Medi-Cal Eligibility Clause Samples
The Medi-Cal Eligibility clause defines the requirements and conditions under which an individual qualifies for Medi-Cal, California's Medicaid program. It typically outlines the income thresholds, residency requirements, and other criteria that applicants must meet to receive benefits. For example, it may specify that only California residents with incomes below a certain level are eligible, and may detail documentation needed for proof. The core function of this clause is to ensure that only those who meet the established standards can access Medi-Cal services, thereby maintaining program integrity and compliance with state and federal regulations.
Medi-Cal Eligibility. 18 1. Persons who appear to be eligible for Medi-Cal and who refuse or fail to cooperate in 19 completing the Medi-Cal eligibility determination process shall be ineligible for benefits from MSI.
20 2. Persons who are eligible for Medi-Cal who refuse or fail to pay a premium, if applicable 21 and said requirement is implemented by the State of California, to maintain eligibility shall be ineligible 22 for benefits from MSI.
23 3. MSI Patients found to have been terminated from Medi-Cal for non-payment of premiums, 24 if applicable and said requirement is implemented by the State, will be immediately terminated from 25 MSI and COUNTY shall make reasonable efforts to inform CLINIC of such patients.
Medi-Cal Eligibility. County shall be responsible for verifying client eligibility for Medi-Cal services. However, if applicable, Contractor shall be responsible for verifying the Medi-Cal eligibility of each beneficiary for each month of service prior to billing for DMC-ODS services to that beneficiary for that month. Medi-Cal eligibility verification should be performed prior to rendering service, in accordance with and as described in the DHCS DMC Provider Billing Manual. Options for verifying the eligibility of a Medi-Cal beneficiary are described in the Department of Health Care Services DMC Provider Billing Manual.
Medi-Cal Eligibility. Paradigm will use its proprietary algorithms and know-how to determine Medi-Cal eligibility and identify Medi-Cal numbers within limits imposed by DHCS and County governments. Eligibility match information will be retained by Paradigm and will be used solely to provide services hereunder subject to all the confidentiality provisions provided in the Agreement.
Medi-Cal Eligibility. If a Beneficiary becomes ineligible for Medi-Cal, CONTRACTOR is at financial risk for services provided to the Beneficiary, unless COUNTY has given advance authorization in writing to treat the Beneficiary as an unsponsored patient.