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MEDI-CAL OUTREACH & ENROLLMENT
IN PARTNERSHIP WITH THE LOS ANGELES COUNTY
DEPARTMENT OF MENTAL HEALTH (DMH)
844-694-8460 FAX
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DISCLAIMER
►◄THIS PRESENTATION IS BASED ON THE MOST CURRENT
INFORMATION AVAILABLE TODAY.
►◄
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ABOUT US• FOUNDED IN 1990 • NEARLY 400 FTES; LARGE PERCENTAGE OF MULTI-
AND BILINGUAL STAFF • SUCCESSFUL TRACK RECORD IN QUALIFYING
PATIENTS INCLUDING THE HOMELESS, THE DISABLED & UNDOCUMENTED IMMIGRANTS FOR COUNTY, STATE & FEDERAL PROGRAMS SUCH AS MEDI-CAL AS WELL AS OTHER THIRD-PARTY RECOVERY BENEFITS INCLUDING SSI/SSDI, VA, COBRA, TPL, WORKERS’ COMPENSATION & NEW “HEALTH REFORM” PROGRAMS
• PARTNERED WITH OVER EIGHTY-FIVE (85) OF CALIFORNIA’S LEADING PUBLIC & PRIVATE HOSPITALS & HEALTH SYSTEMS TO HELP UNINSURED PATIENTS PAY THEIR HEALTH CARE COSTS.
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DMH PARTNERSHIP• HEALTH ADVOCATES HAS BEEN CONTRACTED BY
DMH TO PROVIDE OUTREACH AND ENROLLMENT SERVICES FOR MEDI-CAL BENEFITS
• TWO-YEAR PERIOD FROM JULY 1, 2014 – JUNE 30, 2016
• TARGET POPULATION IS NEWLY ELIGIBLE HARD-TO-REACH POPULATIONS• PERSONS WITH MENTAL HEALTH DISORDER NEEDS• PERSONS WITH SUBSTANCE USE DISORDER NEEDS• PERSONS WHO ARE HOMELESS• YOUNG MEN OF COLOR• FAMILIES OF MIXED IMMIGRATION STATUS• PERSONS WITH LIMITED ENGLISH PROFICIENCY
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• HEALTH ADVOCATES’ ROLE IS AS THE APPLICANT’S AUTHORIZED REPRESENTATIVE; WE DO NOT PROCESS OR APPROVE MEDI-CAL APPLICATIONS.
• HEALTH ADVOCATES PARTNERS WITH DMH TO GUIDE THE APPLICANTS THOUGH THE ELIGIBILITY PROCESS.
• THE APPLICANT IS RESPONSIBLE FOR COOPERATING IN THE MEDI-CAL PROCESS. APPLICANTS THAT FAIL TO COOPERATE MAY BE DENIED BENEFITS, AND HEALTH ADVOCATES WILL BE UNABLE TO ASSIST THEM.
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DMH PARTNERSHIP – CONT.
TRADITIONAL MEDI-CAL*• MINORS
• UNDER 21
• AFDC • PARENTS WITH MINOR CHILDREN IN THE HOME
• AGED • 65 AND OVER
• DISABILITY• PRECLUDES ALL SUBSTANTIAL GAINFUL ACTIVITY
FOR 12 CONSECUTIVE MONTHS
*MUST MEET THE PROPERTY GUIDELINES ESTABLISHED BY THE MEDI-CAL PROGRAM.
