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Lomeli v. Shewry
Issue
Lomeli v Shewry identifies whether an applicant must apply within one year of the month of services to consider a request for retroactive coverage valid. SSI applicants would miss the deadline to apply for retroactive MC unless they are informed of the time limit.
Settlement
DHCS agreed to inform the SSI/SSP applicants in a timely manner of their opportunity to apply for retroactive MC coverage for the three-month period before their SSI/SSP application month.
Informing Notices
The “Important Information for SSI/SSP Applicants” (MC 19A) informs SSI/SSP applicants about the availability of retroactive MC coverage for the months before their SSI/SSP eligibility determination. Additionally, DHCS revised the “Important Medi-Cal Program Information for New Supplemental Security Income/State Supplementary Payment (SSI/SSP) Recipients” (MC 19).
MC 19A
Effective August 1, 2011, DHCS began mailing the MC 19A notice on a monthly basis to all California residents newly eligible for SSI/SSP benefits who are not receiving MC benefits in any one of the three months immediately before the month of the SSI application. The MC 19A also includes a listing of all county offices, telephone numbers, and, the “Multilingual Language Service” (MC 4034) notice which informs the individuals of their right to have interpreter services at no cost.
MC 19
The MC 19 was revised to reflect the changes mentioned above, as well as the following:
- A new paragraph entitled PAYMENT OF MEDICAL BILLS IN THE THREE MONTHS BEFORE THE MONTH OF YOUR SSI/SSP APPLICATION was added. This paragraph informs SSI/SSP recipients of the potential for retroactive MC coverage and how to request it.
- Paragraph PAYMENT OF PRIOR MONTH MEDICAL BILLS has been replaced with HOW TO PAY FOR PAST MEDICAL BILLS SINCE APPLYING FOR SSI/SSP. This paragraph provides information on the reimbursement process for medical/dental expenses incurred while waiting for an eligibility determination from Social Security Administration.
- The Wide Area Telephone system e-mail address and fax number were added for individuals to request the removal of their other health coverage.
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