California’s Protection & Advocacy System

Kev thov kev pab cuam ntawm Medi-Cal & Lwm Feem hauj lwm muab kev Tiv thaiv Them nyiaj qis (Insurance Affordability)

Lub Rau Hlis ntuj, xyoo 2017, Nthuav tawm #5550.09
Medi-Cal yog ib feem hauj lwm pab cuam tiv thaiv kev noj qab haus huv rau tib neeg ua muaj cov nyiaj khwv tau tsawg. Txoj kev cai hais txog kev Saib xyuas Them nyiaj qis (Affordable Care Act-ACA) tau pauv qee qhov zoo muaj txiaj ntsig rau Medi-cal ua kom muaj ntau leej neeg tau txais kev tsim nyog.	Txoj kev cai hais txog kev Saib xyuas Them nyiaj qis (ACA) kuj tseem tsim ua marketplaces rau cov kev pab txog kev noj qab haus huv (sib pauv) los mus pab tib neeg kom tau txais kev pab them nqi kev xaib xyuas kho mob yog tias lawv tsis muaj.  Lav California qhov marketplace yog hus ua tias Covered California. Covered California tau muaj feem hauj lwm muab kev tiv thaiv them nyiaj qis los mus pab then rau tib neeg kev saib xyuas kev noj qab haus huv.
Txhawm rau qee feem hauj lwm muab kev tiv thaiv them nyiaj qis xws li Medi-Cal, tsam sim no Covered California los mus saib xyuas kev txiav txim siab txog qee cov kev tsim nyog uas yog lwm lub koom haum, nrog rau Medi-Cal lub chaw hauj lwm tseem tab tom saib xyuas cov uas seem ntxiv.

Nyob rau ntawm ACA tau muaj Ib daim ntawv Thov kev pab ua Yooj yim (Single Streamlined Application - SSApp) rau Covered California daim phiam thiab feem hauj lwm muab kev tiv thaiv them nyiaj qis nrog rau Medi-Cal. Tam sim no tib neeg muaj feem thov mus koom rau Medi-cal los sis mus hauv Covered California los sis mus rau ntawm Medi-Cal lub chaw hauj lwm los tau (los sis ntawm Chaw Tuav tswj kev Nyob nyab xeeb ntawm neeg Zej zog (Social Security Administration) rau cov neeg tau txais kev pab SSI). Txawm li cas los xij, tej zaum Covered California yuav xa qee cov ntawv thov mus rau lub chaw ua hauj lwm cheeb tsam nroog Medi-Cal kom ua txuas ntxiv.
Zoo ib yam nkaus thiab, lub chaw ua hauj lwm cheeb tsam nroog Medi-Cal tseem yuav tau ua Medi-Cal cov ntaub ntawv thov uas yog siv Covered California cov hau kev coj ua hauv kospistaws (computer system).

Thiab Ib daim ntawv Thov kev pab ua Yooj yim (Single Streamlined Application) yeej tseem muaj feem siv mus thov kev pab rau hauv Medi-Cal, nws tsis yog daim ntawv thov ua tiav rau hauv Medi-Cal txhua feem hauj lwm. Muaj qee zaus yuav zoo tshaj plaws uas yog siv Ib daim ntawv Thov kev pab ua Yooj yim xwb, Muaj qee zaus yuav zoo tshaj plaws uas yog Ib daim ntawv Thov kev pab ua Yooj yim nrog rau daim ntawv

thov (form) txhawb pab ntxiv thiab qees zaus yuav zoo tshaj mas yog siv tag nrho txhua cov ntawv thov ua sib txawv.	Tag nrho cov kev thov ntawv yuav nyob ntawm koj thov kev pab Medi-Cal nyob thaj chaw twg thiab feem hauj lwm twg ntawm Medi-Cal ua koj yuav thov kev pab.

Covered California thiab lub chaw ua hauj lwm cheeb tsam nrog Medi-Cal yuav tsum tau sib tiv toj rau lawv cov kev siv Medi-Cal cov ntawv thov mus koom.  Lav California tau tsim ua ib qhov hau kev coj ua hauv kospistaws (computer system) tshiab los mus saib xyuas cov kev tsim nyog rau txhua feem hauj lwm muab kev tiv thaiv them nyiaj qis tau muaj uas yog mus rau Covered California nrog rau feem hauj Medi-Cal. Qhov hau kev ua no hu hais tias CalHEERS (Kev tsim nyog rau California Healthcare, Kev rau npe thiab Txoj hau kev ua kev Kho mob - California Healthcare Eligibility, Enrollment and Retention System). CalHEERS ua hauj lwm ua ke nrog rau lwm lub lav thiab cov hau kev coj ua hauv kospistaws los mus pab Covered California thiab lub chaw ua hauj lwm cheeb tsam nrog Medi-Cal txiav txim tias koj puas tsim nyog rau Medi-Cal.

Tsab ntawv ceeb toom no yuav piav qhia ntau feem hauj lwm muab kev tiv thaiv them nyiaj qis nrog rau Medi-Cal, yuav thov kev pab ntawm feem hauj lwm ntau ntau ntawv li cas, thiab Covered California thiab lub chaw ua hauj lwm cheeb tsam nroog Medi-Cal yuav coj ua ntxiv cov ntaub ntawv thov kev pab ntawv li cas uas yog siv ntau cov ntawv thov kev pab thiab cov hau kev coj ua hauv kospistaws.

