Mental Illness FAQs

Can Someone Help Me With SSI?

Family members, children, friends, attorneys and other individuals and organizations may help you with your SSI application or appeal. Click HERE for a list of organizations that may help you apply for SSI or appeal a decision by SSA.

YOU MAY CHOOSE SOMEBODY WHO CAN HELP YOU BY:

  • completing forms
  • going with you to your local Social Security office;
  • interpreting for you;
  • helping you gather and give information;
  • taking you to medical examinations or to your local Social Security office
  • receiving mail for you at his or her address

IF YOU WANT MORE HELP, YOU MAY APPOINT A REPRESENTATIVE WHO CAN DO ALL OF THE ABOVE PLUS:

  • review your file at your local Social Security office;
  • get information from us about your claim, including notices and letters, just as you would;
  • represent you at informal or formal hearings;
  • give us evidence for you; or
  • help you with appeals. (See APPEALS PROCESS.)

HOW DO YOU APPOINT A REPRESENTATIVE?

  • You must sign a statement naming your representative. SSA has an “Appointment of Representative” form which you can use. Call them and ask for Form SSA-1696.
  • Your representative does not have to be a lawyer.
  • A representative’s duties are different from those of a representative payee. Click on Additional Information link below and select REPRESENTATIVE PAYEE PROGRAM for information about the duties of a representative payee.

IF YOU DO NOT SPEAK ENGLISH OR HAVE DIFFICULTY SPEAKING ENGLISH:

  • SSA will provide an interpreter, at no cost to you, if you ask for one or if you need language assistance.
  • You may use a bilingual family member, friend, or other third party to interpret for you. For more information, click on Additional Information link below and select the SSI Spotlight on Interpreter Services.
  • SSA will not use minor children age 18 and under as interpreters when dealing with difficult issues, unless they are qualified and you request that we do so.

IF YOU ARE DEAF OR HARD OF HEARING:

  • You may provide your own sign language interpreter, at no cost to us.
  • If you prefer, SSA will provide you with a sign language interpreter, if needed, at no cost to you.

IF YOU WOULD LIKE A LAWYER BUT CAN’T AFFORD ONE:

  • SSA will give you a list of legal aid societies, legal clinics, etc.

WHAT SSA WILL ASK YOU ABOUT:

  • To decide whether you can get SSI benefits, SSA will ask you about:
  • your income;
  • the things you own (resources);
  • your living arrangements––where you live, with whom, who pays for things, etc.; and
  • your citizenship or non–citizen status.If you are age 65 or over, or a child under age 18, SSA will ask for proof of your age (unless you already receive Social Security benefits). If you are under age 18 and living with your parents, SSA will also ask about their income and resources.If you are applying because you are disabled or blind, SSA will also ask about your health problems, your treatment history, and how your health problems affect your daily activities.SSA will also ask for all of your medical records from treating sources and authorization to obtain those records. You can also bring or mail copies of your medical records to the office prior to or at the time of application.

    THIS INFORMATION IS GENERAL. FOR MORE INFORMATION, CALL 1-800-772-1213 (TTY 1-800-325-0778), OR CONTACT YOUR LOCAL SOCIAL SECURITY OFFICE.

    Click Here For Additional Information

    Source: Social Security Website: Understanding Supplemental Security Income Home Page

Link:

http://www.socialsecurity.gov/ssi/text-understanding-ssi.htm

How Do I Appeal Social Security Determinations?

SSA has established appeals procedures for individuals who wish to file an appeal. The levels of appeal are:

  • Reconsideration;
  • Administrative Law Judge Hearing; and
  • Appeals Council Review.SSA calls the determinations they make that you can appeal “initial determinations.” These determinations include but are not limited to:
  • whether or not you are eligible;
  • the amount of your SSI payment; and
  • the fact that you were overpaid and the amount of an overpayment and whether you must repay it.You must request an appeal in writing within 60 days of the date you receive your notice. The notice will tell you how to appeal. If you appeal within 10 days, SSI benefits will continue at the same amount until they make a determination on your appeal.Contact SSA for help you with your appeal.NOTE: You may appoint a representative to act for you in the Social Security appeals process. For information on how to appoint a representative, click on Additional Information link below and select “How Someone Can Help You With Your SSI”.

