Informing Requirements

The following forms and/or information must be provided to clients:

  • EWs must provide clients with the MC 219 and document that it was given/sent to the client. (The client is not required to sign and/or return it.)
  • The “Responsibilities of Public Guardians/Conservators or Applicant/Beneficiary Representatives” (DHCS 7068) must be completed and signed by the client's representative, if applicable.
    • Scan the original copy in IDM, and
    • Give a copy to the applicant/client.
  • For Non-MAGI: The “MC General Property Limitations for All MC Applicants” (MC 007) must be reviewed with applicants, and applicants must be informed of:
    • Property limits.
    • How property is exempted, counted, and valued.
    • Their right to reduce non-exempt excess property within the month of application. 
    • Options of how excess property may be reduced and how adequate consideration may be obtained to establish eligibility for the month MC is requested.
  • If the client declares other health, dental, or vision insurance, the correct other health coverage (OHC) code must be posted on MEDS. For mail-in applications, the EW must check the HIAR screen in MEDS and/or contact the client by phone to obtain the necessary information.
  • If the client declares a pending lawsuit due to accident or injury, the EW must ask the client to complete the “Potential Third Party Liability Notification” (DHCS 6168) form. Refer to Third Party Liability
  • Your Rights Under California Welfare Programs” (PUB 13) must be given to the applicant or to the AR.
  • Women, Infants and Children” (WIC) information must be given to pregnant women and to families with children (included in CW Intake packets).

Related Topics

HIPAA/PII

Application

Third Party Liability