Kev tsim nyog rau Txoj kev cai hais txog kev Saib xyuas Them nyiaj qis (ACA) feem hauj lwm muab kev tiv thaiv them nyiaj qis
ACA feem hauj lwm muab kev tiv thaiv them nyiaj qis. Muaj ntau feem hauj lwm muab kev tiv thaiv them nyiaj qis tau muaj pab los ntawm Covered California mus rau ib tus zuj zus ua khwv nyiaj qis tshaj 400% ntawm tsoom fwv qib teev tseg kev txom nyem (FPL). Feem hauj lwm muab kev tiv thaiv them nyiaj qis tau muaj pab los ntawm Covered California uas yog Credit nqi Se cov Nyiaj tiv thaiv Ua ntej Zoo tshaj plaws (Advance Premium Tax Credit - APTC) thiab Sib pab them cov Nqi see txiav tawm (Cost-Sharing Reduction - CSR). APTC pab them cov nyiaj tiv thaiv zoo tshaj plaws txhua lub hli rau kev pab cuam saib xyuas kev noj qab haus huv. CSR pab them nqi se, Sib koom them nyiaj tiv thaiv (Coinsurance), thiab lwm cov nqi rau kev saib xyuas kho mob.  Lwm feem hauj lwm muab kev tiv thaiv them nyiaj qis xws li Medi-Cal yog tau tuav tswj thiab saib xyuas los ntawm lub tsev hauj lwm cheeb tsam nroog Medi-Cal los sis Feem hauj lwm Pab cuam Saib xyuas kev Noj qab haus huv lav California (California Department of Health Care Services - DHCS). Txwm li cas los xij, koj muaj feem thov Medi-Cal kev pab los ntawm lub chaw ua hauj lwm Covered California los sis cheeb tsam nroog Medi-Cal los tau. Yog tias koj txais kev pab SSI los sis CalWORKs, koj cia li tau txais Medi-Cal yam tsis tau mus thov — koj tsis tas yuav sib faib xa cov ntawv thov.

Txoj kev cai hais txog kev Saib xyuas Them nyiaj qis (ACA) muaj cov npe hauv no yog feem hauj lwm muab kev tiv thaiv them nyiaj qis:

Medicaid (Medi-Cal hauv California)
Feem hauj lwm pab cuam Tiv thaiv Me nyuam yaus kev Noj qab haus huv (Children’s Health Insurance Program - CHIP)

Credit nqi Se cov Nyiaj tiv thaiv Ua ntej Zoo tshaj plaws (APTC)
Sib     pab     them     cov     Nqi     see     txiav     tawm     (CSR)  MAGI—Kev Hloov Kho Cov nyiaj Tag nrho Khwv tau (Modified Adjusted Gross Income). Muaj ntau feem hauj lwm Medi-Cal thiab tag nrho ntawm lwm qhov ACA feem hauj lwm muab kev tiv thaiv them nyiaj qis siv qhov kev suav yooj yim mus suav cov nyiaj khwv tau hu tias MAGI los mus txiav txim koj cov nyiaj txiag tias tias puas tsim nyog tau txais kev pab rau feem hauj lwm. MAGI txhais tau tias kev Hloov Kho Cov nyiaj Tag nrho Khwv tau. Tsis muaj kev sim cov khoom vaj tse rau hauv MAGI. MAGI zoo ib yam li qhov kev hloov kho cov nyiaj tag nrho khwv tau los ntawm koj cov nqi se xa rov qab nrog rau lwm cov nyiaj khwv tau uas tau ntxiv rov qab rau hauv. Cov nyiaj khwv tau tseem ceeb uas tau ntxiv rov qab rau yog ib feem ntawm koj cov nyiaj tau txais kev pab Tiv thaiv hauv Zej zog (Social Security) ua tsis xam tias koj cov nyiaj nqi se khwv tau. Nws kuj muaj ob peb co ua cais tawm los nawm cov nyiaj khwv tau rau cov neeg mus thov rau MAGI Medi-Cal. Cov nyiaj feem ntau yog pab nyiaj rau kawm ntawv, khoom plig, cov nyiaj pab dawb ua phooj ywg zoo tau siv mus them nqi kawm ntawv thiab tsis yog rau cov nyiaj siv yuav noj hauv lub neej. Ib qho ua zoo, txoj cai piav qhia kom nkag siab yooj yim ntawm MAGI cov nyiaj khwv muaj feem nrhiav pom nyob ntawm U.C. Berkeley Qhov chaw pab cuam Neeg ua hauj lwm tus website nyob ntawm link no: http://laborcenter.berkeley.edu/healthcare/MAGI_summary13.pdf.

Medi-Cal/CHIP

Medi-Cal pab cuam kev tiv thaiv rau kev noj qab haus huv rau cov neeg khwv tau nyiaj tsawg. CHIP (Feem hauj lwm pab cuam Tiv thaiv Me nyuam yaus kev Noj qab haus huv) pab nyiaj kev tiv thaiv rau kev noj qab haus huv rau cov me nyuam tus twg khwv tau nyiaj qis ua tsis tsim nyog rau Medicaid. Raws li ACA kev teev tseeg tias kom qee qhov ntawm feem hauj lwm Medi-Cal, thiab txhua feem hauj lwm ntawm CHIP siv MAGI los mus txiav txim cov nyiaj txiag ua tsim nyog. Cov ua seem ntawm feem hauj lwm Medi-Cal siv kev pab ua tsis yog-MAGI txoj cai uas yog tau muab siv los mus suav cov nyiaj txiag ua tsim nyog rau Medi-Cal ua ntej ACA ua pauv mus ua kev cai lij choj.