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MAGI MEDI-CAL*• 19 – 64 YEAR OLDS
• LESS THAN 138% OF FPL
• CHILDREN • HOUSEHOLD INCOMES UP TO 250% OF FPL
• PARENTS CARE-TAKER RELATIVES• UP TO 109% OF FPL
• PREGNANT WOMEN• UP TO 213% OF FPL
• FOSTER CARE YOUTH• IN FOSTER CARE AT AGE 18• NO INCOME LIMIT• UP TO AGE 26
*NO PROPERTY GUIDELINES TO FOLLOW. 7
HOMELESS• 1.4 MILLION CALIFORNIA RESIDENTS ARE NEWLY
ELIGIBLE FOR MEDI-CAL, INCLUDING 53% (742,000) OF HOMELESS INDIVIDUALS
• REASONS FOR NOT SIGNING UP:• DISCOMFORT IN TRADITIONAL MEDICAL SETTINGS;• LACK OF UNDERSTANDING ABOUT THE MEDI-CAL
ENROLLMENT PROCESS;• DISTRUSTFUL OF THE GOVERNMENT;• UNCERTAINTY ABOUT WHETHER THEY QUALIFY FOR
MEDI-CAL; AND• INABILITY TO PROVIDE NEEDED PAPERWORK (SOME
MAY BE VERIFIED ELECTRONICALLY):• BIRTH CERTIFICATES;• DRIVER'S LICENSES; OR• SOCIAL SECURITY CARDS. 8
MENTAL HEALTH DISORDER
• REASONS FOR NOT SIGNING UP:• LACK OF UNDERSTANDING ABOUT THE MEDI-CAL
ENROLLMENT PROCESS;• FEAR OF PROVIDING PERSONAL INFORMATION;• IRRATIONAL FEARS ASSOCIATED WITH VARIOUS
MENTAL CONDITIONS;• FAILURE TO UNDERSTAND THE NEED TO APPLY FOR
BENEFITS; AND• LACK OF CONCERN ABOUT THEIR WELL-BEING
ASSOCIATED WITH DEPRESSION OR OTHER MENTAL ILLNESSES.
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FORMER FOSTER YOUTH*
• REASONS FOR NOT SIGNING UP:• PROCESS FOR ENROLLMENT IS DIFFICULT AND
INACCESSIBLE;• CALL CENTER STAFF UNAWARE OF THE ELIGIBILITY
FOR THOSE FORMERLY IN FOSTER CARE; • EXCHANGE WEBSITE NOT PROPERLY PROGRAMMED
TO ENROLL SUCH INDIVIDUALS;• MISINFORMED ABOUT THEIR ELIGIBILITY STATUS; AND• PLACED ON A WAIT LIST WHEN THEY SHOULD BE
FAST-TRACKED FOR ENROLLMENT.
*RESEARCH SHOWS THAT FORMER FOSTER YOUTH SHOW HIGH RATES OF PSYCHIATRIC DISABILITY WITH NEARLY 33% OF SUCH INDIVIDUALS HAVING SYMPTOMS OF POST-TRAUMATIC STRESS DISORDER.
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ACA & IMMIGRATIONTHE FACTS•NO WAITING PERIOD FOR COVERAGE AS LONG AS YOU HAVE LEGAL STATUS
• NO MATTER HOW LONG ONE HAS BEEN IN U.S.•MUST HAVE PERMANENT RESIDENT ID NUMBER TO APPLY•APPLICATIONS CANNOT BE USED FOR IMMIGRATION ENFORCEMENT OR DEPORTATION•YOU DO NOT NEED TO DISCLOSE YOUR IMMIGRATION STATUS TO APPLY FOR COVERAGE FOR OTHER ELIGIBLE FAMILY MEMBERS
• EACH FAMILY MEMBER IS DETERMINED SEPARATELY FOR IMMIGRATION STATUS.
•YOU CANNOT BE DEEMED A “PUBLIC CHARGE” FOR RECEIVING MEDI-CAL
• IMMIGRATION STATUS IS UNAFFECTED BY HEALTH COVERAGE.
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CITIZENSHIP• HOW WILL AN INDIVIDUAL’S CITIZENSHIP AND
IMMIGRATION STATUS BE CHECKED? ONLY THOSE INDIVIDUALS IN A FAMILY WHO ARE APPLYING
FOR COVERAGE ARE REQUIRED TO PROVIDE CITIZENSHIP AND IMMIGRATION STATUS. APPLICANTS ALSO MUST PROVIDE A SOCIAL SECURITY NUMBER IF THEY HAVE ONE.
CITIZENSHIP AND IMMIGRATION STATUS FOR THOSE APPLYING FOR COVERAGE WILL BE CHECKED ELECTRONICALLY WITH SEVERAL SYSTEMS, INCLUDING THE SOCIAL SECURITY ADMINISTRATION, THE DEPARTMENT OF HOMELAND SECURITY, AND SAVE (SYSTEMATIC ALIEN VERIFICATION FOR ENTITLEMENTS). IF AN INDIVIDUAL’S STATUS CANNOT BE CHECKED THROUGH AN ELECTRONIC MATCH, THE INDIVIDUAL MAY PROVIDE OTHER DOCUMENTATION OF HIS OR HER STATUS.
