What Is Scfhp Dualconnect
SCFHP now offers DualConnect, a Dual Eligible Special Needs Plan , for individuals who are entitled to both Medicare and Medi-Cal. SCFHP DualConnect coordinates all your Medicare and Medi-Cal benefits and even Medicare Part D drug benefits so you dont have to do the juggling. With SCFHP DualConnect, you get healthcare tailored just for you. Simple. Easy. Personal.
If youre unfamiliar with the term D-SNP , it is a special needs Medicare Advantage plan for people who are “dual-eligible” meaning they qualify for both Medicare and Medi-Cal. We can make it even easier to understand: a D-SNP is a simple way to manage all your healthcare plans under one single umbrella and we can set it all up for you. When youre looking for a Medicare plan thats right for you, just ask for SCFHP DualConnect.
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Medicaid Eligibility & Requirements In California
Medi-Cal is Californias Medicaid program. Medi-Cal gives people with low incomes access to health services, including medical and dental care. The program is available for adults, children, pregnant women, older adults and people with disabilities. People who have certain conditions, such as tuberculosis and HIV, might also qualify for Medi-Cal.
Also Check: Medicare And Medicaid Act Of 1965
Presumptive Eligibility: Creating A Pathway To Ongoing Medi
Presumptive eligibility is an important tool for states to enroll people with low incomes into temporary Medicaid coverage. As California continues to expand eligibility for Medi-Cal, its Medicaid program, there is growing interest in understanding options for enrolling all eligible people. This report presents findings from two related studies on PE. One examined a type of PE called hospital presumptive eligibility in Medi-Cal. The other focused on how other states have implemented HPE for adults and PE for children. Both studies point to opportunities for California to improve presumptive eligibility as a pathway to ongoing coverage.
The study on California hospitals experiences points to ways the state and, in some cases, counties could make it easier to help people who receive PE apply for ongoing Medi-Cal coverage:
Findings on the HPE and PE implementation choices in other states, and study respondents views of their effectiveness, suggest additional options for California. These policy and programmatic choices are not currently in place in Medi-Cal, but might be feasible in Californias county-based eligibility determination structure:
Document Downloads
Aged Blind & Disabled Medically Needy Medi
If you cannot qualify for free Medi-Cal or Medi-Cal’s Working Disabled Program , you may be able to get Medi-Cal through the Aged, Blind, & Disabled – Medically Needy program. However, you would to pay a share of cost. A share of cost is a certain amount of money you must spend on medical care each month before Medi-Cal begins to pay for services.
If you are single, you can figure out your share of cost by following the first step for calculating A& D FPL eligibility. After Step 1, take your countable income and subtract the MNL for your family size including yourself and also subtract any health, dental, or vision insurance premiums you pay each month. The resulting figure is your share of cost each month. If you get a number that is 0 or less, then you have no share of cost. You only have to pay a share of cost in months when you have medical expenses.
There are good factsheets translated into a several languages about how your share of cost works.
You live alone and have $1,663 per month in countable income and have no other insurance. Your countable income is too high for free Medi-Cal and you don’t work, so you can’t get Medi-Cal’s Working Disabled Program. You qualify for ABD-MN Medi-Cal.
Your share of cost is $1,663 – $600 = $1,063. You will have to pay the first $1,063 in medical expenses during the month before Medi-Cal will start covering you.
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What If I Am Disabled
- To get Medi-Cal as a disabled person, you must have severe physical and/or mental problem which will:
- Last at least 12 months in a row and,
- Stop you from working during those 12 months, OR
- Possibly result in death.
What Are The Citizenship/immigration Requirements For Medi
- If you have Satisfactory Immigration Status and all other eligibility requirements are met, you may be eligible to Full-scope Medi-Cal Benefits
- If you have a Non-Satisfactory Immigration Status and all other eligibility requirements are met, you may be eligible to Restricted-scope Benefits
- Children and adults under the age of 26 and adults 50 years or older are eligible to Full-Scope Medi-Cal benefits regardless of their immigration status if all other eligibility requirements are met
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How Do I Enroll In Medicaid In California
Eligible participants can apply for Medi-Cal by printing an application and mailing it in to the Department of Health Care Services. You can also apply in person at your local county office or online at the Covered California website. To print an application, visit the Department of Health Care Services website and download the application and mail your completed form to the following address:
Medi-Cal Eligibility DivisionsMS 4607Sacramento, CA 95899-7417
Applicants may also call the DHCS at 300-1506 and apply over the phone. Applicants who want to learn more about Medi-Cal and whether they qualify for benefits can use the online screening tools to determine if they are eligible for coverage.