MAGI Medi-Cal. MAGI Medi-Cal txhais tau tias feem hauj lwm Medi-Cal uas yog siv MAGI txoj hau kev (vib thi) los mus suav cov nyiaj txiag ua tsim nyog.	Tau muab MAGI siv los mus suav Medi-Cal cov kev tsim nyog rau pab pawg neeg loj tsim muaj tshiab cov nyiaj khwv tau qis dua 138% ntawm tsoom fwv qib teev tseg kev txom nyem (FPL). MAGI kuj tseem siv los mus suav Medi-Cal cov kev tsim nyog rau feem ntau ntawm pab pawg tsev neeg uas tau sauv tias tsim nyog nyob rau hauv tshooj 1931(b) los sis nyob rau hauv ntau ntau “feem pua” ntawm feem hauj lwm. Cov ua sau cia (categories) hauv tshooj 1931(b) yog cov ua sau cia tau muab kho dua tshiab Pab mus rau cov Tsev neeg Txom nyem muaj Me nyuam yaus (Aid to Families to Dependent Children (AFDC)) tau tsim ua thaum AFDC cov kev pab nyiaj ntsuab tau tsum txij li thaum lub ib hlis ntuj xhoo 1998. Cov feem pua feem hauj lwm tau muaj ntau cov ua sau cia uas yog siv los mus txiav txim kev tsim nyog rau ntau ntau pab pawg neeg raws li ntawm tsoom fwv qib teev tseg kev txom nyem (FPL).

Hauv qab no yog MAGI Medi-Cal cov pab pawg:

Pab pawg neeg loj tsim muaj tshiab (mus txog rau 138% FPL):
Hnub nyug 19 xyoo los sis laus dua ntawv thiab qis dua 65 xyoo

Tsis xeeb tub
Tsis muaj cai los sis rau npe rau hauv Medicare Feem A los sis Feem B
Yeej tsis muaj txoj cai tsim nyog thiab rau npe rau kev tiv thaiv kho mob raws li kev teev tseg ntawm cai lij choj hauv Medicaid (Medi-Cal hauv California) lub Lav ib Daim phiam npaj cia
Niam thiab txiv los sis tus neeg txheeb ze saib xyuas (mus txog 109% FPL)
Kev xeeb tub—tau txais kev pab puv nkaus  (mus txog 60% FPL)
Kev xeeb tub —muaj kev txwv cia tias tau txais kev pab npaum li cas (mus txog 213% FPL)
Me nyuam mos ab mus txog hnub nyug 1 xyoos (mus txog 208% FPL)
Me nyuam yaus hnub nyug 1-6 xyoo (mus txog  142% FPL)
Me nyuam yaus hnub nyug 6-19 xyoo (mus txog 133% FPL)
OTLIC—Pab pawg me Nyuam yaus ua Tsis yuam kom ua–Khwv tau nyiaj tsawg (Optional Targeted Low-Income Children ) (Feem hauj lwm CHIP— mus txog 266% FPL)

Saib “Ntawv xa nrog (attachment) A” ntawm daim ntawv ceeb toom no rau ib cov npe teev cia txog ntau feem hauj lwm ntawm MAGI Medi-Cal thiab CHIP.

CHIP. Tsis tag li ntawm, cov me nyuam yaus muaj hnub nyug mus txog 1 xyoo ua muaj cov nyiaj khwv tau mus txog 322% ntawm FPL muaj feem tau txais MAGI cov kev pab xub thawj nyob rau lub HOM PHIAJ-Cuam tshuam txog Me nyuam mos ab thiab Feem hauj lwm pab Me nyuam yaus (ALICP). Ntawm no yog ib feem ntawm California feem hauj lwm CHIP tab sis tsis tuav tswj thiab saib xyuas los ntawm Medi-Cal. Cov ua seem ntawm California feem hauj lwm CHIP yog tuav tswj thiab saib xyuas los ntawm Medi- Cal xws li yog feem hauj lwm OTLIC. Cov feem hauj lwm hais no tau pauv rau Feem hauj lwm saib xyuas cov Tsev neeg kev Noj qab haus huv (HFP) nyob rau xyoo 2013.

Non-MAGI Medi-Cal. Tsis yog txhua pab pawg ntawm Medi-Cal tau hloov mus rau MAGI Medi-Cal. Cov pab pawg hauv qab tsis siv MAGI los mus suav cov nyiaj txiag ua tsim nyog. Lawv siv cov nyiaj txiag ua tsim nyog txoj cai ntawv ua ntej hnub tim ntawm ACA.  Lawv raug xa mus xws li cov Pab pawg pre-ACA Medi-Cal.

Cov hauv qab no yog feem ntau ntawm cov pab pawg pre-ACA Medi-Cal tseem tshuav:

Cov neeg txais nyiaj ntsuab —SSI/SSP thiab CalWORKs
SPD—Muaj hnub nyug (65 los sis laus tshaj ntawv) thiab cov neeg xiam oob khab
MN— Kev xav tau kev pab Kho mob heev li (Medically Needy) (Sib pab them nqi & tsis muaj kev sib pab them nqi)
Medicare Txo khaws cia (Saving) (QMB, SLMB, QI)
Kev txhawb nqa kev saib xyuas/Kev txais me nyuam los pab tu
Feem hauj lwm pab cuam kab mob qog noj ntshav (ccancer) Lub Mis thiab Lub Tsev me nyuam (BCCP)
Lub lav-tsuas yog Medi-Cal cov pab pawg xwb

