Medi-Cal Special Treatment Program (MSTP) Approval

Case Situation

A 58 year-old woman who is in need of dialysis treatment applies for the Medi-Cal Special Treatment Program (MSTP) on 11/05/2013. She receives earned income $970 per month and has $45,000 in her savings account. CalSAWS determines she is ineligible for regular Medi-Cal due to excess property; however, she is eligible for MSTP for dialysis treatment with 18% Obligation.

CalSAWS (Pending CalSAWS process & screenshots for the case situation)

On the Collect Case Question window:
1. Select the Disability and Employment/Employment History checkbox from [Non-Financial] tab.
2. Select all applicable boxes relevant to the applicant in the other tabs.

Note: If an MC application date is on/after 01/01/2014, select Yes on the Evaluate for Non-MAGI [Y/N] field of the Collect Case Individual Detail window.

On the Collect Disability/Medical Conditions Detail, the Collect DED Referrals and Results Detail, and the Collect Diagnosis Detail windows:
1. Select Yes on the Able to Work field
2. Select Permanent on the Disability Type field
3. Select Yes on the Does Individuals Claim Disability [Y/N] field
4. Complete all other required fields
5. Click the [DED Referrals/Results] button to open the Collect DED Referrals and Results Detail window.
  1. Select Granted on the Status field and Disabled on the Result field.
6. Click the [Diagnosis] button on the Collect Disability/Medical Conditions Detail to open the Collect Diagnosis Detail window.
  1. Select End Stage Renal Disease w/Dialysis and Verified or Self Care Dialysis from the Diagnosis drop down menu.
  2. Enter the Diagnosis Date.
  3. Enter Verification as Received and select applicable Source.
On the Collect Liquid Asset Detail window, complete information on the [Liquid Asset Resource Detail] and [Liquid Asset Ownership Detail] tabs:
1. Select Savings Account on the Type field.
2. Enter the account balance into the FMV.
3. Enter Verification as Received and select applicable Source.
4. Enter Name of the financial institute
5. Select Yes on the Available [Y/N] field and enter applicable Percent Owned
6. Complete other required fields.
Complete other windows relevant to the case.
Run EDBC and review the budget and aid code for an expected result prior to authorization.
The Display Individual Eligibility Summary window indicates applicant is eligible for the Medi-Cal Dialysis program under Aid Code 71.
1. The ‘Y’ on the Final Aid Code column signifies the Aid Code 71 that will be sent to MEDS.
2. The Display Resource window displays the computation for the Dialysis Only program with “Pass” result and Classic Medi-Cal program with “Fail” result.
3. The Display Medi-Cal SOC/Financial Eligibility Determination window displays the budget computation for the Dialysis Only program.
4. The Display MC Dialysis/TPN Only window displays Annual Net Worth and Percentage Obligation computation. (%Obligation = Annual Net Worth is divided by Maximum Allowed Family Annual Limit). In this example, Obligation is 18%.

Transactions Generated by CalSAWS to MEDS

Add (EW20) transactions for the current and future months are sent to MEDS. As CalSAWS considers each authorized month a closed period of eligibility, a TERM-DT of 11/30/13 and a TERM-REAS of ‘99’ will be displayed on the INQM screen. Eligibility for December, the future month, will appear under the Pending column until MEDS renewal.

Refer to MC Chapter 37: Special Treatment Programs, Section 37.1 MSTP for more information.