Tuesday, April 28, 2009

Medi-Cal and the Regional Center

Given the current economic climate more and more families are being asked to apply for Medi-Cal by their Regional Centers as an additional funding source. Many people are unfamiliar with the process (as was I) so here's what I learned.

Medi-Cal is basically the California version of Medicare and is both funded by the state and the federal government. The Medi-Cal Home and Community-Based Services Developmental Disability Waiver (“Waiver”) allows Regional Centers to get reimbursed for services provided to Regional Center consumers. It’s a "waiver" because it allows Medi-Cal to only pay for certain services for Regional Center consumers and not other people who qualify for Medi-Cal. There are certain criteria that the client has to meet to qualify but its in the best interest of the Regional Center to qualify consumers because it is an additional funding source.

To qualify for the Waiver services the consumer has to be a Medi-Cal recipient. If the consumer is not a Medi-Cal recipient or is a Medi-Cal recipient with a share of cost because of income of his or her Parents or spouse then institutional deeming under the Waiver may qualify him or her for no share of cost under Medi-Cal. (This means that the family's income and resources are not deemed to the consumer, therefore making the consumer eligible for Medi-Cal if all other criteria are met.)

If the Regional Center determines that the consumer is eligible for Waiver services then they will contact Medi-Cal who will do a screening to determine if the consumer is eligible for Medi-Cal without having to pay a share of cost.

Besides providing additional funding for the Regional Centers, if the consumer is a Medi-Cal recipient then their family's contribution under the Family Cost Participation Program is $0. Typically, under the Family Cost Participation Program, which was implemented in 2005, families of consumers who are between 3 and 17 and live at home are required to pay a portion of the cost for respite, day care and camping services. If the consumer is a Medi-Cal recipient, however, including under the Waiver, then the family doesn't have to pay for any portion of the services under the Family Cost Participation Program.

If the consumer does not qualify for Medi-Cal under the waiver and you have to contribute to the cost of the services listed above then you need to submit the required paperwork to your Regional Center within 10 days of signing the completed IPP/IFSP or the Regional Center can set the family contribution at the maximum amount (80% of the cost of the service). The family contribution is based on a sliding scale and only families who have a gross annual income that is four times the Federal Poverty Level or more will have to make a family contribution. If you go to http://www.dds.cahwnet.gov/FCPP/Index.cfm there is a Family Cost Participation Calculator which will allow you to figure out what % your family contribution would be.

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