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QUALIFIED IMMIGRANT• WHO IS A QUALIFIED IMMIGRANT?
QUALIFIED IMMIGRANTS GENERALLY INCLUDE:•LAWFUL PERMANENT RESIDENTS (OR “GREEN CARD HOLDERS”);•PERSONS FLEEING PERSECUTION, INCLUDING REFUGEES AND ASYLEES;•OTHER HUMANITARIAN IMMIGRANTS, INCLUDING THOSE GRANTED TEMPORARY PROTECTED STATUS;•CUBAN/HAITIAN ENTRANTS; AND•SURVIVORS OF DOMESTIC VIOLENCE, TRAFFICKING, AND OTHER SERIOUS CRIMES.
• QUALIFY FOR FULL-SCOPE MEDI-CAL BENEFITS
SEE HTTPS://WWW.HEALTHCARE.GOV/IMMIGRATION-STATUS-AND-THE-MARKETPLACE/ FOR MORE INFORMATION AND OTHER GROUPS THAT ARE LAWFULLY PRESENT.
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UNDOCUMENTED IMMIGRANT• UNDOCUMENTED IMMIGRANT OR NON-QUALIFIED
IMMIGRANT MAY RECEIVE RESTRICTED BENEFITS IF UNDER 138% OF FPL OR HAVE TRADITIONAL LINKAGE. NOT ELIGIBLE FOR FULL-SCOPE MEDI-CAL OR COVERED CALIFORNIA
• ARE INDIVIDUALS GRANTED DEFERRED ACTION UNDER “DEFERRED ACTION FOR CHILDHOOD ARRIVALS” (DACA) OR DREAM ELIGIBLE FOR MEDI-CAL?
THESE YOUTH ARE LAWFULLY PRESENT IN THE UNITED STATES AND CAN BE GRANTED WORK AUTHORIZATION AND SOCIAL SECURITY NUMBERS. ADDITIONALLY, THEY ARE ELIGIBLE FOR FULL-SCOPE MEDI-CAL BENEFITS UNDER PRUCOL.
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PRUCOL AlienPermanently Residing Under the Color Of Law
In general, immigrants are considered PRUCOL if:• They entered the United States without inspection• They are in the United States with expired documentation • Conditional entrance such as a work permit or VISA
and • INS knowingly permits them to remain in the U.S. rather than enforce
departure.Examples of undocumented immigrants who might qualify as PRUCOL include:
• Immigrants with a serious medical condition;• Immigrants who have been here for more than twenty years;• Immigrants who have been granted stays of departure by the courts;• Immigrants who are not being deported because of U.S. citizen children;
and• Immigrants whom, for political reasons, the government is not deporting.
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APPLICATION PROCESS• WAYS TO APPLY
• ONLINE• COUNTY OFFICE• TELEPHONE• MAIL
• VERIFICATION PROCESS• DATA HUB (ELECTRONICALLY)• PAPER VERIFICATIONS
• NON-DISABILITY CASES ARE REQUIRED TO BE PROCESSED WITHIN 45 DAYS
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ACCOUNT REFERRAL PROCESS
• COMPLETE ACCOUNT LOADING LOG WITH CLIENT(S) INFO
• GET AN AUTHORIZATION TO RELEASE PHI FORM SIGNED FOR EACH CLIENT
• FAX TO HEALTH ADVOCATES AT 844-694-8460; OR• SEND ENCRYPTED EMAIL TO
[email protected]• HEALTH ADVOCATES WILL THEN CONTACT YOUR
CLIENTS DIRECTLY AND BEGIN THE MEDI-CAL SCREENING PROCESS SHORTLY FOLLOWING RECEIPT OF THE LOG(S).
• LASTLY, IF YOU HAVE CLIENTS THAT HAVE ALREADY BEEN APPROVED FOR MEDI-CAL BUT ARE IN NEED OF SSI/SSDI ASSISTANCE, PLEASE CALL JOSIE HERNANDEZ HERNANDEZ, BUSINESS DEVELOPMENT COORDINATOR AT 818-286-3727 OR [email protected]
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ACCOUNT LOADING LOG
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SPAClient Auth Form Obtained
PATIENT NAME RESPONSIBLE PARTY ADDRESS1 ADDRESS2 CITY STATE ZIP PHONE SSN DOB Gender M/F
Race/ Ethnicity
Primary Language Homeless