Kuj tseem muaj ib cov pab pawg ntawm Med-Cal tsis siv nyiaj khwv tau los mus txiav txim kev tsim nyog.  Yog li ntawv, cov pab pawg no tsis siv MAGI.  Cov no suav nrog:

FFCC— Tus neeg Txhawb nqa kev Saib xyuas Me nyuam yaus yav Tag los mus txog rau hnub nyug 26 xyoo
Muaj ntau pab pawg ntseeg tias muaj kev tsim nyog rau kev pab (PE)
Muaj ntau pab pawg tau txiav txim tias muaj kev tsim nyog rau kev pab xws li txuas ntxiv muaj kev tsim nyog rau cov me nyuam (CEC) thiab txuas ntxiv muaj kev tsim nyog rau cov poj niam muaj me nyuam
Kev tsim nyog ntawm Express Lane rau txhua us uas tsim nyog xaus rau CalFresh
Kev hloov ntawm Medi-Cal (Transitional Medi-Cal (TMC))
Muaj kev tsim nyog txuas ntxiv 4 lub hlis

APTC — Credit nqi Se cov Nyiaj tiv thaiv Ua ntej Zoo tshaj plaws

APTC tau muaj rau txhua tus ua tsis tsim nyog rau MAGI Medi-Cal thiab tau txais kev pab cuam tiv thaiv los ntawm Covered California. Nws them ib feem ntawm Covered California cov kev tiv thaiv ua zoo tshaj plaws rau cov neeg ua muaj MAGI qis dua 400% ntawm tsoom fwv qib teev tseg kev txom nyem (FPL). Nws yog ib cov credit nqi se (tax credit) thov rov qab tau xws li “kev tau them ua ntej (advanced)” los ntawm feem hauj lwm kev Pab cuam Nyiaj khwv tau Hauv teb chaws (Internal Revenue Service - IRS) txhua lub hli los mus pab txo cov nqi them ntawm cov nqi tiv thaiv zoo tshaj plaws txhua lub hli.	Cov nyiaj ntawm cov credit rau ib xyoo yog yuav txiav txim zaum kawg thaum cov neeg ntawv mus thov tau rov qab lawv cov nyiaj nqi se tom qab kaw cov kev thov ntawm ib xyoo.

CSR — Sib pab them cov Nqi see txiav tawm

Feem hauj lwm kev Sib pab them cov Nqi see txiav tawm los kuj tseem tuav tswj thiab saib xyuas mus rau Covered California.	Nws pab them tag nrho los sis ib feem ntawm cov nqi se txiav tawm los sis muab kev sib pab them kev tiv thaiv rau cov neeg ua muaj MAGI tsawg dua 300% ntawm FPL.

Ib daim ntawv Thov kev pab ua Yooj yim (Single streamlined application)
Tam sim no muaj Ib daim ntawv Thov kev pab ua Yooj yim rau MAGI Medi-Cal, APTC thiab CSR.   Nws muaj feem xa rau ntau txoj hau kev.

Covered California lub website. Cov ntawv thov kev pab online muaj feem xa us rau Covered California lub website ntawm no: https://www.coveredca.com/. Muaj qee zaus Covered California lub website tej zaum yuav qeeb rau kev tso mus (laod), yog li ntawv tej zaum koj yuav tau nkag mus rau hauv ntawm Covered California Kev pab cuam Sib pauv lub website ntawm no: http://www.healthexchange.ca.gov/.

Nplooj 6 ntawm 11

Covered California tus npawb xov tooj. Covered California tus npawb xov tooj hu sij hawm ceev (call center) yog: 1-800-300-1506. Koj kuj muaj feem mus saib Covered California lub website: http://www.coveredca.com/get-help/contact/.

Daim ntawv thov. Daim ntawv ntawm Ib daim ntawv Thov kev pab ua Yooj yim muaj feem rub tawm tau ntawv no: http://www.dhcs.ca.gov/services/medi- cal/eligibility/Pages/SingleStreamApps.aspx. Muaj feem xa ntawm tus kheej, xa hauv huab cua (mail) los sis fev (fax) mus rau lub chaw ua hauj lwm Covered California los sis cheeb tsam nroog Medi-Cal. Yog tias xa ntawv mus rau cheeb tsam nroog, yuav yog ib qho zoo thiab yog tias hu thooj txhij mus rau cheeb tsam nroog tus npawb xov tooj hu sij hawm ceev ib yam thiab qhia rau lawv tias koj xav mus thov rau Medi-Cal. Tus neeg ua hauj lwm ntawm cheeb tsam nroog yuav ua ntxiv cov xwm txheej rau ib daim ntawv thov SAWS 1 xws li yuav qhia rau koj ib lub hnub tim muaj kev tiv thaiv (protective filing date) sij hawm thaum daim ntawv thov tau ua mus.

Cov neeg sawv cev muag kev tiv thaiv/lees txais kev rau npe cov neeg tawm tswv yim (counselor)/taw qhia kev (navigator)/lwm cov neeg muab kev pab cuam. Cov neeg sawv cev muag kev tiv thaiv los sis cov neeg tawm tswv yim rau kev lees txais kev rau npe kuj muaj feem xa rau koj ib daim ntawv thov kev pab ua yooj yim.	Koj kuj muaj feem thov txais daim ntawv thov los ntawm cov neeg taw qhia kev los sis cov neeg muab kev pab cuam los ntawm ntau lub koom haum. Ib daim ntawv thov kev pab ua yooj yim npaj siab muab ib lub qhov rooj tsis pub yuam kev rau kev mus thov ntawm ntau ACA feem hauj lwm muab kev tiv thaiv them nyiaj qis.

