Medi-Cal Aid Codes and the CCT Project - California

1 Medi-Cal Aid Codes and the CCT ProjectAid CodeThe Department of Health Care Services (DHCS) has assigned specific Codes , terme aid Codes to identify the various types of recipient under the Medi-Cal aid Codes in this chart are meant toassist providers in identifying the types ofservices for which Medi-Cal and Public Health Program recipients are eligible. Thechart includes only aid Codes used to bill for services through the Medi-Cal claimsprocessing systems and for other non Medi-Cal programs that need to verifyeligibility throughthe Eligibility Verification System (EVS).

2 Note:Unless stated otherwise, these aid Codes in the master chart cover UnitedStates citizens, United States Nationals, and immigrants in a satisfactoryimmigration status. Satisfactory immigration status includes lawful permanentresidents, Permanently Residing in the Under Color of Law (PRUCOL) aliensand certain amnesty :May individuals with PRUCOL status enroll in the CCT Project ? , orPermanent Residence Under Color of Lawis notrecognized as an immigration status by Citizenship and ImmigrationServices (USCIS). This category was created by the courts and is a publicbenefits eligibility category.

3 If an individual claims PRUCOL statusandmeetsresident eligibility and other Medi-Cal requirements, s/he may be deemed eligibleto receive Medi-Cal designated as PRUCOL is an illegal alien and may have been able togive birth to a US citizen or be so debilitated that they collect SSI,or for otherhealth reasons, have benefits coming to them, ortheyare inthe process of filing toobtain such benefits. It means that they are illegal butmaystill stayin the the illegal alien can stay they have the same rights as if they were withPRUCOL status may not apply for citizenship.

4 ( ).Question:Do aid Codes stay the same for each person all the time?Answer:Aid Codes change depending on an individual s situation. Once anindividual residing in an inpatient nursing facility goes home, their aid code willchange from the one they had in the nursing facility to a community of this change, the Lead Organization(LO)will assist theCCTenrolleewith finding out what their aid code most likely will be prior to transition, to insurethe enrollee doesn t lose his/her Medi-Cal eligibility for services after :Does the LO need special permission to find this information out about aCCT enrollee?

5 Answer:Yes. The enrollee must complete/sign the Medi-Cal Appointment ofRepresentative Form, to allow the LO/transition coordinator (TC) to work with thecounty Medi-Cal eligibility office on behalf of the enrollee. See the URL below forthe form: :My local county Medi-Cal eligibility office will not work with theLO/TC, even though the form was signed by the :The LO needs to contact theCounty Medi-Cal policy /Program Coordinatorabout the issue, and request a contact person to work with on the CCT enrollee sMedi-Cal eligibility.

6 Check with DHCS CCT Nurses for a list of these county code Master ChartThe Aid Codes Master Chart was developed for use in conjunction with the Medi-Cal Eligibility Verification System (EVS). Providers must submit an inquiry to theEVS to verify a recipient s eligibility for services. The eligibility response returns amessage indicating whether the recipient is eligible, and for whatservices. Themessage includes an aid code if the recipient is eligible. If a recipient has anunmet Share of Cost (SOC), an aid code is not returned, since the recipient is notconsidered eligible until the Share of Cost is met.

7 A recipient may have more thanone aid code , and may be eligible for multiple programs and Aid code Master Chart lists the following information for each types of services for which the individual is eligible under that servicecodeare listed as one of the following: Full benefits; Restricted toa specific type of service listed: Restricted to emergencyservices; Valid for ambulatory prenatal care services; of Cost(SOC) or Spend down: Yes; No; or Y/N; : Disabled SSI/SSP Cash Medically Indigent Long Term Care (LTC) services.

8 Aid to the Aged Long Term Care (LTC).2 Information onMedi-Calaid codesmaybe found in theMedi-Cal Aid code MasterChartlocated on the Medi-Cal website. Use the following URL or type aid codemaster chart in the search box located in the upper right-hand Codes that show the individual currently is not eligible for CCT ServicesAidCodeExplanation53 This code is used for individuals who are aged 21 or older butunder 65 who are residing in an ICF or SNF. Benefits arerestricted to LTC and related services. Individuals, who mayhave a qualifying disability, can have aid code 53 during theperiod of verification of their disability status.

9 The aid codecould change, if verification is ascertained, and the individualmay be eligible to participate in eachindividual s aid code each month for several months todetermine eligibility for CCT before determining s/he is code is used for someone who is an undocumentedimmigrant who is receiving care in a LTC facility. If verificationof citizenship occurs, the aide code will s aid code each month for several monthsto determine eligibility for CCT before determining s/he isnot aid Codes that show the county individual s Medi-Cal eligibility is under former Supplemental Security Income/StateSupplementary Payment recipients who are aged, until thecounty re-determines their Medi-Cal former Supplemental Security Income/StateSupplementary Payment recipients who are disabled.

10 Untilthe county re-determines their Medi-Cal needs to check with his/her Medi-Cal EligibilityWorker to determine ifdocuments are needed for the redetermination. This code may result from anunopened Medi-Cal packet sent back return to sender due to an address change or anincorrect address. If needed information is not returned to the county Medi-Cal officein time, beneficiarymayloss his/her Medi-Cal eligibility is lost, beneficiarymay re-apply for services ServicesA Medi-Cal beneficiary receiving hospice services is eligible to be a CCT participant ifs/he meets the CCT residency and eligibility requirements(refer to Residency andEligibility Requirement Update below).