    INITIAL DETERMINATION

    After you have filed an application for SSI, SSA will mail you a written determination. This is your first “initial determination.” Each time they make a decision about your eligibility or payment amount after that is also an initial determination.

    STEPS IN THE APPEALS PROCESS

    1. RECONSIDERATION

    If you disagree with the initial determination, you may request reconsideration by writing to SSA or by completing a Form SSA-561 (Request for Reconsideration) or a Form SSA-789 (Disability Cessation Appeal).

    You or your representative must ask in writing for reconsideration within 60 days of the date you receive the written notice of the initial determination. If you ask for reconsideration in writing within 10 days, any payment SSA are currently making will continue until they make a determination, providing that your income and resources does not exceed our limits.

    SSA will send you a notice of the reconsideration determination.

    If you appeal a disability cessation and you want to keep receiving benefits until SSA makes a determination, you must make a written request for benefit continuation within 10 days of the date you receive the written notice. You are entitled to a face-to-face hearing with a disability hearing officer.

    In certain States, SSA is using a revised appeal process, which may replace the reconsideration step. SSA will provide you with specific instructions concerning appeals in these States.

    2. HEARING

    If you disagree with the reconsideration determination, you or your representative may request a hearing before an Administrative Law Judge by writing to us or by completing a Form HA-501 (Request for Hearing). SSA will help you complete this form.

    You or your representative must request a hearing within 60 days after you get the notice of reconsideration. You or your representative may review your file before the hearing and may submit new evidence then. You may continue to receive your SSI if you are appealing a disability cessation issue. You must ask in writing for your benefits to continue.

    If you do not want to appear at a hearing before a judge, you or your representative may ask the judge to make a decision based on the evidence in your file.

    If you do want to have a hearing before a judge, it is very important that you or your representative appear in person at the scheduled hearing. If for any reason you cannot make it, contact the judge as soon as possible before the hearing and explain why. If you do not attend the scheduled hearing, you may lose your appeal rights and benefits.

    SSA may pay you for travel costs if the distance to the hearing from your home is more than 75 miles one way. If you need money for travel costs, tell the judge as soon as possible before the hearing.

    In a disability case, the judge may also want you to have more medical exams or tests. You may request further medical exams or tests if you think that you need more medical information. The judge decides whether to grant your request.

    The judge may ask other witnesses, such as doctors, to come to the hearing. You may ask the judge to order certain witnesses to attend the hearing.

    During the hearing, the judge will explain your case and may ask you and any of your witnesses questions. You may also ask any witnesses questions and present new evidence.

    The hearing is informal, but SSA will record it. You may ask for a copy of the tape.

    The judge will send both you and your representative a copy of the hearing decision.

    3. APPEALS COUNCIL

    If you disagree with the judge’s decision, you or your representative may request an appeal by writing to SSA and requesting an Appeals Council review, or by completing a form HA-520 (Request for Review of Hearing Decision/Order). SSA will help you complete this form.

    You or your representative must ask for an Appeals Council review within 60 days after you get the hearing decision.

    You or your representative may submit new evidence. The Appeals Council will carefully examine your case and will grant, deny, or dismiss your request for review. If the Appeals Council grants your request for review, it will either decide your case or return it to the judge for further action, which could include another hearing and a new decision. The Appeals Council will send you and your representative a copy of its decision, which will explain the action taken on your request.

    4. FEDERAL COURT

    If you disagree with the action of the Appeals Council, you may file a civil action with the U.S. District Court in your area. SSA cannot help you file a court action. You may want to contact a lawyer or a legal aid group to help you.

    You must file an action in Federal court within 60 days after you receive the notice of Appeals Council action.

    The Federal Court will review the evidence and the earlier decisions, but will not conduct another hearing.

    THIS INFORMATION IS GENERAL. FOR MORE INFORMATION, CALL 1-800-772-1213 (TTY 1-800-325-0778), OR CONTACT YOUR LOCAL SOCIAL SECURITY OFFICE.

    Click Here For Additional Information

    Source: Social Security Website: Understanding Supplemental Security Income Home Page

 

Link: http://www.socialsecurity.gov/ssi/text-understanding-ssi.htm

How Do I Apply For SSI?