Kev mus thov kev pab mus rau non-MAGI Medi-Cal
Lub chaw hauj lwm cheeb tsam nroog Medi-Cal txuas ntxiv mus coj ua cov ntaub ntawv thov rau non-MAGI Medi-Cal (rau lwm tus ntau dua muab rau cov neeg tau txais SSI los sis CalWORKs cia li tau txais Medi-Cal yam tsis tau mus thov).	Yog tias koj thov rau Medi-Cal los ntawm Covered California, koj daim ntawv thov yuav raug xa mus rau lub chaw hauj lwm cheeb tsam nroog Medi-Cal mus coj ua rau kev pab non-MAGI Medi-Cal yog tias koj thov kom xa mus los sis koj tsis tsim nyog rau MAGI Medi-Cal.

Txoj kev xaiv ntawm feem hauj lwm Medi-Cal. Koj muaj feem muaj txoj cai txuas ntxiv los mus xaiv ib feem hauj lwm pab cuam Medi-Cal twg uas yog koj tsim nyog rau thiab zoo tshaj plaws rau koj txawm hais tsis yog yam ua cheeb tsam nroog xav tau. Cheeb tsam nroog tseem muaj kev lav ris los mus txiav txim koj qhov kev tsim nyog rau feem hauj lwm Medi-Cal rau hauv qee qhov kev teev tseg ntawm koj raws li txoj kev xaiv feem hauj lwm. MAGI Medi-Cal yog nyob rau ntawm lub npe thib ib—cheeb tsam nroog yuav nrhiav tias koj puas tsim nyog rau MAGI Medi-Cal los ntawm CalHEERS cov hau kev ua, raws li tau piav qhia hauv qab no; tom qab ntawv cheeb tsam nroog yuav txiav txim koj qhov kev tsim nyog mus rau kev pab non-MAGI Medi-Cal.

Hauv qab no yog cov qib teev tseg (hierarchy) uas yog cheeb tsam nroog yuav tsum tau ua raws los mus txiav txim tias feem hauj lwm twg koj thiaj li tsim nyog rau:

Feem hauj lwm tus neeg Muaj hnub nyug thiab cov neeg ua xiam oob khab (SPD)
MAGI Medi-Cal

Tau xav hais tias SSI (DAC, Cov poj ntsuam Xiam oob qhab (Disabled Widow), muaj kev txom nyem (Pickle))
133% ntawm Hnub nyug thiab Xiam oob qhabTsoom fwv Qib teev tseg kev Txom nyem (A&D FPL) & SPD Kev xav tau kev pab Kho mob heev li (MN) Tsis muaj kev Sib pab them nqi
SPD Kev xav tau kev pab Kho mob heev li (MN) kev Sib pab them nqi
Tsev neeg thiab me nyuam yaus
MAGI Medi-Cal
Kev hloov ntawm Medi-Cal (Transitional Medi-Cal (TMC))
Pab mus rau cov Tsev neeg Txom nyem muaj Me nyuam yaus-Xav tau kev pab Kho mob heev li (AFDC-MN)
Feem hauj lwm pab cuam Xav tau kev pab Kho mob heev li/ Txom nyem xav tau kev pab Kho mob (MN/MI)
Kev dig muag
Hnub nyoog
Kev Xiam Oob Qhab
Kev cuam tshuam mus rau AFDC

Rov qab txiav txim dua Tsoom fwv loj Cov Kev cai lij choj tshooj 87 (Senate Bill-SB). Txuas ntxiv thiab, sij hawm thaum koj pauv los mus tsis tsim nyog rau Medi-Cal nyob rau hauv ib feem hauj lwm Medi-Cal (vim yog poob SSI los sis tsim nyog rau CalWORKs), cheeb tsam nroog yuav tsum txiav txim tias koj puas muaj kev tsim nyog rau lwm feem hauj lwm ntawm Medi-Cal ua ntej koj qhov kev tsim nyog ntawm Medi-Cal yuav raug txiav tawm. (SB 87.) Koj qhov kev tsim nyog rau txhua feem hauj lwm Medi- Cal, nrog rau koj qhov kev tsim nyog rau MAGI Medi-Cal thiab kev pab non-MAGI Medi- Cal, yuav tsum muab los saib nyob rau hauv Tsoom fwv loj Cov Kev cai lij choj tshooj 87.

Covered California cov ntaub ntawv thov.  Yog tias koj thov mus rau Medi-Cal los ntawm Covered California, Covered California yuav xub thawj txiav txim tias koj puas tsim nyog rau MAGI Medi-Cal los sis feem hauj lwm muab kev tiv thaiv them nyiaj qis. Yog tias koj tsis tsim nyog, koj yuav raug xa mus rau lub chaw hauj lwm cheeb tsam nroog Medi-Cal rau kev txiav txim siab ib qhov kev pab non-MAGI Medi-Cal. Muaj qee zaum koj yuav xav tau kev txiav txim siab mus rau ib qhov kev pab non-MAGI Medi-Cal txawm hais tias koj koj tsim nyog rau MAGI Medi-Cal. Koj yuav tsum tau thov qhov no los ntawm lub chaw ua hauj lwm Covered California los sis cheeb tsam nroog Medi-Cal.