Aged & Disabled Federal Poverty Level Medi
If you are aged or disabled, and are not eligible for SSI, you may be able to get Medi-Cal through the Aged & Disabled Federal Poverty Level program. You must:
- Be either aged , or disabled
- Have less than $130,000 in assets . Like SSI, this program does not count all of your assets. for a list of exemptions.
- Note: If your disability began before you turned 26, you can open an ABLE account and save up money without having it counted by Medi-Cal. Learn more about ABLE accounts.
If you are single and live on your own, follow these steps to figure out if your countable income makes you eligible for A& D FPL Medi-Cal. If you live with others, you should use DB101’s Benefits and Work Estimator.
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$1959 |
The number you get is the amount of monthly income that is counted for the A & D FPL program. If it is less than $1,563 for individuals or $2,106 for a couple, then you qualify for free, full scope Medi-Cal based on A& D FPL rules.
If it is higher than $1,563 for individuals, you may qualify for Medi-Cal’s Working Disabled Program or ABD-MN Medi-Cal instead.
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California Medicaid Long Term Care Programs
Nursing Home / Institutional Medicaid
Medi-Cal will cover the cost of long term care in a nursing home for eligible California residents through Nursing Home / Institutional Medicaid. This includes payment for room and board, as well as all necessary medical and non-medical goods and services. These can include skilled nursing care, physicians visits, mental health counseling, prescription medication, medication management, social activities and assistance with Activities of Daily Living .
Some of the things that Medi-Cal wont cover in a nursing home are a private room, specialized food, comfort items not considered routine , personal reading items, plants, flowers, and any care services not considered medically necessary.
Any Medi-Cal beneficiary who receives Nursing Home Medicaid coverage must give most of their income to the state to help pay for the cost of the nursing home. They are only allowed to keep a personal needs allowance of $35 / month. Medi-Cal recipients with no income can apply for the Supplemental Security Income/State Supplemental Program to receive a monthly personal needs allowance from the state.
Nursing Home Medicaid is an entitlement, which means that anyone who meets the requirements is guaranteed by law to receive the benefits.
Home and Community Based Service Waivers
Aged Blind and Disabled / Regular Medicaid
Bilingual Customer Service Team Plus Interpreter Services In Any Language At No Cost
Our bilingual staff speaks Spanish and Vietnamese, and we offer interpreter services in all languages at no cost to you. If you need help in your language, call . Aids and services for people with disabilities, like documents in braille and large print, are also available. Call
SCFHP also offers bilingual in-person support and no-cost health education workshops at the SCFHP Blanca Alvarado Community Resource Center in East San José.
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A Care Team And Personal Care Coordinator Just For You
We make healthcare easy and friendly. Your SCFHP personal care coordinator works closely with your primary care provider and other members of your care team. Together with you, they develop your Individualized Care Plan that helps you meet your health care goals. Your coordinator can help you:
- Understand your specific healthcare concerns
- Coordinate care and services among the physical, behavioral, dental, and social services delivery systems
- Schedule your preventive screenings and other tests
- Direct you to other helpful services within SCFHP and in the community
California Medicaid Eligibility Groups By Medi
This dataset identifies Californias eligibility groups by aid code. California uses aid codes to account for eligibility group populations and the eligibility requirements, scope of benefits, services, costs, claims, encounter data, and managed care arrangements related to those populations. Aid codes in this dataset are mapped to the Transformed Medicaid Statistical Information System eligibility group descriptions and codes. California uses this mapping to submit claims data, enrollee encounter data, and supporting information to the Centers for Medicare & Medicaid Services , as required by Section 4735 of the Balanced Budget Act of 1997 and Section 6504 of the Affordable Care Act for the purpose of program integrity, program oversight, and administration. This dataset includes aid codes that do not have Medi-Cal benefits or have benefits and are not federal programs. Some aid codes may appear to be identical but possess distinct benefits or grouping factors. An aid code may appear more than once if multiple populations are represented in one aid code and can be identified and mapped to distinct T-MSIS groups.
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Medicaid Eligibility Income Chart By State Updated Jul 2022
The table below shows Medicaids monthly income limits by state for seniors. Income is not the only eligibility factor for Medicaid long term care there is also an asset limit and level of care requirements. Additionally, there are state-specific details. Click on the state name below to see that states complete Medicaid eligibility criteria.