HOW TO APPLY FOR SSI

You can apply for SSI by:

  • Calling the Social Security Administration (SSA) office and making an appointment to apply for SSI. With an appointment, one of their representatives will help you apply for benefits. You can make an appointment to apply for SSI on the telephone or in person at your local Social Security office.
  • Having someone else call and make the appointment for you or assist you with your application for SSI. Click on the Additional Information link below and select the “Spotlight on How Someone Can Help You With Your SSI” .
  • Visiting the SSA office to apply without making an appointment, but you may have to wait awhile.
  • You will have to provide information and work with SSA to get documents concerning SSI eligibility.
  • You will have to sign an application.Most of the forms to apply for SSI are not designed for self-completion. An SSA claims representative will interview you and complete the forms with information you give to them using a personal computer.WHEN TO APPLYApply as soon as possible so that you do not lose benefits. SSA cannot pay benefits for time periods earlier than your application date.

    If you call SSA to make an appointment to apply and you file an application, SSA may use the date of your call as your application filing date.

    If you do not keep this appointment and you do not contact SSA to reschedule the appointment, they will try to contact you. If they do not get in touch with you to reschedule the appointment, they will send you a letter. The letter will say that if you file an application within 60 days from the date of the letter, they will use the date of your original contact with SSA as your SSI application date.

    If you are in a public institution but you will be leaving within a few months, you may not be eligible for SSI until you leave. You may, however, be able to apply before you leave so that SSI benefits can begin quickly after you leave. Check with the institution and SSA about filing an application under the “prerelease procedures.”

    Click on the Additional Information link below and select the “SSI Spotlight on the Prerelease Procedure”.YOU HAVE THE RIGHT TO APPLY

  • Anyone may apply for SSI.
  • There is no charge to apply.YOU HAVE THE RIGHT TO RECEIVE HELP FROM SOCIAL SECURITYSSA will complete the application forms for you based on information you give to them.SSA will help you get documents you need to show that you meet the SSI eligibility requirements.

    If you are applying because of disability or blindness and SSA decides that the medical information needed to make a determination is not available from existing sources, SSA will pay for you to have a doctor examine you. If you need a medical exam, you must go to the exam in order to receive SSI. SSA may also pay your travel costs to get to this exam.

    Click on the Additional Informaiton link below and select the “SSI Spotlight on Payment for Travel to Medical Exams”.

    YOU HAVE THE RIGHT TO A REPRESENTATIVE

    You may appoint someone to help you with your SSI claim and go with you to your appointment(s) with SSA. Click on the Additional Information link below and select “How Someone Can Help You With Your SSI”.

    YOU HAVE THE RIGHT TO A NOTICE

    SSA will notify you in writing of any determination about your eligibility or any change in your benefit amount. They will also send copies of all notices to your representative if you have one. Each notice affecting your eligibility or change in SSI benefit amount will explain your appeal rights.

    YOU HAVE THE RIGHT TO EXAMINE YOUR FILE

    You or your representative may examine and get a copy of the information in your case file, upon request. You or your representative also may review and copy the laws, regulations and policy statements used in deciding your case.

    YOU HAVE THE RIGHT TO APPEAL

    You may appeal most determinations SSA makes about your eligibility for SSI, or changes they make in your benefit amount.

    Our administrative appeals process has 3 levels.

    Click on the Additional Information link below and select “Appeals Process”.

    THIS INFORMATION IS GENERAL. FOR MORE INFORMATION, CALL 1-800-772-1213 (TTY 1-800-325-0778), OR CONTACT YOUR LOCAL SOCIAL SECURITY OFFICE.

     For Additional Information

    Source: Social Security Website: Understanding Supplemental Security Income Home Page

Psychiatric Advance Directives in California

Ten commonly asked questions about PAD’s for California

Please note: the following 10 FAQs are designed to provide a quick and accessible guide to what your state’s Statutes say – or do not say – about PADs.  The FAQs do not attempt to provide a complete picture of the law in your state, nor can they take the place of legal advice.  The answers were accurate when written in October 2006.

