Diligent Search

The diligent search process involves the “search” for an applicant's available income and resources when the applicant is unable to assist in the application process. The following are guidelines to be used in determining eligibility for persons who are comatose, amnesiac or otherwise incompetent and there is no friend, guardian, or relative available to supply the information necessary for a Medi-Cal (MC) eligibility determination.

The diligent search process requires the worker to take the following actions:

Diligent Search Process

Determine and document applicant’s competency.
Refer to the Disability Determination Service Division (DDSD) for a disability determination, excluding applicants who appear to be under 21 years old or over 64 years old.
Conduct reasonable search.
Determine eligibility based on diligent search findings.

Disability Determination Referral

Eligibility Workers (EWs) must determine eligibility for MAGI MC first before making a referral to Disability Determination Service Division (DDSD) for all persons whose eligibility is determined through Diligent Search procedures unless the individual is obviously under 21 years old or over 65 years old. The person making the referral must sign the “Authorization for Release of Information” (MC 220), and write “patient is comatose” on the face of the form. The forms “Disability Determination and Transmittal” (MC 221) and “Statement of Facts for Medi-Cal Regarding Disability” (MC 223) must be completed with all available information.

Diligent Search Review

The following is for persons with or without identification:

Persons With Identification

The County SSA must conduct the following search for a person with identification and document the results in the case.

Property search in the county of physical presence. (If there is information which indicates an address in another county, a property search must also be requested from the county). EWs can contact the County Assessor’s Office to determine if the applicant has any real property in Santa Clara County.
Verification of Social Security benefits via the “SSA Referral Notice” (MC 194) or “Social Security Information Request and Referral” (SCD 1955).
Verification of Veteran’s Administration benefits via form “Military Verification and Referral Form” (MC 05).
Verification of vehicle registration through written request to the Department of Motor Vehicles.
If the Income and Eligibility Verification System (IEVS) report indicates an account at a specific banking institution, request information from that bank. Request the bank to search for all accounts belonging to the individual. If the bank refuses to provide the requested information, the EW will document actions in the Journal Detail page.

When requesting any of the above information, include a cover letter indicating the circumstances, (i.e., the individual is comatose and therefore cannot sign a release of information form; there is no friend or relative to act on behalf of the individual, and the county is trying to establish MC eligibility).

Persons Without Identification

If a member of the hospital staff has attempted to establish the identity of a person who is admitted in a comatose, amnesiac, or senile condition, and the person’s identity remains unknown, the County SSA must document in the case record that a search by hospital staff was conducted to establish the identity of this person. The following are the instructions for establishing an identity to use in opening up a MC case and issuing MC cards.

Note: If a comatose person regains consciousness or is otherwise identified after eligibility is established, revise the case record to reflect the person’s true identity and eligibility status. If the person remains eligible for MC and a MC identification number has been assigned, change the aid code, if necessary. If the person is found to be ineligible, discontinue the case with a timely and adequate notice.

Name

If the person’s name is unknown, use either John C. Doe or Jane C. Doe for the case name. Clients are primarily identified by CIN and CWIN.

Aid Code

Generally, clients who require immediate healthcare coverage will be granted Hospital Presumptive Eligibility for a minimum of two months while MC eligibility is being determined. EWs will use the aid codes below while identification of the individual is pending:

If the individual’s age is unknown, but appears to be under age 21, use Aid Code 82.
If the individual’s age is unknown, but appears to be age 21 or older but under 65, use Aid Code 38, or if the individual is in a Skilled Nursing Facility (SNF), use Aid Code 53.
If the individual’s age is unknown, but appears to be age 65 or older, use the appropriate aid code (14, 17, or 13 if they are in Long Term Care).

Birth Date

If unknown, use “01” for the month and “01” for the day; use the following for the year of birth:

If the estimated age is under 21 years old, use the current year minus 10 years.
If the estimated age is between 21 and 64 years old, use the current year minus 40 years.
If the estimated age is 65 years old or over, use the current year minus 70 years.

Social Security Number

If unknown, leave blank. A pseudo number will be assigned by Medi-Cal Eligibility Data System (MEDS).

Health Insurance Claim Number

If unknown, leave blank.

Address

Since MEDS will produce a reject message if the address field is blank, use the address of the district office or the address of the facility where the individual is receiving care.

Case Processing

Action on the application cannot be taken until a determination of ineligibility has been established or the diligent search and the disability determination (for persons 21-64) have been completed. However, if a comatose person is placed in a skilled nursing facility/intermediate care facility, aid code 53 may be appropriate.

If at any time during the application process the person’s condition changes or a friend or relative is found so that information can be obtained in the usual manner, the diligent search efforts must end, at this point normal case processing must be completed.

Eligibility determinations based on the results of diligent search procedures will be completed in the same manner as any other determination. Residency requirements will be considered to be met in the absence of any other conflicting information. Only the income and resources discovered through the search will be considered available. Once the diligent search and disability determination have been completed, an eligibility decision must be made.