Medi-Cal Handbook Residency 7. ResidencyAug 13, 2015 · Medi-Cal Handbook page 7-1 Residency 7. Residency 7.1 Overview 7.1.1 General [50320, 50320.1] California residence is a requirement

Medi-Cal Handbook page 7-1Residency

7. Residency

7.1 Overview

7.1.1 General [50320, 50320.1]

California residence is a requirement for the Medi-Cal Program. This applies to all applicants, regardless of their level of benefits, immigration or citizenship status. This is a condition of eligibility.

California residence requirements are met when the applicant:

• Is physically present and is living in California with the intent to remain permanently, or for an indefinite period; or,

• The applicant has entered California with a job commitment or to seek employment, whether or not currently employed, and

Note:This refers to migrant workers who do not declare the intent to remain permanently or indefinitely. [Refer to “Migrant Workers,” page 7-9.]

• Provides acceptable verification of California residency.

7.1.2 Additional Ways to Establish Residence [50325,50327, 50329]

The following persons may also establish California residence:

• Children living with their parents shall normally have their residence determined as that of their parents. Parents who do not meet the California residency requirements may establish California residence for their children if both of the following circumstances apply. The parents:

• Intend for their children to remain in California on other than a temporary basis, and

Update # 2015-20 Revised: 08/13/2015

page 7-2 Medi-Cal HandbookResidency

• They have made arrangements for the children to remain in the state independent of the parents.

• Family members may establish separate residences without a break in marital or family ties. Only those family members who meet California residency requirements are eligible for Medi-Cal.

• A person who dies during a temporary absence from the state. [Refer to “Definitions,” page 1-1 regarding “temporary absence”.]

• Persons living within the boundaries of California on land leased or owned by the Federal Government shall be considered to be California residents.

• A person on parole from correctional or other institutions.

• A child placed in out-of-state foster care under either of the following conditions:

• Through the Interstate Compact on the Placement of Children. [Refer to “Medi-Cal Programs [50201, 50203, 50227],” page 20-1 for definition of Interstate Compact], or

• By a state or county agency responsible for the child's care.

Note:There is no eligibility for a child placed outside of the United States, for example, with military foster parents or other parents who move out of the United States.

• An out-of-state foster child placed in California if both of the following conditions are met:

• The child was placed by an out-of-state court directly with a guardian or foster parent in California, and

• The other state has adopted the Interstate Compact on the Placement of Children.

• An institutionalized person placed by a state or county agency responsible for that person's care out of state unless the other state accepts the responsibility for that person.

• An institutionalized person placed in California by another state agency, or by a local government agency in another state responsible for the person's care, remains a resident of the placing state unless a California state or county agency accepts responsibility for that person.

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Note:The Department of Health Services (DHS) shall have the authority to determine the state of residence for a person who is living in an institution in another state when that state's medical assistance agency claims that the person is a California resident. An application for Medi-Cal on behalf of that person shall be referred to the Medi-Cal program coordinator.

7.1.3 Who Must Provide Verification?

All Medi-Cal applicants and beneficiaries must provide evidence of California residence regardless of the level of benefits requested, alienage, or citizenship status. This includes U.S. citizens, legal immigrants, nonimmigrants, undocumented aliens, migrant workers and homeless individuals.

7.1.4 Exception to Providing Proof of Residency

Persons applying for the Minor Consent Program or those Foster Care children who receive Medi-Cal ARE NOT required to provide proof of residence.

However, they are still required to be California residents.

7.1.5 When Required

California residence must be verified at:

• Application• Reapplication• Restoration, or whenever there is a break-in-aid• Redetermination, only if California residence has not been verified previously.

Note:If one of the eight “specified documents” is already in the case file, then there is no need for the client to submit any additional proof of residency.

7.1.6 CalWORKs to Medi-Cal Only

Receipt of Public Assistance (CalWORKs) in California is a “specified” evidence of residency. Therefore, no other proof of residence is required when converting from cash to Medi-Cal Only.

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Residency verification is not required when changing from CalWORKs to Medi-Cal only, unless California residency is questionable.