1.  Can I write a legally-binding psychiatric advance directive (PAD)

Yes.  California’s Health Care Decisions Law  allows you to appoint an agent to make decisions about your treatment if you become incompetent to make decisions; write instructions about how you would like your health care to proceed; or both.  This law covers all types of health care, including psychiatric treatment.  Protection & Advocacy, Inc has published a helpful guide for consumers, which includes the latest version of the statutory Advance Health Care Directive (AHCD) form .  This form is not mandatory but is highly recommended.  Protection & Advocacy also offers a detailed Trainer’s Manual on the subject of AHCDs. The state of California maintains a central registry of Advance Directives, which you may wish to use but is not mandatory.  Click here for more information on that program.

2.  Can I write advance instructions regarding psychiatric medications and/or hospitalization

Yes.  The statute allows you to set out your instructions on any aspect of your health care treatment, which could include advance decisions about psychiatric medications and/or hospitalization.  The statutory AHCD form gives a variety of prompts for you to state your instructions in the event of a crisis (for example, you could state that you would prefer to remain in a quiet room).  If you wish, you may make advance decisions to refuse medications and/ or hospitalization.  If you do this, however, note that that state law may require your hospitalization in an emergency, even if you have declined it in your instructions.

3.  Does anyone have to approve my advance instructions at the time I make them

No.  However, the document containing your advanced instructions must be notarized, or signed by two witnesses.  Neither witness can be an employee of your health care provider, and one must be a non-relative. If you are a patient in a “skilled nursing facility”, meaning a facility providing skilled nursing care on a long term basis, your form must additionally be signed by a Patient Advocate or Ombudsman.

4.  Can I appoint an agent to make mental health decisions for me if I become  incompetent

Yes, in one of two ways:

(1) You may appoint an agent (called a “surrogate” in California), using your AHCD.  Your agent must be someone other than an employee of your health care or community care provider, unless he/she is also related to you.  If you have a conservator under the Lanterman-Petris-Short Act, you must seek the authorization of an attorney before appointing an agent.

(2) If you are already being treated in a health care facility, you may designate a surrogate to act during your current stay, for a maximum of 60 days in total.  To do this, you need only inform your health care provider.  The person nominated in this way has priority over any agent you already nominated in an AHCD, but only during that particular period of treatment, or 60 day period in total.

5.  If I become incompetent, can my agent make decisions for me about medications, and/or hospitalization

Yes, with some exceptions. In general, once you are determined to be incompetent (see below) your agent may make decisions about anything that you could decide on if you were competent.  However, your agent cannot consent on your behalf to your commitment to, or placement in, a mental health treatment facility; nor can he/she consent on your behalf to psychosurgery, electroconvulsive treatment (ECT), sterilization or abortion.  If you wish, you may use your AHCD to limit your agent’s authority to a certain type, or types, of decision.

6.  Does my agent have to make decisions as he/she thinks I would make them (known as “substituted judgment”), or does he/she have to make them in my “best interests”

Your agent must exercise substituted judgment to the extent that he or she can do so, based on your advance instructions and/or on your preferences as known by the agent.  If it is not possible to make a decision in that way, your agent must make the decision in your best interests.

7.  Is there any rule that says that I can only make advanced instructions, only appoint an agent, or that I must do both

No.  You may do one, the other, or both.

8.  Before following my PAD, would my mental health care providers need a court to determine I am not competent to make a certain decision

No.  The California statute allows you to choose when your AHCD must be followed.  Your AHCD will be followed when your primary physician determines that you do not understand the benefits and/or risks of a particular mental heath care decision.  Alternatively, you may state on your form that your AHCD should be followed at all times, whether or not you are competent to make decisions.

9.  Does the statute say anything about when my mental health providers may decline to follow my PAD

Yes.  Your providers must decline to follow your AHCD if they would violate professional standards in doing so, or for “reasons of conscience”.  In these situations, your provider must assist in trying to find another provider who will follow your AHCD. Additionally, your providers could decline to follow your AHCD if you became subject to compulsory treatment or hospitalization under California law.

10.  How long does my PAD remain valid?

Your AHCD is valid as long as you do not revoke it.  If you wish, however, you may specify an expiry date for your AHCD.

