SOC Examples

Intake

SOC Applicant, No Retroactive Coverage

Joseph applies on September 6, 2017, and is determined eligible with a $300 SOC. He has $1500 in unpaid medical expenses with dates of service between June 2015 and August 31, 2017. When the required documentation has been received, these unpaid bills are to be divided and used to meet his SOC for September, October, November, December 2017 and January 2018.

Reminder: In January, a 10-day NOA must be issued in order to increase the SOC to $300 for February.

SOC Applicant, Retroactive Coverage Requested

Alexis applies for MC on September 23, 2017 and is determined eligible with $70 SOC. She asks for retroactive coverage for June, July and August 2017. She has unpaid medical bills in the amount of $35 for services provided in April 2017, one for $18 in May 2017 and a $350 bill for June 2017. The bills for April and May total $53, thus reducing the June SOC to $17. For June 2017, the $350 is used to meet her remaining June SOC ($17). The provider can then bill MC for the unpaid portion ($350 minus $17) of Alexis’ June bill.

In this case, there would be no remaining bills to reduce the SOC for current and continuing months. There is no requirement to use certain bills for certain months, only that the same medical expense or portion of a medical bill not be used twice.

Continuing

Saving Old and Current Bills to Apply in a Future Month

Adam has a SOC of $100 each month. Every month he pays approximately $20 for a prescription that is not covered by MC. Since this amount is less than his SOC ($100), he is never able to meet his SOC. Under the Hunt v. Kizer provisions, as long as he still owes the bills after five months ($20 times 5 months = $100 SOC), he can submit all of the $20 bills to meet his SOC for one month.

Ineligible Member of MFBU

Mrs. Brown and her children have had a SOC of $300 every month for the last two years. Her husband, Mr. Brown lives with her but he is not eligible for MC. He has a $3,000 hospital bill from three years ago which Mr. and Mrs. Brown still owe but which is not covered by insurance or any medical program. Mrs. Brown and the children may use his bill to meet their SOC for 10 months ($3,000 divided by $300 a month = 10 months).

Intake and/or Continuing

Client Fails to Provide Timely Documentation

Kyle is determined eligible for Medi-Cal on October 1, 2017, with a $100 SOC. He informs the eligibility worker that he has unpaid medical expenses for May and June 2017, but doesn't have a current bill with all of the required documentation.

In December 2017, he brings in the required documentation. His SOC is reduced beginning January 2018 until all of his unpaid medical expenses are applied to his SOC.

Old Medical Expenses for Persons No Longer in the MFBU

Morgan is applying for MC today. She has unpaid bills for her husband who died in May 2017. Her husband would have been a member of the MFBU had they applied prior to his death. Since medical expenses may be used for anyone who would have been a member of the MFBU on the date the medical expenses were incurred, Morgan’s husband’s unpaid bills may be used to reduce her future month(s) SOC.

Unpaid bills for individuals not in the home on the date the medical expenses were incurred may not be used to adjust a SOC. Further verification may be necessary to determine if the expenses are allowable.