7.1.7 Ineligibility

Medi-Cal applicants or beneficiaries (except for those exceptions previously defined) who do not provide residency verification, or who otherwise do not meet residency requirements, are ineligible for Medi-Cal.

7.2 Establishing California Residency Requirements

The following chart provides a general overview of California residency requirements in sequential order. The EW must:

Step Action

1 Determine whether the applicant meets either of the basic residency requirements:

• Intends to remain permanently or for an indefinite period, or

• Entered the state with a job commitment or to seek employment.

2 Ensure that the applicant answers questions #27 of the “Medi-Cal Statement of Facts” (MC 210). The question is worded to initiate discussion. Answers to this question must be explored. In order to meet California residency requirements, the applicant must intend to remain here permanently or for an indefinite period (except for migrant workers).

• If a principal residence outside of California is declared, then the EW must review the circumstances to determine if the client is living here for an indefinite period. [Refer to “Principal Residence,” page 7-13.]

• If public assistance or government benefits are being received at an out-of-state address, again, the EW must determine if there is intent to remain here. Has the payor been notified of an address change, etc.? [Refer to “Principal Residence,” page 7-13 and “Public Assistance/Government Benefits,” page 7-14, as applicable.]

NOTE: When other Statement of Facts forms are used (e.g., SAWS 2, MC 262, MC 321 HFP, etc.), EWs must have the client complete the “Medi-Cal Residency Declaration” (MC 212) form.

3 Obtain from the applicant one of the documents specified by the State as an acceptable verification of residency. [Refer to ““Specified Documents”,” page 7-5.]

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7.3 Verification of Residency

7.3.1 “Specified Documents”

Applicants must provide evidence of California residency by submitting one of the following “specified documents” as acceptable verification.

4 If the applicant does not have one of the “specified documents” listed below, then he/she must sign the “Important Information About Residency” (MC 214) form, AND

• Provide other acceptable evidence of residency. If a rent receipt or a statement regarding free housing from a relative is the applicant’s only proof of residency. “Income In-Kind/Housing Verification” (MC 210 S-I) form must be completed in addition to the MC 214.

Note: A General Affidavit (CSF 2) signed by the applicant or by another person is not acceptable, unless the individual is providing housing.

4 Review all facts to determine whether the applicant's statements and evidence of residency support a finding of California residency and that there is no evidence to the contrary.

5 Approve or deny Medi-Cal based on the preponderance of evidence.

Specified Residency Documents Additional Information/Requirements

California DMV Driver's License; or a California DMV I.D. Card

It must be current, valid and in the client's name and with a California address.

NOTE: Expired driver's licenses or expired DMV I.D. Cards are not acceptable.

California Motor Vehicle Registration

It must be current, valid and in the client's name and with a California address.

NOTE: Expired motor vehicle registrations are not acceptable.

Employment Document A document showing that the client is employed in California, such as an earnings statement or paystub.

Registration With Employment Agency

A document showing client is registered with a California employment agency (public or private).

Step Action

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7.3.2 Other Evidence of Residency

Applicants who cannot provide one of the “specified documents” previously listed must sign and date the “Important Information About Residency” (MC 214).

On the MC 214, the client is declaring under penalty of perjury that he/she does not have one of the requested specified residency verification documents.

School Enrollment Papers showing the client's children in the home have enrolled in a California school. Verification must show enrollment during the month of application, or during the term immediately prior to the month of application, if school is not currently in session.

NOTE: Written evidence from the school is required. Telephone calls or other collateral contacts are not acceptable.

Receipt Of California Public Assistance (Other Than Medi-Cal)

Evidence showing the client is receiving public assistance other than Medi-Cal, at an address in California.

IMPORTANT: For purposes of “Residency”, the term “public assistance” includes other federal, state, county or city government benefits, such as, but not limited to, Social Security. This may be the only available “specified document” for an aged applicant who is in a nursing home.

California Voter Registration The Voter registration Form and Receipt, by itself, is not sufficient to establish that the applicant is a resident of California. The EW may accept a copy of the Voter Registration Form and/or Receipt along with other evidence the applicant may provide to support his/her claim of California residency. (i.e. property records, California ID, court documents with an address, etc.)

