Medi-Cal Only - Direct Medical Support

(CCR 50175, 50185)

Requirements

In most instances, medical support enforcement requires that an NCP obtain medical insurance for his/her dependents; however, there may be a few situations in which a recipient receives direct support payments, specifically, for medical services. Should this occur, the recipient must turn in the medical support payments to the SDU or DCSS. The recipient is not required to turn in medical support in the month of application.

The EW must advise the applicant/recipient of the:

  • Requirement to turn any medical support received directly into the SDU or DCSS, and
  • The consequences of failing to do so.

Example 1Example 1  A recipient receives $100.00 from the absent parent each month specifically to pay for the family's health insurance premiums. The recipient must submit these payments to the SDU or DCSS within the same month they are received.

Example 2Example 2  A recipient receives $350.00 reimbursement from Blue Cross for medical services already paid by Medi-Cal. The recipient must turn in the monies to the SDU or DCSS.

The parent or caretaker relative who keeps directly received medical support payments or who fails to turn in the payments to the SDU or DCSS, is ineligible for Medi-Cal. He/she is treated as an ineligible member of the MFBU. His/her child(ren) remain Medi-Cal-eligible. The EW must ensure that the DCSS is notified that the recipient receives direct medical support payments, including situations in which the NCP is paying the child's medical expenses directly to the provider.

The EW must manually check the box in Section A of the CW 371 indicating the recipient is receiving direct medical support payments and action is needed to immediately transfer payments to SDU. A copy of the CW371 must be scanned into Imaging. A “Social Services Agency/Department of Child Support Services” SC 1603 may be used when a referral has already been made. The EW must inform the recipient receiving Medi-Cal Only benefits that he/she IS NOT required to turn in any direct child or spousal payments received.

Example 3Example 3  A recipient receives $200.00 month direct child support. Medical support regulations do not require her to turn in child support. The $200.00 is counted as income to the MFBU, with the appropriate child support disregard deduction allowed. The EW must inform the client that he/she can voluntarily have the DCSS enforce child support activities.

Example 4Example 4  The absent parent is ordered through the court to pay $450.00 child support, but has not been making the payments. A Medi-Cal Only client can have the DCSS enforce this court order by indicating this on the CW 2.1Q.

Procedure for Turning in Medical Support Payments

SSA staff must not accept any medical support payments brought into the District Office. If a recipient comes into a District Office to turn in support payments, they are instructed to mail the payment directly to:

State Disbursement Unit
P. O. Box 989067
West Sacramento, CA 95798

OR

Take their payment directly to:

Department of Child Support Services (DCSS)
880 Ridder Park Drive
San Jose, CA 95131

Budgeting

If a recipient is ineligible for Medi-Cal due to failure to turn in direct medical support received:

  • The amount of medical support received is to be counted as unearned income, and
  • The MFBU's eligibility for the disregard must be allowed. Only one disregard can be allowed for each month (not for each child).

A recipient is eligible for a disregard even though he/she does not turn in the direct medical support.

Example 5Example 5  A mother has been receiving and keeping the $150 received directly from the absent parent each month (for health insurance premiums). The EW has properly notified her and she will be an ineligible MFBU member effective May 1. When budgeting the $150, count it as unearned support income and allow the disregard. The health insurance premium paid remains an allowable deduction to the MFBU.

Example 6Example 6  A Medi-Cal only recipient receives the following monthly payments from the absent parent: $100 child support and $75 in cash to pay for health insurance premiums for their children. The recipient has been notified to turn in the monies, but has not done so. When budgeting the $100 and $75 monthly payments, total the amounts and enter $175 as unearned income. Allow ONE disregard each month.

Note: The health insurance premium paid by the client is an allowable deduction from the family’s net income or MFBU.

Related Topics

Direct Support & the State Disbursement Unit Overview

Medi-Cal Only - Direct Medical Support