Lub chaw ua hauj lwm cheeb tsam nroog Medi-Cal cov ntaub ntawv thov. Yog tias koj thov Medi-Cal ntawm lub chaw ua hauj lwm Medi-Cal cheeb tsam nroog yuav tshawb nrhiav ua ntej tias koj puas tsim nyog rau MAGI Medi-Cal. Ntxiv thiab, tej zaum koj yuav xav tau kev txiav txim siab ib qhov kev pab non-MAGI Medi-Cal txawm tias koj tsim nyog rau MAGI Medi-Cal.  Koj yuav tsum tau nug cheeb tsam nroog los mus ua li ntawv. Cheeb tsam nroog yuav tau mus soj ntsuam saib mus nrhiav tias feem hauj lwm Medi-Cal twg koj xav tau tab sis cheeb tsam nroog yuav tsis ua li ntawv tas li. Li hais ntawv tej zaum koj yuav tsum tau nug cheeb tsam nroog rau feem hauj Medi-Cal ua koj xav tau.

Cheeb tsam nroog cov ntawv thov kev pab online. Koj kuj muaj feem thov rau qhov kev pab non-MAGI Medi-Cal online nyob rau ntawm e-Benefits California lub website.

Ntawm no yog tus link: http://www.benefitscal.org/. Kuj tseem muaj kev sib txuas (link) los ntawm lub website no mus rau Covered California rau txhua tus neeg xav mus thov kev pab rau hauv MAGI Medi-Cal.

Cheeb tsam nroog tus npawb xov tooj hu mus thov kev pab. Koj kuj muaj feem mus thov kev pab rau non-MAGI Medi-Cal los ntawm npawb xov tooj. Koj muaj feem nrhiav tus npawb xov tooj nyob rau ntawm e-benfits California lub website ntawm no: http://www.benefitscal.org/.

Cheeb tsam nroog cov ntaub ntawv thov kev pab cuam. Yog thaum twg ua tiav ib daim ntawv thov kev pab ua yooj yim rau feem hauj lwm muab kev tiv thaiv them nyiaj qis uas tau muaj los ntawm Covered California, nws tsis yog daim ntawv ua tiav rau cov kev pab non-MAGI Medi-Cal. Ntawm no vim yog muaj ntau feem hauj lwm kev pab non- MAGI Medi-Cal tau txuas ntxiv mus rau kev sim cov khoom vaj tse thiab lwm yam kev tsim nyog tau teev tseg uas yog txawv los ntawm MAGI qhov kev tsim nyog tau teev tseg. Ntawm no txhais tau tias daim ntawv thov mus rau kev pab non-MAGI Medi-Cal yuav tsum muaj ib daim ntawv txhawb pab ntxiv rau ib daim ntawv thov kev pab ua yooj yim, los sis koj yuav tsum siv cov ntaub ntawv thov sib txawv mus ua ke.

Koj muaj feem thov mus rau kev pab non-MAGI Medi-Cal los ntawm xa ib daim ntawv twg ntawm SAWS 2 daim ntawv thov Ntxiv los sis daim ntawv txhawb pab ntxiv rau ib daim ntawv thov kev pab ua yooj yim.  Cov hauv qab no yog cov npe muaj rau koj xaiv:

SAWS 2 Ntxiv, los sis
Ib daim ntawv thov kev pab ua yooj yim nrog rau cov ntawv txhawb pab ntxiv—
Xa ib daim ntawv thov kev pab ua yooj yim, thiab
Xa cov ntawv thov (form) ntxiv hauv qab no:
MC 210 ACA cov ntawv Txhawb pab ntxiv rau Cov nyiaj khwv tau thiab txiav Nqi se (DRAFT)2
MC 322 Cov khoom muaj nqi thiab Tus kheej cov Khoom vaj tse Txhawb pab ntxiv mus rau Medi-Cal Xa mus nrog Daim ntawv thov
Lwm daim ntawv thov (form) xav tau los ntawm cheeb tsam nroog

Muaj ntau daim ntawv thov kev pab ntawm Medi-Cal muaj feem nrhiav pom nyob rau ntawm Feem hauj lwm Pab cuam Saib xyuas kev Noj qab haus huv (DHCS) lub website los sis Feem hauj lwm Pab cuam Zej zog hauv lav California (California Department of Social Services) lub website. SAWS 2 daim ntawv thov (form) Ntxiv muaj feem nrhiav pom ntawm no: http://www.cdss.ca.gov/cdssweb/entres/forms/English/SAWS2PLUS.pdf.

Ib daim ntawv thov kev pab ua yooj yim muaj feem nrhiav pom ntawm no: http://www.dhcs.ca.gov/services/medi-cal/eligibility/Pages/SingleStreamApps.aspx. MC 210 ACA daim ntawv ( form) txhawb pab ntxiv tseem tsis tau muaj online. MC 322 daim ntawv (form) muaj feem nrhiav pom ntawm no: http://www.dhcs.ca.gov/formsandpubs/forms/Forms/mc322.pdf. Muaj ntau daim ntawv thov (form) Medi-Cal muaj feem nrhiav pom nyob ntawm no: http://www.dhcs.ca.gov/formsandpubs/forms/Pages/MCEDFormsMain.aspx

Nplooj 9 ntawm 11

Yog tias koj tab tom thov mus rau kev pab non-MAGI Medi-Cal, yog ib qho zoo tshaj mus siv SAWS 2 daim ntawv thov Ntxiv.  Yog tias koj tab tom thov mus rau CalFresh los sis CalWORKs ntxiv mus rau Medi-Cal, Koj yuav tsum siv SAWS 2 daim ntawv thov Ntxiv. Yog tias koj tab tom thov rau CalWORKs, ib qho kev xam phaj tim ntsej tim muag nrog rau cheeb tsam nroog yuav tsum tau ua.

