MEDI-CAL OUTREACH
& ENROLLMENT
IN PARTNERSHIP WITH THE LOS ANGELES COUNTY
DEPARTMENT OF MENTAL HEALTH (DMH)
LADMH@HEALTHADVOCATES.COM
844-694-8459
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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DMH PARTNERSHIP – CONT.
• 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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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.
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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.
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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 & IMMIGRATION
THE 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 Alien
Permanently 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
LADMH@HEALTHADVOCATES.COM
• 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 JOSEPHINEH@HEALTHADVOCATES.COM
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ACCOUNT LOADING LOG
Client
SPA Auth Form
Obtained
PATIENT NAME
RESPONSIBLE PARTY
ADDRESS1
ADDRESS2
CITY
STATE
ZIP
PHONE
SSN
DOB
Gender Race/
M/F
Ethnicity
Primary
Language Homeless
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QUESTIONS
LADMH@HEALTHADVOCATES.COM
844-694-8459
844-694-8460 FAX
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