Medically Indigent Adults

While an MI person is a resident of an SNF/ICF, he/she will receive limited MC services under aid code
53. MI individuals can receive all MC benefits with the exception of stays in Acute Care Facilities (hospitals). MI individuals receive the LTC Maintenance Need for the month(s) they are in the SNF/ICF.

Reminder: Clients should be evaluated for MAGI before aid code 53. If ineligible to MAGI, the following rules apply.

A person with a 53 aid code MC card is eligible to receive whatever outpatient treatment that is not available to them at the facility in which they reside.

Aid code 53 identifies a client as eligible for MC benefits limited to services received while residing in an SNF/ICF. The MC identification card for aid code 53 contains the following restriction message: “Services to acute hospital inpatients are not covered.”

Aid code 53 can be granted as long as the SNF/ICF verifies (verbal is acceptable) that arrangements have been made to accommodate the client’s admission to their facility. Most SNF/ICF do not accept clients without a 53 card upon admission. Document in the Journal page.

For acute care facilities with SNF beds:

Call the facility and verify the level of care patient is receiving with and Administrator, nursing station or billing clerk. Document in the Journal page, or
Request a signed statement on the facility's letterhead concerning the level of care the patient is receiving.

Retroactive Eligibility

These MIA-X's (exceptions) may be eligible for retroactive eligibility if both of the following conditions are met:

The MIA resided in an SNF/ICF for one day or more during the month of application, and
The MIA resided in an SNF/ICF for one day or more during the retroactive month(s) for which MC coverage is requested.

The retroactive month(s) (up to three) are also coded with aid code 53, and the same services are covered in the retroactive month(s) as in the current month of eligibility.

Medi-Cal Identification Card

Aid Code 53 identifies a client as eligible for MC benefits limited to services received while residing in an SNF/ICF. It is not necessary to input any special code to indicate eligibility to limited services. The MC identification card for Aid Code 53 contains the following restriction message: “Services to acute hospital inpatients are not covered.”

If acute care is needed, it may be provided through the Health Care Access Program within Santa Clara County’s health system (VMC, O’Connor, St. Louise Regional).

Note: Any MIA who goes to an acute care hospital outside of the county’s health system, will usually be referred to one of them if he/she has no other health coverage.

A client may have concurrent aid code 53 MC coverage and county medical assistance in any month medical services were received in an SNF/ICF and an acute care facility.

DDSD Approvals

Should a disability evaluation subsequently be approved, aid code 53 must be changed to a disabled aid type category (e.g. 63, 64, 67) at the disability onset date.

Terminating Benefits

If the client is subsequently released from the LTC facility, he/she is no longer eligible for MC as aid code 53. A 10-day notice is required to discontinue MC under this aid category.

EW Responsibilities for MIA

Health Care Access Program

The EW must refer any aid type 53 MIA person to the Health Care Access Program when that person becomes an inpatient at an acute care facility .DO NOT refer client to the MBA Medi-Cal units.

A MIA residing in a SNF/ICF is entitled to all benefits normally covered by MC. However, should that MIA person become an inpatient at an acute care hospital, any services provided during that hospital stay will not be covered by the MC program.