Cov hau kev coj ua hauv Kospistaws
CalHEERS

CalHEERS (Kev tsim nyog rau California Healthcare, Kev rau npe thiab Txoj hau kev ua kev Kho mob (California Healthcare Eligibility, Enrollment and Retention System)) yog ib txoj hau kev ua ntawm kospistawj (computer system) los mus txiav txim siab txog kev tsim nyog rau ACA feem hauj lwm muab kev tiv thaiv them nyiaj qis ua siv MGAI nrog rau MAGI Medi-Cal. Kev tsim nyog tau txiav txim los ntawm kev siv ib feem ntawm CalHEERS txoj hau kev ua tau hu tias CalHEERS lub cav ntawm txoj cai ua lag luam (BRE).

CalHEERS BRE (yog Lub cav ntawm Txoj cai ua Lag luam). Txhua cov ntawv thov rau Medi-Cal yuav tsum tau ua mus rau CalHEERS BRE los mus txiav txim siab thawj zaug tias koj puas muaj kev tsim nyog rau MAGI Medi-Cal. Yog tias cov ntawv thov tau xa mus rau Covered California, cov xwm txheej kev tsim nyog yuav tau muab nkag ncaj qha mus rau CalHEERS. Yog tias cov ntawv thov tau xa mus rau cheeb tsam nroog, Medi-Cal cov xwm txheej kev tsim nyog muaj feem muab nkag ncaj qha mus rau SAWS thiab muab xa mus hauv CalHEERS rau ib qho kev txiav txim siab kev tsim nyog MAGI Medi-Cal. (Saib hauv qab rau ib cov kev piav qhia ntawm SAWS.)  Cheeb tsam nroog los kuj muaj feem muab MAGI Medi-Cal cov xwm txheej kev tsim nyog nkag ncaj qha mus hauv CalHEERS.

Qhov chaw sib cuam tshuam (interface) ntawm CalHEERS-SAWS/MEDS. Tom qab tau tsim nyog rau MAGI Medi-Cal uas yog tsim ua los ntawm CalHEERS BRE, qhov kev txiav txim siab kev tsim nyog xa los ntawm CalHEERS mus rau SAWS thiab MEDS. (Saib hauv qab rau ib cov kev piav qhia ntawm MEDS.)  Yog tias koj tsim nyog rau MAGI Medi-Cal tab sis koj ho xav tau kev pab non-MAGI Medi-Cal los pauv, koj cov ntawv thov rau Medi-Cal yuav tsum tau coj ua los ntawm cheeb tsam nroog mus rau SAWS thiab CalHEERS qhov kev txiav txim siab kev tsim nyog yuav tsum tau txiav tawm. Cov ntaub ntawv kev pab Non-MAGI Medi-Cal yuav tsis coj ua los ntawm CalHEERS. Tej zaum cheeb tsam nroog yuav tsum tau ua kev txiav txim siab rau hauv SAWS los mus coj ua ntxiv koj cov ntawv thov thiab ntaus tus leb kev pab cuam ua tsim nyog.	Tom qab ntawv cheeb tsam nroog muaj feem nkag mus rau MEDS kom ntseeg siab tau tias tau ntaus tus leb kev pab cuam ua tsim nyog rau hauv MEDS. Cheeb tsam nroog los kuj tseem muaj feem nkag mus rau MEDS los mus ua kom tiav daim ntawv thov sai li sai raws li xav tau kev pab ntawm Medi-Cal.

SAWS

SAWS yog ib qhov Kev pab cuam kev Noj qab nyob zoo Thoob plaws lub Lav, tab sis qhov tseeb tsis muaj ib yam dab tsi thoob plaws lub lav hais txog nws. Txoj hauv ke SAWS yog ib txoj hau kev los mus txiav txim kev tsim nyog rau kev pab non-MAGI

Nplooj 10 ntawm 11

Medi-Cal, CalWORKs, CalFresh thiab lwm feem hauj lwm pab cuam. Cov hau kev coj ua yog ua hauv cheeb tsam nroog thiab txhim kho los ntawm cheeb tsam nroog. Thoob plaws lub xyoo, cov hau kev ua tau muab txwv kom nqaim mus rau peb txoj hau kev hauv no xws li tau txhim kho los ntawm peb lub koom haum cheeb tsam nroog sib txawv:

CalWIN (Pab pawg Sib koom tes Ua hauj lwm txog Feem xyuam thiab kev Lees paub rau Me nyuam yaus Cov xwm txheej hauv California (California Work Opportunity and Responsibility to Kids Information Network)) nyob hauv Alameda, Contra Costa, Fresno, Orange, Placer, Sacramento, San Diego, San Francisco, San Luis Obispo, San Mateo, Santa Barbara, Santa Clara, Santa Cruz, Solano, Sonoma, Tulare, Ventura, thiab cov cheeb tsam nroog Yolo

(Cov koom haum sib koom tes ua ke (Consortium) IV) hauv  Alpine, Amador, Butte, Calaveras, Colusa, Del Norte, El Dorado, Glenn, Humboldt, Imperial, Inyo, Kern, Kings, Lake, Lassen, Madera, Marin, Mariposa, Mendocino, Merced, Modoc, Mono, Monterey, Napa, Nevada, Plumas, Riverside, San Benito, San Bernardino, San Joaquin, Shasta, Sierra, Siskiyou, Stanislaus, Sutter, Tehama, Trinity, Tuolumne thiab cov cheeb tsam nroog Yuba

