Limited Services for MIAs in SNF/ICF

The State discontinued the Medically Indigent Adult (MIA) category from the Medi-Cal program, with a few exceptions. One of the exceptions is the category of MIAs residing in a skilled nursing facility (SNF) or intermediate care facility (ICF) who are identified by Aid Code 53. While a MIA is residing in an SNF/ICF, they are entitled to all benefits normally covered by Medi-Cal. 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 Medi-Cal program.

County Responsibility

If acute care is needed, it may be provided through the Health Care Access Program within Santa Clara County’s health system. The EW must refer any aid code 53 MIA person to the Health Care Access Program when that person becomes an inpatient at an acute care facility. Do not refer the customer to Medi-Cal Benefits Assistance (MBA).

The MIA individual who goes to an acute care hospital outside of the county’s health system will usually be referred by the hospital to VMC/O’Connor/St. Louise Regional if he/she has no other health coverage.

If a disability evaluation is subsequently approved, Aid Code 53 must be changed to a disabled aid code category effective with or retroactive to the disability onset date.

Medi-Cal Benefits

Aid Code 53 identifies a recipient as eligible for Medi-Cal benefits limited to services received while residing in an SNF/ICF. The Medi-Cal record for individuals who are eligible for Aid Code 53 contains the following restriction message:

“Services to acute hospital inpatients are not covered.”

Retroactive Medi-Cal

MIAs may be eligible for retroactive Medi-Cal 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 Medi-Cal coverage is requested.

The retroactive month(s) are also coded with Aid Code 53, and the same services are covered in the retroactive month as in the current month of eligibility.

Reimbursements of IHSS CFCO Provider Payments Due to a Retroactive Spousal Impoverishment Evaluation

Retroactive Spousal Impoverishment evaluations for the IHSS CFCO waiver population can be evaluated back to the HCBS Spousal Impoverishment program implementation date of January 1, 2014. If an individual is found retroactively Medi-Cal eligible or is currently Medi-Cal eligible and their benefit is positively impacted by a retroactive Spousal Impoverishment evaluation (lower SOC) they may seek reimbursement for IHSS provider payments through the Conlan II reimbursement process.

Individuals seeking reimbursement for IHSS CFCO provider payments must have their retroactive IHSS eligibility established, retroactive Medi-Cal eligibility established and have a completed “Doctors Verification Form” (MC 604_MDV completed for the retroactive time period. Once the criteria are met, the recipient must contact the Beneficiary Service Center at (916) 403-2007 to request a Conlan II claim packet for IHSS. The Beneficiary Service Center will determine whether the claim is valid and the reimbursement amount. Individuals must contact the Beneficiary Service Center directly for any reimbursement related questions.

Undocumented Immigrants in LTC