A California resident or resident alien who meets income and property limits may be eligible for Medi-Cal if he or she:
- has a presumptive diagnosis which either causes disability or is end-stage in nature
- is in a skilled nursing facility
- is under the age of 21
- is a parent/guardian with a child under the age of 21 living in the same household
- is 65 or older
- has a disability which meets the Social Security and or MediCal criteria. Social Security Disability Adult Listings
The Social Security Administration has implemented a 20 day “quick disability determination” process for individuals with conditions listed under 88 diagnostic categories including cancers and rare diseases. This “Compassionate Allowances” initiative facilitates rapid determination of eligibility for both Social Security and MediCal benefits for individuals who meet the criteria based on objective medical information. Please look at the website for details: Social Security Compassionate Allowances
To help your patient obtain Medi-Cal or SSI Disability:
- Prepare a brief letter for the Department of Social Services and Social Security Administration, clearly documenting the diagnosis, supporting test results and severity of the disease. If the condition is on the Compassionate Allowance list or List of Disabilities, make note of this as well as the code associated with it if possible.
- For patients with end-stage disease, Medi-Cal requires a physician’s note stating that the patient has a “medical prognosis with a life expectancy of six months or less.” Using language which reflects uncertainty may be misunderstood and delay Medi-Cal approval.
- Give a copy of the letter to the patient and to whomever is assisting the patient with the process (with the patient’s permission)
- Don’t give advice to your patient about how to manipulate or “spend down” their assets, as this can disqualify them from Medi-Cal and also the MIA program for many months.