What Are Redeterminations?

Social Security Administration (SSA) will review your income, resources, and living arrangements to be sure you are still eligible for SSI and are getting the right amount of SSI benefits.

If you are married to someone not receiving SSI benefits or you are a disabled child under age 18 living with your parent(s), SSA also reviews the income, resources, and living arrangements of your spouse or parent(s).

WHEN DOES SSA CONDUCT A REDETERMINATION

SSA selects some beneficiaries within 3 months after we award them benefits. After that, we redetermine eligibility and benefit amounts of the vast majority of beneficiaries once every 1 to 6 years.

Sometimes when you report a change that affects eligibility or payment (e.g., marriage), SSA may review your income, resources and living arrangements.

HOW DOES SSA DO A REDETERMINATION

There are 3 ways that SSA does a redetermination:

  • by telephone interview;
  • in person; or
  • by mail.For telephone and in person interviews, SSA sends a letter telling you that they will be calling you on a certain date and time, or asking you to come into the local Social Security office for a redetermination. Their staff will fill out the forms during the interview based on information you give to them. If you have a representative payee, SSA will send the appointment letter to your payee.If you are not able to keep the scheduled appointment, call them; they will make a new appointment that is more convenient.For a redetermination conducted by mail, SSA will send you a short redetermination form for you to complete, sign and return.

    If you have a representative payee, he or she must complete and sign the redetermination form for you.

    If you need help completing a redetermination form you receive in the mail, call SSA or visit your local Social Security office. Their staff will help you fill it out.

    RESPONDING TO THE APPOINTMENT LETTER OR THE REQUEST TO COMPLETE FORMS

    You have 30 days to:

  • respond to the appointment letter;
  • complete and return the form; or
  • tell SSA that you cannot keep the appointment or are having trouble filling out the form.Note: It is to your advantage to respond to SSA requests as soon as possible.WHAT HAPPENS IF YOU DO NOT RESPOND TO THE APPOINTMENT LETTER OR COMPLETE AND RETURN THE FORMIf you do not respond, you may:
  • have your checks stopped;
  • be overpaid; or
  • be underpaid.If you lose SSI eligibility, you may lose Medicaid eligibility based on getting SSI.DOCUMENTS YOU MAY NEED FOR A REDETERMINATION
  • savings account, checking account, or other bank statements;
  • pay stubs or income tax returns;
  • proof of other income you receive (e.g., pensions, annuities, unemployment compensation, worker’s compensation, etc.)
  • life insurance policies;
  • burial contracts; and
  • household receipts (lease, utilities, etc.)NOTE: SSA may not need all of these documents. If necessary, they will tell you what we need and help you get it.THIS INFORMATION IS GENERAL. FOR MORE INFORMATION, CALL 1-800-772-1213 (TTY 1-800-325-0778), OR CONTACT YOUR LOCAL SOCIAL SECURITY OFFICE.

    Click Here For Additional Information

    Source: Social Security Website: Understanding Supplemental Security Income Home Page

 

Link: http://www.ssa.gov/ssi/text-help-ussi.htm

What Documents Do I Need To Apply For SSI?

You may not need all of the following documents. Sometimes one document can substitute for another. The lists are not all-inclusive. The Social Security Administration (SSA) will tell you what you need and what other documents are acceptable. They will help you get them if you are having trouble.

SOCIAL SECURITY CARD OR NUMBER

You will need to apply for a Social Security number if you do not have one.

PROOF OF AGE

 