There are three voter registration documents that can provide evidence of California residency:

• Voter Registration Form and Receipt, along with other evidence

• Voter Notification Card• Abstract of Voter Registration

Current California Rent/Mortgage Receipt or Statement; or Current Utility Bill

Rent, mortgage, and utility receipts or statements must be in the client's name and include a California address. A “current” receipt or bill means the month prior to, or the month of application for Medi-Cal.

Specified Residency Documents Additional Information/Requirements

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The EW will then consider other evidence produced by the client in addition to completion of the MC 214. Evaluate such evidence for authenticity and consistency with the client's statements (on the MC 210, etc.) and other known facts and information.

The following list includes, but is not limited to, documents which may also be used to verify a client's statement of California residency:

• Records showing the client owns property or pays property taxes in California.

• California church records.

• A current and valid California school I.D.

• Recent marriage or divorce records issued in California.

• Recent court documents showing client's California address.

• California insurance documents.

• Police records from a California law enforcement agency.

• A listing in the city directory or phone book, provided the EW can verify that the client is in fact the person listed.

• Statements from a homeless shelter or other public or community service agency in California indicating that the client is receiving services from the agency.

• California adoption records.

• Any other available information provided to the EW during eligibility determination which supports the client's claim of California residency.

Note:Whenever there is contrary evidence that the EW believes is sufficient to determine that the applicant/beneficiary is not a California resident, the facts supporting that finding must be documented in the case file. If the questions raised by the contrary evidence are resolved, that information must also be documented in the case file.

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7.3.3 Rent Receipt From a Relative

Acceptable verification of residency includes rent receipts or statements from the client's relative. However, if a rent receipt from a relative is the only evidence of residency that can be provided, it must be verified on the form, “Income In-Kind/Housing Verification” (MC 210 S-I). This includes rent paid with in-kind services (earned income in-kind). The form includes the applicant and provider-relative's declaration under penalty of perjury that the information is true and correct.

The provider-relative signing the MC 210 S-I does not have to live with the Medi-Cal applicant. However, there must be evidence which establishes that the relative completing the form is the one responsible for paying the property expenses.

7.3.4 Free Housing

A written statement from a provider confirming free housing (unearned income in-kind) to an applicant can serve as “other” evidence of residency. However, as “other” evidence, the “Important Information About Residency” (MC 214) must be signed by the applicant or beneficiary.

If free rent is received from a relative, verification must be completed on the MC 210 S-I form, when the client has no other proof of CA residence. Again, as “other” evidence, the client must sign the MC 214.

7.3.5 Unmarried Parents

Unmarried parents are not considered related to each other, even if they have mutual children. Therefore, if one unmarried parent (the applicant) pays rent to, or receives free rent from, the other unmarried parent, the MC 210 S-I is not required in residency verification.

Example:An unmarried pregnant woman applies for Medi-Cal for herself and unborn. Also in the home are her two-year old daughter and her daughter's father (they are not applying for Medi-Cal). The housing bills are in the unmarried father's name and he pays the expenses. She has no income and does not pay rent. The unmarried father may complete a statement verifying free housing as evidence of residency for the applicant. The MC 210 S-I is not required. The applicant must sign the MC 214 as this is “other” residency verification.

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Example:The same situation above, except that the woman has income and shares in paying the housing expenses. A rent receipt or statement from the unmarried father may be used to verify residency. Because a rent receipt is a “specified” document, the MC 214 DOES NOT have to be signed by the applicant. As a nonrelative, the unmarried father DOES NOT have to complete the verification on the MC 210 S-I.

7.3.6 Migrant Workers

Migrant workers are those workers that travel from place to place, changing residences to seek agricultural related work.

Some migrant workers do not intend to reside permanently or indefinitely in California. However, they can establish California residency based on having entered the state with a job commitment or to seek work, whether or not currently employed. A declaration of intent to remain permanently or indefinitely is not required. A migrant worker may establish California residency even if he/she plans to return to a residence in another state.

To establish California residency, based on having entered the state to work, the migrant worker must provide all of the following information:

• Proof of employment in California, or proof of seeking employment. Examples of evidence include:

• Paystubs in the client's name, from an employer in California.• Employer letter indicating a job offer in California.• An employment contract from an employer in California.• A letter from a prospective employer acknowledging inquiries about work in

California.

