Cal. Code Regs. Tit. 22, § 50185 - Applicants' and Beneficiaries' General Responsibilities

(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.

(b) Applicants and recipients whose eligibility is determined by the Social Security Administration shall, as a condition of eligibility, comply with subsections (a)(9), (a)(10), and (a)(11) above, and report to the Department and utilize all other health care coverage available to them in accordance with Section 50763.

(c) If the Statement of Facts has been completed and signed by someone other than the applicant or beneficiary, the responsibilities stated in (a) and (b) shall rest with that person as well as with the applicant or beneficiary.

(d) The county shall assist the applicant or beneficiary as necessary in meeting the requirements of this section.

Notes

Cal. Code Regs. Tit. 22, § 50185

1. Amendment of subsection (a)(2) filed 12-15-77; effective thirtieth day thereafter (Register 77, No. 51).
2. New subsection (a) (7) filed 9-1-78; effective thirtieth day thereafter (Register 78, No. 35).
3. New subsection (a)(8) filed 6-14-84; designated effective 7-1-84 pursuant to Government Code section 11346.2(d) (Register 84, No. 24).
4. Amendment of section heading, subsections (a), (a)(6) and (b) and NOTE filed 4-16-93 as an emergency; operative 4-16-93 (Register 93, No. 16). A Certificate of Compliance must be transmitted to OAL 8-16-93 or emergency language will be repealed by operation of law on the following day.
5. Certificate of Compliance as to 4-16-93 order including amendment of NOTE transmitted to OAL 8-13-93 and filed 9-23-93 (Register 93, No. 39).
6. Amendment of subsection (a)(4), new subsections (a)(4)(A)-(a)(7), and subsection renumbering filed 9-10-97; operative 10-10-97 (Register 97, No. 37).

Note: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions Code. Reference: Sections 10740, 11004(a) and (b), 11053, 14001, 14008.6, 14011, 14016 and 14100.1, Welfare and Institutions Code; and 42 C.F.R. Sections 433.135, 433.136, 433.137, 433.138, 433.145, 433.146, 433.147, 433.148 and 435.604.

1. Amendment of subsection (a)(2) filed 12-15-77; effective thirtieth day thereafter (Register 77, No. 51).
2. New subsection (a) (7) filed 9-1-78; effective thirtieth day thereafter (Register 78, No. 35).
3. New subsection (a)(8) filed 6-14-84; designated effective 7-1-84 pursuant to Government Code section 11346.2(d) (Register 84, No. 24).
4. Amendment of section heading, subsections (a), (a)(6) and (b) and Note filed 4-16-93 as an emergency; operative 4-16-93 (Register 93, No. 16). A Certificate of Compliance must be transmitted to OAL 8-16-93 or emergency language will be repealed by operation of law on the following day.
5. Certificate of Compliance as to 4-16-93 order including amendment of Note transmitted to OAL 8-13-93 and filed 9-23-93 (Register 93, No. 39).
6. Amendment of subsection (a)(4), new subsections (a)(4)(A)-(a)(7), and subsection renumbering filed 9-10-97; operative 10-10-97 (Register 97, No. 37).