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Determination of Percentage Obligation
CalSAWS will determine the Percentage Obligation. The portion of medical expenses which the client is responsible for paying is based on the Annual Net Worth.]
Determination of Percentage Obligation
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NET WORTH |
PERCENTAGE OBLIGATION |
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Less Than $5,000 |
None |
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$5,000 - $250,000 |
MSTP-Only = 2% for each $5,000 of ANW |
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MSTP-Supplement = 1% for each $5,000 of ANW |
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More Than $250,000 |
Not Eligible for MSTP. |
The percentage obligation is applied after all other sources of payment have been exhausted. If the patient has Medicare, private health insurance, or any other non-Medi-Cal coverage, that coverage must be billed first. The patient’s percentage obligation applies to the balance remaining after payment by the other coverage.
Example: MSTP - OnlyExample: MSTP - Only
A Family’s Net Worth is $78,000. To determine the Total Percentage Obligation:
- Divide $78,000 by $5,000 = 15.6
- Round 15.6 down to 15.
- Multiply 15 x percentage obligation (15 x 2% = 30%).
Eligibility for the MSTP-Only program is being evaluated, therefore, a percentage obligation of 2% is required. The patient’s ANW is $78,000. There are 15 sets of $5,000 in the ANW. 15 x 2% equals 30% (Total Percentage Obligation)
The patient must pay 30% of each dialysis/TPN bill, after any insurance payments are received. MC will pay the rest.
Example: MSTP - SupplementExample: MSTP - Supplement
Costs which are obligated by the beneficiary under the MSTP-Supplement Program are applied to the MFBU’s SOC, permitting the beneficiary’s entire family to be certified as eligible when the SOC is met.
A family of four applies for MC and the MSTP-Supplement Program and is approved with a $100 SOC. The percentage obligation is 1%. The medical bill for dialysis from VMC for the month of May is $1,000.
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TOTAL BILL |
$1,000.00 |
for self-care dialysis clinic |
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- 800.00 |
Medicare pays (80%) |
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200.00 |
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- 80.00 |
Blue Cross pays |
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120.00 |
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- 1.20 |
1% obligation (120 x 1%) |
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118.80 |
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- 98.80 |
remainder of SOC |
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$21.00 |
VMC bills Medi-Cal |
The other family members can receive MC benefits when the SOC is met. The dialysis patient also receives MC benefits, including full-care dialysis.
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