• Complete the “Important Information About Residency” (MC 214), when appropriate.

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7.3.7 Homeless Persons

Homeless persons may have difficulty proving California residence due to a lack of a fixed address or stable living arrangements. EWs shall follow these steps in obtaining residency verification from a homeless person:

IF the homeless client... THEN the EW shall...

Is applying for Medi-Cal, Request one of the specified documents verifying residency.

Does not have any of the specified documents,

Have the client complete page 5 of the MC 219 and request any other evidence. (The evidence does not have to include a client address.)

Does not have other evidence of residency,

Suggest any verification documents provided by an agency in California showing a CA address to which the client has access.

EXAMPLES: Letter from a homeless shelter or other public or community service agency stating that the applicant is receiving services from the agency; police records from a CA law enforcement agency; church records; a current & valid school I.D.; marriage or divorce records issued in CA; court documents; medical records.

Is unable to provide verification from a California agency,

Request any document or any form of identification. Review the document to ensure information supporting the client's claim of CA residency is included.

Still cannot provide any document or any form of identification,

Ask the client whether he/she ever received public assistance in CA, and request permission to obtain such information.

Has not received public assistance in CA, and is unable to provide any other documentation,

Deny application due to lack of CA residency.

7.3.8 Foreign Students and Others With Non-Immigrant Visas

Foreign students and others with non-immigrant visas who reside in California may have plans to return to another state or country at some point in the future. When making a determination of California residency for these persons, the individual's intent to remain, including the actions taken to establish residency, is more important than whether the person plans to leave at some point in the future. Foreign students and others who:

• Set up residency for the period of time their activities last, and• Declare the “intent to remain for an indefinite period of time” and

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• Provide satisfactory verification of residency,

can meet residency requirements. They if otherwise eligible are entitled to receive Medi-Cal benefits.

Note:Possession of a current and valid non-immigrant visa that allows entry into the United States for a period of less than one year is NOT, by itself, evidence that the applicant or beneficiary possessing such a document is not a resident of California. The EW must determine California residency based on the preponderance of the evidence produced by the applicant.

7.3.9 Holders of Border Crossing Cards and Temporary Visas

A Border Crossing Card is an identity document issued to an alien who is a resident of a foreign contiguous territory.

A short-term visa is any visa which allows entry for a period of less than one year.

Possession of a current and valid Border Crossing Card, or any current and valid visa that allows entry into the United States for a period of less than one year (including but not limited to, B-1/B-2 visas) shall NOT automatically establish that the applicant or beneficiary possessing such a document is not a resident of California.

In determining eligibility, EWs must consider all available evidence, including evidence that supports a claim of residence as well as evidence that contradicts a claim of residency. To overcome the evidence of non-residency in California that a border crossing card or short-term visa represents, THE APPLICANT or BENEFICIARY MUST SUBMIT OTHER EVIDENCE WHICH SUPPORTS A FINDING OF CALIFORNIA RESIDENCY.

If the EW determines that someone with a border crossing card or short-term visa is a California resident, the basis of that finding must be documented in the case file.

An applicant or beneficiary who is known to possess a current and valid Border Crossing Card or short-term visa must NOT be automatically denied eligibility on the basis that he/she is NOT a resident of California.

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Note:It is possible for an individual to hold a border crossing card or short-term visa AND also be able to verify that s/he is lawfully admitted for permanent residence.

7.3.10 Entry to Seek Medical Care

The California residency of an applicant who seeks medical care immediately after entering the state and who applies for Medi-Cal to cover the costs must be closely examined. EWs must ask the applicant some of the following questions:

• Is this a pre-existing condition?

• Is treatment for the medical condition available in the state or country of origin?

• Was this treatment pre-arranged before the applicant came to California?

• Does the applicant have a spouse and/or minor children still living in the other state or country?

• Does the applicant have a round trip ticket?

• Is the applicant maintaining a home in the other state or country?

• Is the applicant staying with friends or relatives?

An applicant who has entered the state to seek medical care may establish California residency when all the evidence and information provided supports a finding that the applicant is a California resident.

