Tuberculosis Program

The TB program provides limited coverage for outpatient TB-related services. Eligible individuals receive MC coverage for TB services at no cost to the client.

The TB program provides benefits to TB-infected individuals who are:

Otherwise ineligible for MC

Currently receiving full-scope MC with a share-of-cost

Individuals who are MC eligible with no SOC are not eligible for the TB program, as MC already covers TB-related care for these clients.

Covered Services

Some of the services covered under the MC TB program include:

Prescription drugs,
Physician services,
Outpatient hospital services,
Laboratory, X-ray and clinic services,
Federally Qualified Health Center services,
Case management services, and
Services to monitor usage of prescribed drugs.

Aid Code

Adults and children eligible for the TB program are identified on MEDS as Aid Code 7H. TB eligibility information appears on the MEDS [INQ1] screen.

Dually Eligible

Some TB applicants may also be eligible for or currently receiving benefits under another SOC MC program. Individuals eligible for the following MC programs may also be eligible for the TB program:

AFDC-MN with a share-of-cost
ABD-MN with a share-of-cost
QMB, SLMB, or QWDI
Medi-Cal Dialysis or Parenteral Hyperalimentation (TPN).

TB Eligibility Criteria

To be eligible for the TB program, the following eligibility criteria must be met.

Income Limit

Eligible individuals must have net nonexempt income which does not exceed the TB program income limit, also referred to as the “TB income standard”. The TB income standard is the same one used for a disabled individual under the SSI/SSP program.

Resource Limit

Eligible individuals cannot exceed the TB property limit. The program property limit is the same amount that disabled persons may have under the SSI/SSP program.

Citizen/Alien Status

Individuals eligible for the TB program must be either a U.S. citizen or a noncitizen with legal permanent residence.

Note: Undocumented individuals, individuals here on a temporary visa, or any other person who would be eligible for only restricted MC benefits are not eligible for the TB program.
Undocumented non-citizens can receive TB-related care through county health clinics, even though they are ineligible for the TB program.

Certification of TB Infection

To be eligible for the TB program, an applicant must be TB-infected. This means that the applicant must:

Require preventive therapy for tuberculosis infection, or
Require treatment for active tuberculosis.

The determination of whether an individual is TB-infected is made by a physician. The “Medi-Cal Tuberculosis Program Referral” (MC 274TB, Part B), which is part of the TB application form, must be completed by the physician to certify TB infection.

Other Requirements

TB applicants and recipients must meet all other MC program requirements and must not be eligible for zero SOC or MAGI MC.

TB Child

A TB child is defined as a TB-infected applicant/recipient who is:

Unmarried, and
Under age 18, and
Living with his/her parent(s).

For purposes of TB eligibility determination, a TB child is subject to the deeming of parental income and resources.

Note: All individuals 18 or over, including an 18-21 year old who is a full time student and tax dependent of their parents, is treated as an adult for TB MC purposes.

Ineligible Spouse/Child

The spouse who is living with the TB applicant/recipient, but who is not applying for the TB program is referred to as an ineligible spouse.

A minor child who is living with the TB applicant/recipient, but who is not applying for the TB program, and is:

Unmarried and under age 18, or
Unmarried, between the ages of 18-21 and a full-time student, is referred to as an ineligible child.

These terms apply when determining if the applicant meets TB income and property requirements, and there is a spouse or minor child in the home who is not applying for the TB program.

Married Individuals

A married person is evaluated as an individual when determining TB income and resource eligibility. This rule applies whether one or both spouses apply for TB Medi-Cal.

The income of a married individual is income received in his/her own name.
The property of a married individual is his/her separate property and one-half of the community property.