LEADER (Los Angeles Kev tsim nyog, kev Siv tshuab los mus Txiav txim siab, Kev tshawb xyuas thiab kev Qhia tawm (Los Angeles Eligibility, Automated Determination, Evaluation and Reporting)) hauv cheeb tsam nroog Los Angeles

eHIT (Kev Xa tawm Xwm txheej Electronic kev Noj qab haus huv (Electronic Health Information Transfer)). MAGI Medi-Cal kev txiav txim siab yuav tsum tau xa los ntawm CalHEERS mus rau SAWS hauv zej zog vim yog tias cheeb tsam nroog yuav tsum tau tuav tswj thiab saib xyuas Medi-Cal tom qab tau txiav txim tias tsim nyog. Qhov no tau ua los ntawm Qhov chaw sib cuam tshuam (interface) hu tias eHIT. Medi-Cal cov xwm txheej kev tsim nyog los kuj yuav tsum xa los ntawm SAWS mus rau CalHEERS uas yog siv eHIT yog li ntawv CalHEERS muaj feem ua MAGI cov kev suav nyiaj.

SAWS online thiab cov hau kev ua mus thov los ntawm xov tooj. Txhua txhua lub ntawm peb lub koom haum SAWS yuav tsum tau muaj lub web site online rau kev mus thov. Txhua lub website muaj feem nkag mus saib tau los ntawm link hauv no: http://www.benefitscal.org/. Txhua txhua lub ntawm peb lub koom haum yuav tsum tau muaj npawb xov tooj pab cuam tub lag luam sij hawm ceev. Cov npawb xov tooj muaj nyob ntawm no: http://www.benefitscal.org/.

MEDS

MEDS yog Medi-Cal Txoj hau kev ua Cov xwm txheej Tsim nyog (Eligibility Data System). Nws yog txoj hau ke ua thoob plaws hauv lub lav. Cov xwm txheej ua tsim nyog kev pab Non-MAGI Medi-Cal yuav tsum tau xa tawm los ntawm SAWS ntau txoj hau kev ua mus rau MEDS. Cov xwm txheej ua tsim nyog ntawm MAGI Medi-Cal eligibility yuav tsum tau xa tawm los ntawm CalHEERS txoj hau kev ua mus rau MEDS.

Nplooj 11 ntawm 11

MEDS yog ib qhov tseem ceeb tshwj xeeb rau Medi-Cal cov xwm txheej hauv qab no:

Medi-Cal tus leb kev pab cuam
Medi-Cal sib pab them nqi (SOC)
Medi-Cal kev tuav daim phiam kev saib xyuas thiab xub thawj tus neeg muab kev saib xyuas, tshwj tsis yog cov cheeb tsam nroog ua muaj COHS (Cheeb tsam nroog-Tuav tswj Cov hau kev coj ua kev Noj qab haus huv (County-Organized Health Systems))
Lwm cov kev pab them kho mob rau kev noj qab haus huv (OHC)

MEDS thiab Medi-Cal sib faib them nqi. MEDS yog siv los mus hloov kho Medi-Cal cov nyiaj sib pab them mus rau txhua lub hli kom mus txog thaum sib pab them tag. Feem hauj lwm IHSS los tseem kuj siv MEDS los mus txiav txim IHSS cov nyiaj sib pab them.

MEDS thiab Medi-Cal kev tuav tswj kev saib xyuas. MEDS yog siv los mus rau npe ntawm Medi-Cal cov neeg tau txais kev pab mus rau Medi-Cal daim phiam kev tuav tswj kev noj qab haus huv (zam rau cheeb tsam nroog COHS) thiab kev xaiv tus neeg muab kev saib xyuas xub thawj. Yog siv nws mus xa cov xwm txheej tau txais los ntawm Medi-Cal tus neeg sawv cev kev tuav tswj kev saib xyuas kev rau npe, Txoj kev xai kev Saib xyaus kev Noj qab haus huv (Health Care Options) (MAXIMUS), hais txog cov neeg tau txais kev pab uas tau xaiv los sis daim phiam tuav tswj saib xyuas xub thawj thiab tus neeg muab kev pab xub thawj.

MEDS thiab muaj ntau lub luag hauj lwm thoob plaws lub lav.  Txuas ntxiv thiab, vim yog tias MEDS yog ib txoj hau ke ua thoob plaws lub lav, nws siv rau qee cov luag hauj lwm thoob plaws lub lav xws li kev tsim ua ib tus Naj npawb tshwj xeeb Qhia paub tus kheej rau Neeg mob (CIN) rau cov kev pab thoob plaws lub lav thiab feem hauj lwm Covered California, khaws cia qee cov xwm txheej ua tsim nyog rau CalWORKs thiab CalFresh (muaj xws li Medi-Cal), thiab muab kev pab cuam xa mus/los rau cov cheeb tsam nroog sij hawm thaum ib tus neeg twg tsiv mus rau lwm lub cheeb tsam nroog.

Peb xav hnov los ntawm koj! Thov ua kom tiav cov kev ntsuam xyuas txuas ntxiv no txog peb qhov kev tshaj tawm thiab qhia rau peb paub seb peb yuav tsum ua li cas!  [Muaj kev tshawb fawb]

Rau kev pab ua raug cai hu rau 800-776-5746 los sis ua kom tiav ib thov daim ntawv thov kev pab. Rau txhua lwm qhov lub hom phiaj hu rau 916- 504-5800 (Qaum teb CA); 213-213-8000 (Qab teb CA).

Disability Rights California tau txais kev pab nyiaj los ntawm ntau lub chaw pab nyiaj, kom pom tag nrho cov npe chaw pab nyiaj, mus rau http://www.disabilityrightsca.org/ Documents/ListofGrantsAndContracts.html.