However, there also may be situations when an applicant does not meet California residency requirements. EWs are not required to accept an applicant's stated intent to remain in California, or any evidence supporting a claim of California residence, when there is sufficient evidence to the contrary. In such cases, the application must be denied. [Refer to “Discrepancies/Evidence to the Contrary,” page 7-15]

7.3.11 Case Documentation

EWs must make a copy of all residency verifications for the case record. Written evidence must be on file. It is not acceptable to use collateral contacts as residency verification.

Revised: 08/13/2015 Update # 2015-20


Documents obtained to meet other Medi-Cal eligibility requirements may also be acceptable as verification of residency.

Example:EWs may accept a driver's license or DMV identification card to verify the identity of the client. These documents may also be used to verify residence. Whenever the EW does not request a separate residency verification document because the file already includes one, it must be noted in the case record the particular document used to verify residence.

Reminder:If one of the specified documents is not used as residency verification, client must complete the “Important Information About Residency” (MC 214).

7.3.12 Unacceptable Evidence

CSF 2 affidavits, declarations, or other statements from the client or any other person are not acceptable as verification of residency. To verify California residency, the client must produce some acceptable evidence beyond a sworn statement.

A landlord (including a friend or relative) who is providing free housing to an applicant or beneficiary may complete a statement to that effect for purposes of residency verification. [Refer to “Free Housing,” page 7-8] and [Refer to “Unmarried Parents,” page 7-8 for additional information.]

7.4 Principal Residence

If the applicant declares a principal residence outside of California, then California residency is questionable. The EW must then review the circumstances to see if the principal residence is exempt and if the other facts support the applicant's claim of California residency. Or, is there any evidence that contradicts the client's declared California residency? The following areas should be considered:

• Circumstances surrounding the client's decision to come to California.• At the time of application, whether the client already had plans to leave

California.

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Having an exempt principal residence outside the state should raise questions about the client's residency, but does not necessarily disqualify him/her from eligibility for Medi-Cal.

Example:Exempt out-of-state principal residence and California residency: The applicant and his spouse own a home in Arizona which was their former residence. Their adult son now resides in the home. The applicants have no present intent to leave California; they are renting an apartment here and have CA driver's licenses. They have no other real property. The EW establishes that the former home is an exempt principal residence and that the couple are residents of California. An individual in a nursing home declares “intent to return” to her former home in Oregon. She has no other real property. The EW determines, based on the statements made by her representative, that the client is not likely to leave the nursing facility. The home is an exempt principal residence and California residence is established. [Refer to “Principal Residence,” page 48-1 for regulations pertaining to principal residence.]

7.5 Public Assistance/Government Benefits

The applicant is also declaring that he/she does not receive public assistance at an address outside of California. For purposes of establishing California residency, the term “public assistance” includes any type of assistance such as CalWORKs, Food Stamps, GA, etc. It also includes any type of federal, state, county or city benefits (including pensions), paid to the applicant at an address outside of California, for example, Social Security.

Exception:It does not include unemployment insurance benefits.

If such benefits are being paid to an address outside of this state, then the EW must determine if the applicant meets California residency requirements. Is there verification that the payor has been notified of a change in address? If no, deny Medi-Cal due to lack of California residency unless there is other credible evidence.

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Note:Public assistance or other types of government benefits paid to the applicant at a California address can be used as one of the eight “specified documents” to verify residency.

7.6 Discrepancies/Evidence to the Contrary

An applicant’s declaration of residency together with the evidence required to establish California residency is accepted unless there is evidence to the contrary. In general, evidence to the contrary is any information available to the EW that contradicts an applicant or beneficiary’s claim that he/she is a California resident. This evidence may include (but is not limited to) information or documents which show the applicant:

• Entered the state for a visit or other temporary purpose.

• At the time of application, has plans to leave the state to return to another state or country (for example, the applicant has a return airline ticket) and the applicant has not previously established and continuously maintained California residency.

• Entered the state to obtain medical care.

• Was granted a short-term legal entry to obtain medical care.

• Possesses a Border Crossing Card.