  • a public birth record recorded before age 5;
  • a religious birth record recorded before age 5; or
  • other documents showing your age or date of birth.NOTE: If you already proved your age when you applied for Social Security benefits, you do not need to prove it again for SSI.CITIZENSHIP OR ALIEN STATUS RECORDIf you are a citizen, examples of documents you may need are:
  • birth certificate showing you were born in the U.S.; or
  • religious record of birth or baptism showing your place of birth in the U.S.; or
  • naturalization certificate; or
  • U.S. passport; or
  • certificate of citizenship.L/li>If you are an alien, examples of documents you may need are:
  • a current immigration document; e.g., an I-551 (Permanent Resident Card); or
  • I-94 (Arrival/Departure Record).If you are an alien who has served in the U.S. Armed Forces, you may need your military discharge paper (form DD-214).PROOF OF INCOMEIf you have income, you may need to provide the following:
  • earned income – payroll stubs, or if self-employed, a tax return for the last tax year.
  • unearned income – any records you have (e.g., award letters, bank statements, court orders, receipts) showing how much you receive, how often, and the source of the payment.
  • work expenses.PROOF OF RESOURCES
  • bank statement(s) for all checking and savings accounts.
  • deed or tax appraisal statement for all property you own besides the house you live in.
  • life or disability insurance policies.
  • burial contracts, plots, etc.
  • certificates of deposit, stocks, or bonds.
  • car titles or registrations.PROOF OF LIVING ARRANGEMENTS
  • lease or rent receipt.
  • names, dates of births, medical assistance cards or social security numbers for all household members.
  • deed or property tax bill.
  • information about household costs, food, utilities, etc.MEDICAL SOURCES (If you are filing as blind or disabled)
  • medical reports, if you have them.
  • names, addresses, and telephone numbers of doctors, hospitals and other providers of medical services to you.OTHER SOURCESIf you are applying as a disabled child, or on behalf of a disabled child, SSA will need the names, addresses, and telephone numbers of people (teachers, caregivers) who can provide information about how the disabled child’s medical condition affects his or her day-to-day activities.THINGS TO REMEMBER
  • Do not wait to apply. If you think you may be eligible for SSI, you should contact SSA right away. The earliest they will pay SSI is the month after the filing date of your application. SSA may use the date you contact them as the filing date. If you do not have all of the things they need, you can get them later.
  • SSA needs to see the original documents. They do not accept photocopies. They will return the original documents to you.
  • Try to keep a copy of things you send to them. Keep track of the dates you send information to SSA, or talk to them, as well as the name of the Social Security employee with whom you spoke.THIS INFORMATION IS GENERAL. FOR MORE INFORMATION, CALL 1-800-772-1213 (TTY 1-800-325-0778), OR CONTACT YOUR LOCAL SOCIAL SECURITY OFFICE.

    Click Here For Additional Information

    Source: Social Security Website: Understanding Supplemental Security Income Home Page

 

Link: http://www.socialsecurity.gov/ssi/text-understanding-ssi.htm

What Is A Continuing Disability Review?

The Social Security Administration (SSA) periodically reviews your disability or blindness to decide if you are still disabled or blind. If you are no longer disabled or blind, your benefits will stop.

SSA calls this review a Continuing Disability Review (CDR). The law requires SSA to perform a CDR approximately every 3 years, unless SSA determines you have a condition that they expect will improve sooner than that. However, if you have a condition that they expect will not improve, SSA will still review your case, but not as often.

NOTE: SSA also reviews your income, resources, and living arrangements. They call this periodic review a redetermination.

HOW DO CONTINUING DISABILITY REVIEWS WORK FOR CHILDREN

If a child is under age 18, SSA will do a CDR every 3 years if they expect the child’s condition may improve. SSA may also do a CDR if they do not expect the child’s condition to improve.

If they decided the child was disabled based on low birth weight, we will generally do a CDR by age 1. However, they will schedule the child’s CDR for a later date if at the time of the initial determination they decide that improvement is unlikely to have happened by age 1.

When SSA performs the CDR, they may ask the child’s representative payee to show evidence that the child is, and has been getting treatment that is medically necessary and available for his or her condition.

If the child’s representative payee refuses without good cause to show SSA this evidence, they may look for another representative payee. SSA may pay the child directly, if he or she is old enough.

WHAT HAPPENS TO MY CHILDHOOD DISABILITY AT AGE 18

If you are eligible as a child at least one month before you turn 18, SSA will redetermine your disability. To do the disability redetermination, SSA will use the rules that they use for adults who are filing new applications for SSI.

THIS INFORMATION IS GENERAL. FOR MORE INFORMATION, CALL 1-800-772-1213 (TTY 1-800-325-0778), OR CONTACT YOUR LOCAL SOCIAL SECURITY OFFICE.

