Current through Register 2024 Notice Reg. No. 12, March 22, 2024
(a) The county department shall:
(1) Be responsible for determining initial
and continuing eligibility for Medi-Cal applicants or beneficiaries promptly
and humanely, in accordance with:
(A)
Medi-Cal regulations.
(B)
Departmental directives.
(2) Construe Medi-Cal regulations fairly and
equitably when determining Medi-Cal eligibility.
(3) Have available at each office copies of
all laws, rules, regulations and bulletins relating to Medi-Cal.
(4) Comply with state hearing decisions of
the Director.
(5) Assist applicants
or beneficiaries in understanding their rights and responsibilities in relation
to application for Medi-Cal.
(6)
Evaluate the capacity of the applicants or beneficiaries to discharge their
responsibilities as set forth in these regulations.
(7) Assist applicants or beneficiaries as
needed in establishing their eligibility.
(8) Determine eligibility, assess need, and
authorize personal care program services for eligible beneficiaries, as
needed.
(b) The county
department shall take the following actions whenever an applicant or
beneficiary, who is applying for or receiving Medi-Cal on behalf of a child
under eighteen years of age who was born out of wedlock or who has an absent
parent, meets his/her responsibilities as specified in Section
50185(a) 10.
(1) As soon as possible after the applicant's
or beneficiary's opportunity to claim good cause as specified in 50771.5, and
not later than two working days after approval of eligibility, the county shall
provide to the district attorney the following forms, whether or not the
Child/Spousal and Medical Support Notice and Agreement (CA 2.1 Notice and
Agreement) has been completed;
(A) A completed
Referral to District Attorney (CA 371, Revised December 1992)
(B) A Child Support Questionnaire (CA 2.1 Q
Support Questionnaire, Revised March 1993), if one has been
completed;
(C) Health Insurance
Questionnaire (DHS 6155, Revised October 1990), if one has been
completed.
(D) Any other forms or
information requested by the district attorney.
(2) If the referral described in (1) above
has previously been provided to the district attorney, the county shall
promptly report to the district attorney whenever good cause has been claimed.
The district attorney will suspend all activities to establish paternity or
secure medical support until notified of a final determination of good cause by
the county.
(3) The county shall
promptly report to the district attorney all cases in which it has been
determined that there is or is not good cause for refusal to cooperate as
specified in Section
50771.5. The district attorney
will not undertake to establish paternity or secure support if there has been a
finding of good cause unless there also has been a determination by the county
that the district attorney may proceed without the participation of the parent
or caretaker relative. If there has been such a determination, the district
attorney may undertake to establish paternity or secure support but may not
involve the parent or caretaker relative.
(4) If the county determines that the
applicant or beneficiary and the child on whose behalf the application was
filed are not eligible, the applicant or beneficiary shall be informed that
he/she may go to the district attorney for help in locating the absent
parent(s) of the child, collecting child and medical support for the child, and
establishing paternity.
(5) The
county shall provide the district attorney with any information requested
concerning medical support cases and shall advise the district attorney in
writing if any of the following circumstances arise:
(A) A person is added to or deleted from the
MFBU.
(B) The child ceases living
with the person who is receiving Medi-Cal on his/her behalf.
(C) A child moves out of foster care and
begins living with a parent or relative.
(D) A child has been accepted for adoption by
a public or private adoption agency or such an acceptance has been
terminated.
(E) Medi-Cal benefits
have been discontinued.
(6) If the district attorney notifies the
county that the applicant or beneficiary has not cooperated, the county shall
verify the facts, determine whether he/she had good cause for failure to
cooperate pursuant to Section
50771.5, and notify the district
attorney of the determination.
(7)
Prior to making a final determination of good cause for refusing to cooperate,
the county shall:
(A) Afford the district
attorney the opportunity to review and comment on the findings and basis for
the proposed determination;
(B)
Consider any recommendation from the district attorney; and from any witnesses
on behalf of the applicant in any hearing that results from an applicant's or
beneficiary's appeal of any county action relating to establishing paternity or
securing medical support.
1.
Amendment filed 5-30-80 as an emergency; effective upon filing (Register 80,
No. 22). A Certificate of Compliance must be transmitted to OAL within 120 days
or emergency language will be repealed on 9-27-80.
2. Certificate of
Compliance filed 9-26-80 (Register 80, No. 39).
3. Amendment of
subsection (a)(2) filed 3-25-83; effective thirtieth day thereafter (Register
83, No. 13).
4. Editorial correction of NOTE filed 7-7-83 (Register
83, No. 29).
5. New subsection (a)(8) filed 4-14-93 as an emergency;
operative 4-14-93. Submitted to OAL for printing only pursuant to section
8, AB 1773 (Chapter 939, Statutes
of 1992) (Register 93, No. 16).
6. New subsections (b)-(b)(7)(B) and
amendment of NOTE filed 4-16-93 as an emergency; operative 4-16-93 (Register
93, No. 16). A Certificate of Compliance must be transmitted to OAL 8-16-93 or
emergency language will be repealed by operation of law on the following
day.
7. Certificate of Compliance as to 4-16-93 order including
amendment of subsection (b)(1)(C) and NOTE transmitted to OAL 8-13-93 and filed
9-23-93 (Register 93, No. 39).
Note: Authority cited: Sections
10725
and
14124.5,
Welfare and Institutions Code. Reference: Sections
10000,
10058,
10747,
10800,
10963,
11000,
11490,
14008.6
and
14016,
Welfare and Institutions Code; and
42 C.F.R. Sections
433.135,
433.136,
433.137,
433.138,
433,
145,
433.146,
433.147,
433.148 and
435.604.