TB Program Approval

Case Situation

A single 54 year old individual with TB who has legal permanent resident status applies for Medi-Cal. She earns $2500 monthly. She is not eligible for MAGI, but eligible for full-scope TB Medi-Cal.

  1. Enter all required information on the Individual Demographic Detail page, including Alien number in the A Number field.
  2. On the Citizenship Status Detail:
    1. Select appropriate document from the Document drop down list and the corresponding Section Code from the drop down list.
    2. Complete all other required fields.
  3. Enter employment on the Employment Detail page.
  4. On the Customer Options page:
    1. Select Full Medi-Cal Hierarchy, Verification Consent and Maintain Verifications from the Type drop down list.
    2. Complete all other required fields.
  5. On the Medi-Cal Condition List page select Active from the Medical Condition Category drop down list. 
  6. On the Medical Condition Detail page:
  • Select Limited Services - Tuberculosis from the drop down list.
  • Complete all other required fields.

      7. Complete other Data Collection pages relevant to the case.

Note: Due to Medi-Cal hierarchy, MAGI determination is to be requested and failed before running EDBC.

      8. Run EDBC, review budget and eligibility results on the Medi-Cal EDBC Summary page and Accept and Save results.

  • The Eligible Budget for MEDS page section signifies the Aid Codes that will be sent to MEDS. 
  • The Failed and Overridden Budget page section indicates MAGI MC failed.

Click hereClick here for CalSAWS step-by-step process.

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 and a TERM-REAS of ‘99’ will be displayed on the INQM and INQ1 screens. Eligibility for future month will appear under the Pending column until MEDS renewal.

Refer to MC HB Chapter 32: Special Treatment Programs, Section Tuberculosis Program for detailed information.

Related Topics

Pickle Approval

QMB Approval

Retroactive Medi-Cal Approval

Terminations

Deceased Individual - Termination

SSI Recipient - Termination