• Has a spouse and/or minor children remaining in another state or country who lived with the applicant immediately prior to his or her arrival in California.

• Possesses any visa of a temporary nature (similar to B-1/B-2 visas).

• Operates a business outside of California.

• Has motor vehicles registered in another state or country.

• Receives public benefits from another state or country.

• Maintains a home outside of California.

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Reminder:This evidence to the contrary DOES NOT automatically render a beneficiary or applicant ineligible or a non-resident.

Any evidence of residency submitted by the client must be consistent with other statements and information supplied by the client or otherwise made available to the EW. EWs must request additional clarification or verification if the residency verification is questionable. Any discrepancies that arise, and any information which resolves those discrepancies, must be documented in the case record.

Medi-Cal residency regulations provide that a client has established California residency if a “preponderance of the credible evidence” supports a claim of California residency. This means that when the EW reviews all the information available, including any resolved or unresolved discrepancies, and the determination is that all evidence indicates the client is more likely to be a California resident than not, California residency requirements are met.

If after reviewing all the available information in the case, including any resolved and unresolved discrepancies, the EW determines the client is more likely not to be a California resident, the Medi-Cal application must be denied or discontinued.

If after reviewing all available residency information in the case, the EW is unable to determine whether or not the applicant/beneficiary’s claim of California residence is supported, the Intake EW should request an investigation of the facts by initiating a “FRED” referral to the Department of Health Services (DHS) prior to making a final eligibility determination. [Refer to Common-Place Handbook, “Intake Investigation Referrals (FRED),” page 38-6.]

7.7 Temporary Absence

7.7.1 Definition [50321]

When a person is absent from the state less than 60 days it shall be presumed to be a temporary absence unless there is evidence to the contrary. Residence may be considered terminated when the beneficiary leaves California and takes any of the following actions in another state:

• Buys, leases, rents a residence.• Becomes employed.• Obtains an out-of-state driver's license.

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• Applies for aid.

7.7.2 Temporary Absence, More Than 60 Days [50323]

When a person is absent from the state for more than 60 days, it shall be presumed to be a change of residence unless the person declares in writing, both:

• An intent to return to California, and

• The existence of the following circumstances:

• Illness or emergency circumstances which prohibit the return.

• Family members with whom the beneficiary lives are California residents and are physically present in the State.

• The beneficiary maintains California housing arrangements.

7.7.3 EW Actions

The EW shall send a letter to the client to request for information when a beneficiary is absent from the state for 30 days, tickle the case for return of the information, and discontinue if necessary.

[Refer to “Tax Dependency Requirements,” page 59-3 regarding tax dependency.]

[Refer to “Out-of-State Billing,” page 64-26 for information on out-of-state billing.]

7.8 Out-of-State Students

For the purpose of California residency there are two types of out-of-state students:

1. Students attending school in California, but planning on returning to their residence in another state, and;

2. Students who have Medi-Cal coverage in California but attend school in another state.

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In general, an out-of-state individual attending school in CA can meet residency requirements for MC eligibility purposes even if they plan on returning to their state of residence between school years.

Similarly, MC clients can remain MC eligible if they leave CA temporarily to attend school in another state. In both cases, all CA residency requirements apply. A “temporary absence” from the state does not have a specific time-frame requirement but a 60-day absence can lead to presumption that a client is no longer a CA resident. Therefore, an individual who leaves the state temporarily to attend school should inform the County of his or her intent to maintain CA residence during a temporary absence from the state.

This MC Update does not supersede the suspension of paper verification of state residency as provided in Program Directive (PD) 2014-5.

An individual must reside in CA and meet all other eligibility requirements to be eligible for MC in CA.

For most individuals, CA residency is established if he or she:

• Is living in CA and intends to reside in the state; or • Entered the state with a job commitment or to seek employment, whether or not

currently employed.

7.8.1 Individuals Who Come to California to Attend School

To meet the CA residency requirement for MC, the client must be a resident of CA and cannot be commuting into CA to attend school. In general, an individual may not receive Medicaid/(Medi-Cal) coverage in more than one state at the same time. However, an individual can receive MC in two states during a transition from one state to the other, as long as the termination date is set in the previous state. All other MC eligibility rules and regulations apply.

