As of May 1, 2016, the County Medical Services Program (CMSP) is changing some of its eligibility requirements and benefits. CMSP provides limited-term health coverage for indigent residents in 35 mostly rural California counties. These changes should be operational in C-IV counties by May 23, and in CalWIN counties by May 9.
Eligibility Changes
The CMSP Eligibility Manual has been revised with new provision taking effect after May 1, 2016. Among the changes that have been made:
- Increasing the cap on income eligibility from 200% FPL to 300% FPL
- Eliminating the asset test and share of cost for those with incomes up to 138% FPL (in line with MAGI Medi-Cal)
- Increasing the asset limit for those with incomes between 138% FPL and 300% FPL to $20,000 for individuals and $30,000 for couples
- Reducing the share of cost for those with incomes between 138% FPL and 300% FPL by 75%
- Establishing a one-month retroactive eligibility period that replaces the ten-day pre-enrollment eligibility period
- Revising the term of enrollment to six months
Note that the CMSP application process is supplemental to the Medi-Cal application. The time period for counties to complete all processing will be 75 days. Undocumented recipients will still be primarily limited to restricted scope benefits.
CMSP ACL No. 16-02 (April 27, 2016).
Benefit Changes
As of May 1, 2016, CMSP members with a share of cost will qualify for a new CMSP Primary Care Benefit in addition to the CMSP Standard Benefit. Under this new Primary Care Benefit, eligible members will receive:
- Up to three medical office visits with a primary care doctor, specialist, or other selected services with no share of cost or copay
- Preventive health screenings with no copay or share of cost
- Specific diagnostic tests and minor office procedures with no copay or share of cost
- Prescription drug coverage up to $1500 in prescription costs, with a $5 copay
Benefits must be provided during the Primary Care Benefit eligibility period (members will get a special card in addition to the standard CMSP card and BIC) by a contracted CMSP provider with a reservation.
The Primary Care Benefit will begin the first of the month following approval for CMSP eligibility with no retroactive coverage provided.
CMSP ACL No. 16-03 (April 27, 2016).