Medi-Cal What it Means to You - San Francisco Public Schools

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27. WHAT CAN I DO IF I DISAGREE WITH ANY DECISION ABOUTMY MEDI-CAL ELIGIBILITY OR BENEFITS?STATE HEARING: You get a Notice of Action (NOA) in the mail from theCWD whenever your MEDI-CAL eligibility changes. If you disagree witha decision, you should talk to your county eligibility worker. If you arestill dissatisfied, you may ask for a State hearing through the CWD or theCalifornia Department of Social Services. On the back of the NOA, youwill find out how you can request a State hearing and where to send yourrequest. If you disagree with the denial of a health benefit, you can also askfor a State hearing by:Writing to:California Dept. of Social ServicesState Hearing DivisionP.O. Box 944243, Mail Station 19-37Sacramento, CA 94244-2430Or by calling:California Dept. of Social ServicesPublic Inquiry and Response UnitToll-free Number: 1-800-952-5253 ORHearing impaired (TTY) only:1-800-952-8349You must ask for a State hearing within 90 days from the date on whichyou believe the wrong action took place. If you ask for a hearing before theeffective date of the action which stopped or lowered your MEDI-CAL benefits,you may continue to get the same MEDI-CAL benefits until the hearing.You or your representative can read the regulations about the MEDI-CALprogram and most of the facts in your case. Help is also available in somelanguages other than English, including Spanish. At the hearing, anAdministrative Law Judge will review the CWD’s actions to see if someonemade a mistake. You must either go to the hearing or give written noticefor someone to go in your place. You may bring others to represent youas witnesses. You may ask questions of the county representative or anyCounty or State witnesses.DISCRIMINATION: If you believe a decision about your right to getMEDI-CAL benefits was unfairly made because of your sex, race, religion,color, national origin, sexual orientation, marital status, age, disability orveterans status, you may file a written or telephone complaint with theDepartment of Health Care Services, Office of Civil Rights, MS 0009, P.O.Box 997413, Sacramento, CA 95899-7413, (916) 440-7370,(916) 440-7399 TTY or (916) 440-7395 FAX. Your complaint ofdiscrimination will be investigated.- 20 -
28. WHAT IF I HAVE BEEN HURT BY ANOTHER PERSON OR HURTAT WORK?If you are hurt by another person or hurt at work, you may use your BICto get services. You must report the accident or injury to your countyeligibility worker so that the MEDI-CAL program can be paid back by theresponsible party.Also, send or fax the information OR You may call:listed below to: (916) 650-0490Dept. of Health Care ServicesRecovery Personal Injury UnitP.O. Box 997425, MS 4720Sacramento, CA 95899-7425FAX (916) 650-65811. Your name, address, and phone number.2. Your BIC number, and Social Security Number.3. The date you were hurt and what happened.4. The name, address, and phone number of your attorney, if you hired one.5. The name, address, and phone number of the person who hurt you.6. The name, address and phone number of the liable insurance company;also add the policy number.7. If you were hurt at work, the name, address and phone number of youremployer.29. WILL MEDI-CAL BILL A DECEASED MEDI-CAL BENEFICIARY’SESTATE?MEDI-CAL may claim against the estate of a MEDI-CAL beneficiary who hasdied after October 1, 1993, only if:• MEDI-CAL paid for certain medical services after the beneficiary’s 55 thbirthday, and the deceased MEDI-CAL beneficiary had no survivingspouse, minor, or totally disabled child(ren), and• the MEDI-CAL claim against the estate does not create a substantialhardship on the heirs of the deceased MEDI-CAL beneficiary.MEDI-CAL shall impose a lien upon the equity interest in the home or otherproperty of an institutionalized MEDI-CAL beneficiary if certain conditionsare met. Such claims and liens may be reduced if it can be demonstratedthat a substantial hardship is created on the survivors or heirs of thedeceased MEDI-CAL beneficiary.- 21 -
Page 2 and 3: Table of Contents1. MEDI-CAL - WHAT
Page 4 and 5: have the support or care of one par
Page 9 and 10: 2. Fill out the application form(s)
Page 11 and 12: 14. All burial trusts/prepaid buria
Page 13 and 14: If any of this information is missi
Page 15 and 16: If you are having a claims payment
Page 17 and 18: Some services are restricted to two
Page 19 and 20: 19. WHAT IF I LOSE MY BIC, IT IS ST
Page 21: 23. IS MEDI-CAL MANAGED CARE THE SA
Page 25 and 26: 5. INPATIENT HOSPITAL CARE - Care y
Page 27 and 28: MEDI-CALLo Que SignificaPara UstedD
Page 29 and 30: 1. MEDI-CAL - LO QUE SIGNIFICA PARA
Page 31 and 32: • el primer año de vida de su be
Page 33 and 34: NO SE PROPORCIONAN SERVICIOS DE PAT
Page 35 and 36: encima del límite durante todo un
Page 37 and 38: (pruebas)?” Le dice qué pruebas
Page 39 and 40: cuentas, el inventario actual, incl
Page 41 and 42: servicios médicos que usted reciba
Page 43 and 44: • mandarle al Departamento de Ser
Page 45 and 46: 15. WHAT DOES THE BENEFITS IDENTIFI
Page 47 and 48: • Lentes (gafas) y aparatos para
Page 49 and 50: 20. ¿CÓMO OBTENGO SERVICIOS DE ME
Page 51 and 52: 23. ¿ES EL CUIDADO MÉDICO ADMINIS
Page 53 and 54: preguntas al representante del cond
Page 55 and 56: 3. PLAN PARA EL CUIDADO DE LA SALUD
Page 57 and 58: State of CaliforniaHealth and Human
Page 59 and 60: Lake County (17)Department of Socia
Page 61 and 62: Sacramento County (34)Department of
Page 63 and 64: Tehama County (52)Department of Soc

Medi-Cal What it Means to You - San Francisco Public Schools

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