The maximum income limits change dependent on the marital status of the applicant, whether a spouse is also applying for Medicaid, and the type of Medicaid for which they are applying. Nursing home Medicaid may have a different income limit than home and community based Medicaid services, and both of those may differ from the Aged, Blind and Disabled income limits.
Exceeding the income limits does not mean an individual cannot qualify for Medicaid. Most states have multiple pathways to Medicaid eligibility, such as a medically needy pathway. Furthermore, many states allow the use of Miller Trusts or Qualified Income Trusts to help person who cannot afford their care costs to become Medicaid eligible. There are also Medicaid planning professionals that employ other complicated techniques to help persons become eligible. Finally, candidates can take advantage of spousal protection laws that allow income to be allocated to a non-applicant spouse.
| Medicaid Eligibility Income Chart Updated July 2022 |
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California Medicaid Eligibility And Enrollment
- California Medicaid provides medically necessary services for children and adults with limited income. Find out if you qualify for California Medicaid.
California Medicaid is a joint federal and state government medical program designed to pay for health care services for 12 million low-income participants with disabilities, people 65 years and older and pregnant women who need medically necessary treatment and meet the programs financial requirements. The program also helps provide medical coverage to financially needy people with specific diseases such as breast cancer, HIV/AIDS or tuberculosis. The Department of Health Care Services administers and manages Californias Medicaid health care program, which is financed equally by the state and federal government.
Also Check: What Is Family Planning Services Medicaid
How Do I Know If I Qualify For Medicaid Services
If youre unsure whether you meet the Medicaid qualifications and income requirements, you can use a Medicaid calculator. Simply enter your information, including your state/zip code, income, household size and the number of adults and children you want to enroll. A Health for California agent can also help you determine your eligibility. Our agents will review your income information, family details and other relevant factors, such as your age and health, and help you put together your application.
Health For California is here to help you determine your Medi-Cal eligibility. Our free agents are always available to answer your question. If you want to enroll yourself or your family in Medi-Cal, get your free quote today.
Not sure how Obamacare affects your health care plans in California? Learn how the ACA works in California, including benefits, costs and enrollment.
Medicaid Certified Home Care Agency In California
An agency can only be eligible for Medicaid reimbursement if they are a certified HHA . Every state has issued a checklist of regulations and certifications that an agency must consider.
One can get the details associated with California Medicaid, like license and certification, through the Human Service Department and Bureau of Licensing and certification. One can also look for exemptions regarding licenses for the agencies offering non-med private-duty services.
Governing Body: Medi-Cal
Recommended Reading: Dc Medicaid Provider Number Lookup
How The Eligibility Rules Based On A Disability Work When You’re 19 Or Older
The fourth situation listed above is the most complicated. When Medi-Cal looks at your eligibility based on your disability, your income will be counted, but your parents income will not be counted once you turn 19. The exact income limit will depend on your situation, such as whether you are single or married. Usually, if you have a disability and youre single, the income limit is $1,563, and its $2,106 for couples. What’s tricky is that not all of your income will be counted by Medi-Cal, so its important to go ahead and apply, because you might qualify even if you think you wont qualify. You can read more about how income is calculated in DB101’s Medi-Cal article.
Here are a few reasons you might be able to keep getting Medi-Cal even if your income is above this limit:
Aged & Disabled Federal Poverty Level Program
If you are aged or disabled and are not eligible for the SSI program, you may be able to get Medi-Cal through the Aged & Disabled Federal Poverty Level program. To qualify, you must:
This Medi-Cal program uses SSI countable income rules as well as a few extra rules you should know. For more information, visit the Medi-Cal section of the Disability Benefits 101 website.
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Options For Joining Outside The Annual Election Period
You may also enroll after the Annual Election Period ends December 7, 2022. You may still enroll if this is your first time enrolling in Medicare or you have a qualifying event that entitles you to a Special Enrollment Period. See options below for more information.
Initial Enrollment Period: You can enroll when you first become eligible for Medicare at age 65. You are allowed a seven-month Initial Enrollment Period which includes three months before your birthday month and three months after. For example, if you turn 65 in May, you can enroll three months before, beginning in February, and your enrollment period will end three months after your birthday month in August.
Please Note: You can also qualify for Medicare due to a disability If you have been receiving Social Security Income or Railroad Retirement Board disability benefits for 24 months, you become eligible for Medicare even if you are not 65. Your initial enrollment period then would include three months before and after the 25th month of your disability.
Special Enrollment Period: You can enroll if you have certain special reasons or a qualifying event that entitles you to a Special Enrollment Period, like the following:
