California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 2 - Determination of Medi-Cal Eligibility and Share of Cost › Article 4 - Beneficiary Application Process › Section 50167 - Verification-Prior to Approval

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
					 With regard to information on the Statement of Facts, the county department
					 shall obtain verification of the following items in the manner specified below,
					 prior to approval of eligibility:
(1)
					 Blindness, as determined in accordance with Section
					 50219, and federal disability, as
					 determined in accordance with Section
					 50223(a)(1) or
					 (b), shall be verified by any of the
					 following methods:
(A) By determining that the
					 person was eligible as an MN person on the basis of blindness or disability in
					 December 1973, and that there has been continuing eligibility since that
					 time.
(B) By obtaining verification
					 that a prior determination of blindness or disability is still valid.
					 Verification shall be documented by viewing any of the following or similar
					 items and noting in the case record the date of the award letter or
					 notification and the disability onset and reexamination dates:
1. A Social Security Administration Title II
					 award letter indicating receipt of disability benefits provided the
					 reexamination date has not passed or a reexamination date is not indicated and
					 the applicant is still receiving those benefits.
2. A Social Security Administration
					 notification that Title II disability benefits have been increased or decreased
					 provided the applicant is still receiving those benefits.
3. A Railroad Retirement Board notification
					 of a total and permanent disability award provided the applicant is still
					 receiving those benefits.
4. A
					 signed statement from the Social Security Administration that states that the
					 person is eligible for Title II benefits on the basis of a
					 disability.
5. Documentation of a
					 prior determination of disability under the MN program, if the determination
					 was performed within the last 12 months unless:
a. The reexamination date has
					 passed.
b. The applicant indicates
					 his/her physical or mental condition has improved.
6. Data on the SDX or a signed statement from
					 the Social Security Administration indicating that a person was discontinued
					 from SSI/SSP for reasons other than cessation of disability provided the
					 procedures specified in (D) are followed within twelve months of the SSI/SSP
					 discontinuance date.
(C)
					 By obtaining a letter from a physician verifying any of the physical or mental
					 impairments meeting the federal definition of presumptive disability or
					 blindness contained in Title 20, Code of Federal Regulations, Section
					 416.934, provided the procedures
					 specified in (D) are followed after eligibility is determined.
(D) By following procedures established by
					 the California Department of Social Services, Disability Evaluation Division.
					 All necessary information shall be submitted to that division not later than 10
					 days after the receipt of the Statement of Facts by the county, except in the
					 event of a delay due to circumstances beyond the control of the
					 county.