If the individual. . . Then . . .

Comes to CA from another state or country to attend school,

He/she has the option to apply for MC while residing in CA.

Was on Medicaid (the equivalent to MC in other states) in his/her prior state of residence, and is otherwise MC eligible,

The Medicaid must be discontinued in his/her previous state as soon as possible to meet the CA residency requirement for MC.

Is claimed as a tax dependent, They must provide the tax household and income information when they apply for MC.

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7.8.2 California Residents Attending School in Another State

A client may continue MC coverage in CA if attending school out-of-state as long as the absence is temporary.

If the client. . . Then . . .

Leaves CA temporarily to attend school out-of-state, and informs the county that he/she plans to return to CA,

His/her MC may continue (if otherwise eligible).

In this case, the address in MEDS should remain as the CA address to which the client plans to return.

Chooses to discontinue MC in CA and apply for Medicaid in the state in which he/she is attending school,

The MC should be discontinued as quickly as possible with proper notice. The individual must follow Medicaid application rules in the new state of residence.

Is an out-of-state student who maintains CA MC coverage and needs services while he/she is temporarily absent from CA,

• MC will only cover emergency services.

• Emergency Services are only covered in the United States, Canada and Mexico.

• The Out-of-State provider must agree to accept MC and meet the requirements as detailed on http://files.medi-cal.ca.gov/pubsdoco/contact/services.asp

• The student can contact the Out-of-State Field Office at (415) 904-9608 for more information of Out-Of-State MC coverage.

7.8.3 Parents of Out-of-State Students

Parents and Caretaker of out-of-state students may continue receiving MC without change if the student continues to meet the following criteria:

If the student. . . Then . . .

Is a tax dependent, temporarily leaves the state and terminates his/her MC in the Primary Tax Filer’s household,

The Primary Tax Filer’s household size is not impacted as long as the student is still being claimed as a tax dependent.

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http://files.medi-cal.ca.gov/pubsdoco/contact/services.asp




7.8.4 CalWIN Entries for Out-Of-State Students

For eligible out-of-state students requesting MC, complete the windows as follows:

Collect Individual Residency Detail Window

• Home County: The original county the client moved from.• Intent to Reside: Yes• CA Resident: Yes• Intent to Reside: Yes• Client Out of: State

Collect Case Individual Detail Window

• In Home: No• Temporary Absence: Yes

Is the only eligible child on the case and temporarily leaves the state,

The parent(s)/caretaker(s) will retain linkage, as long as the student meets the requirements.

• Age requirement as detailed in Update 2014-23.

• The parents are still primary caregivers/financially responsible for the student.

• The student still “resides with” the parents/caretaker.

If the student. . . Then . . .

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• Reason for Absence: School

Collect Individual Address Detail Window

• Home Address: The address of the state where the individual is attending school.

• Mailing Address: If the client wants to use the out-of-state address to get mail, they can. It will not affect eligibility. They can also choose to receive mail at their original address in Santa Clara County.

Home Address

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Mailing Address

•

7.9 Out-of-County Students

When a family reports that their child attends college outside of the family’s residence county, CalWIN must be updated so the correct address and eligibility information are sent to MEDS. Once the correct information is in MEDS, the student will be discontinued from their current health plan and information will be sent to the student to enroll in a health plan in the new county. Until a new plan is selected, the student will have access to Fee-for-Service MC.

7.9.1 CalWIN Entries for Out-of-County Students

For eligible out-of-county students requesting MC, complete the windows as follows:

Collect Case Individual Detail Window:

• In Home: No• Temporary Absence: Yes

Revised: 08/13/2015 Update # 2015-20


• Reason for Absence: School

Collect Case Individual Residency Detail Window

• Home County: Santa Clara• Intent to Reside: Yes

Collect Individual Address Detail Window

• Home Address: The address of the county where the individual is attending school.

• Mailing Address: If the client wants to use the out-of-county address to get mail, they can. It will not affect eligibility. They can also choose to receive mail at their original address in Santa Clara County.

Update # 2015-20 Revised: 08/13/2015


Home Address

Mailing Address

Revised: 08/13/2015 Update # 2015-20