/dlse/FAQ_MinimumWage.htm
3. Fair Labor Standards Act Advisor. In United States Department of Labor. Retrieved fromhttp://webapps.dol.gov/elaws/faq/esa/flsa/014.htm
4. Labor force characteristics. In Bureau of Labor Statistics. Retrieved from http://www.bls.gov/cps/lfcharacteristics.htm#fullpart
5. Do you qualify for Medi-Cal benefits? In California Department of Health Care Services. Retrieved fromhttp://www.dhcs.ca.gov/services/medi-cal/Pages/DoYouQualifyForMedi-Cal.aspx
6. In-Home Operations. In California Department of Health Care Services. Retrieved fromhttp://www.dhcs.ca.gov/services/ltc/Pages/In-HomeOperations.aspx
7. Community-Based Adult Services (CBAS) – formerly Adult Day Health Care (ADHC). In California Department of Health Care Services. Retrieved from http://www.dhcs.ca.gov/services/Pages/Community-BasedAdultServices(CBAS)AdultDayHealthCare(ADHC)Transition.aspx
8. Medi-Cal Questions and Answers. Retrieved from http://www.dhcs.ca.gov/services/ltc/Documents/Medi_CalQandA.pdf
Attachments:
feedback_sample_wk_5.docx
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