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 50185 - Applicants' and Beneficiaries' General Responsibilities

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) As a condition of eligibility, applicants
					 and beneficiaries, and persons acting on behalf of such applicants or
					 beneficiaries, shall:
(1) Complete and
					 participate in the completion of all documents required in the application
					 process or in the determination of continuing eligibility.
(2) Make available to the county department
					 all documents needed to determine eligibility and share of cost, as specified
					 in Sections
					 50167 through
					 50172.
(3) Report all facts that are pertinent to
					 the determination of eligibility and share of cost.
(4) Report the following facts to the county
					 department that may affect the determination of eligibility and share of cost
					 within 10 calendar days following the date the change occurred:
(A) Change of address.
(B) Change in property or income.
(C) Change in family composition.
(D) Change in other health care
					 coverage.
(5) The
					 requirement to report to the county department and to any provider of health
					 care services any existing contractual or other legal entitlement to other
					 health care coverage; and, to fully utilize other health care coverage before
					 using Medi-Cal benefits. The information to be reported shall include the name
					 of the other health care coverage, policy and group numbers, and termination
					 date, if available.
(6)
					 Responsibility to report to the county department the availability of any
					 option to obtain other health care coverage through, but not limited to, the
					 beneficiary's employer, labor union, trust fund, spouse or parent and to
					 provide information necessary for the Department to determine if it would be
					 cost effective for the Department to pay the premium to obtain or continue
					 other health coverage.
(7) The
					 requirement to apply for, and/or retain any available other health care
					 coverage when there is no premium cost to the beneficiary. Compliance with this
					 requirement shall be a condition of coverage for Medi-Cal covered benefits to
					 the party responsible for the acquisition or continuance of such health care
					 coverage, and shall not interfere with Medi-Cal benefits provided to the
					 remaining family unit.
(8)
					 Cooperate fully in any investigation that may be required for quality
					 control.
(9) Report, apply for, and
					 utilize all other health care coverage available to the individual or family
					 group in accordance with Section
					 50763.
(10) Complete Medi-Cal status reports in
					 accordance with Section
					 50191(a) or
					 (b).
(11) Promptly notify the county department
					 which initially established Medi-Cal eligibility of any changes in residence
					 from one county to another within the state and apply for a redetermination of
					 eligibility within the new county of residence. "Apply for a redetermination of
					 eligibility," as used in this section, is defined as any clear expression to
					 the county department, whether verbal or written, that the beneficiary is
					 living in the county and wishes to continue receiving Medi-Cal.
(12) Cooperate with the state, county
					 department, and the district attorney's office in all of the following:
(A) Establishing paternity for a child under
					 eighteen years of age born out of wedlock for whom Medi-Cal is
					 requested.
(B) Obtaining medical
					 support and payments; and
(C)
					 Providing all of the information requested by the state, county department, and
					 district attorney's office, which is necessary to identify, locate, and pursue
					 any third party, including an absent parent, who is or may be liable for
					 medical care and services or support.
(13) In the case of a woman who is pregnant,
					 or a child who was born out of wedlock or whose parent is absent from the home,
					 at the conclusion of the 60-day postpartum period:
(A) Complete the Child Support Questionnaire
					 (CA 2.1 Q Support Questionnaire, Revised 3/93), the Child/Spousal and Medical
					 Support Notice and Agreement (CA 2.1 Notice and Agreement, Revised 12/92), and
					 any additional forms specified in the district attorney and approved by the
					 Department of Health Services;
(B)
					 Appear at the county department and at the office of the district attorney to
					 provide information, when requested;
(C) Provide to the county department and to
					 the district attorney all information which is relevant to the case.
(D) Appear as a witness in court or in other
					 hearings and proceedings relating to (9) and (10) above.
(14) Assign to the state all rights to any
					 medical support and to payments for medical care from any third party, as
					 specified in Section
					 50157.