As a condition of eligibility, applicants
and beneficiaries, and persons acting on behalf of such applicants or
(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 Sections50167 through 50172.
Report all facts that are pertinent to the determination of eligibility and
share of cost.
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
(A) Change of
(B) Change in property or
(C) Change in family
(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
(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
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.
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
(B) Obtaining medical
support and payments; and
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.
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;
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.