Click Here For Additional Information

Source: Social Security Website: Understanding Supplemental Security Income Home Page

Link: http://www.ssa.gov/ssi/text-help-ussi.htm

What Is Medi-Cal? How Do I Apply For It?

What is Medi-Cal

Medi-Cal is California’s Medicaid health care program. This program pays for a variety of medical services for children and adults with limited income and resources. Medi-Cal is supported by federal and state taxes. You can apply for Medi-Cal benefits regardless of sex, race, religion, color, national origin, sexual orientation, marital status, age, disability, or veteran status. If you are found (or determined) eligible, you can continue to get Medi-Cal as long as you continue to meet the eligibility requirements

Your local County Welfare/Social Services Department manages Medi-Cal eligibility determinations. If you have questions, you can find the addresses and telephone numbers under County Social Services Office Listing.

How Can Medi-Cal Help You

Medi-Cal is a large program made up of many separate programs designed to assist Californians in various family and medical situations. When you apply for Medi-Cal, the information you provide on your Medi-Cal Application and any required verification will be used to determine which program(s) you qualify for, and which program is best for you and your family

Who Can Get Medi-Cal

People in many different situations qualify for Medi-Cal. They are listed below. If you are not in one of these groups, call your county social service agency to determine if you qualify for a county-operated medical assistance program.

You may automatically be eligible for Medi-Cal if you receive cash assistance under one of the following programs:

 

  • SSI/SSP. (Supplemental Security Income/State Supplemental Program)
  • CalWORKs. (California Work Opportunity and Responsibility to Kids). Previously called Aid to Families with Dependent Children (AFDC).
  • Refugee Assistance.
  • Foster Care or Adoption Assistance Program.Even if you don’t receive cash assistance, you may be eligible for Medi-Cal if you are one of the following:
  • 65 or older
  • Blind
  • Disabled
  • Under 21
  • Pregnant
  • Diagnosed with breast or cervical cancer
  • In a skilled nursing or intermediate care facility.
  • Refugee status during a limited period of eligibility. Adult refugees may or may not be eligible depending upon how long they have been in the U.S.
  • Parent or caretaker relative of a child under 21 and
  • The child’s parent is deceased or doesn’t live with the child, or
  • The child’s parent is incapacitated, or
  • The child’s parent who is the primary wage earner is unemployed or underemployed.Do I Have To Live In California To Get Medi-CalYes, you must be a resident of California to get Medi-Cal. A California resident is someone who lives here and plans to stay here, or someone who is working or looking for work in California.How Do I Apply For Medi-Cal?
  • Call or visit your local county social services office and ask for a Medi-Cal application.
  • If you need help filling out the forms, call the county social services agency. Mail or take your application with the required verifications (proof) to the nearest social services agency in your county. If you don’t have all your verifications, or are not sure of what you need, please send what you have. You can send the rest later. The sooner the social services agency receives your application, the sooner your case may be processed and your Medi-Cal benefits can begin.
  • If you get SSI/SSP payments, your Social Security administration office automatically sets up Medi-Cal for you. No separate application for Medi-Cal is needed. You will get your Medi-Cal card (BIC) in the mail.
  • The forms and instructions are available for download in Armenian, Chinese, English, Farsi, Hmong, Khmer, Korean, Lao, Russian, Spanish and Vietnamese by clicking HERE. You can also call the numbers below for assistance.

    Medi-Cal and Healthy Families Information Line – 888.747.1222 or 800.952.8349 (TDD Service)

    Medi-Cal Regulation Specialists – 877.677.6334 or 800.997.0009 (county routing line)

    If you get CalWORKs payments, the county social services agency automatically sets up Medi-Cal for you. No separate Medi-Cal application is needed. You will get your Medi-Cal card (BIC) in the mail.

    How Is My Application Processed

  • When the county receives your application, it will be given to an eligibility worker. The worker will review your application and determine if additional information is needed. The worker may ask you for information by mail or by phone. If you want to meet with your worker to discuss your application, call your worker to set up an appointment.
  • Once the eligibility worker has all of the necessary information, he or she will determine if you are eligible for Medi-Cal. You will get a letter in the mail telling you if your Medi-Cal application is approved or denied. If you do not understand this letter or do not agree with the information in this letter, contact the eligibility worker at the county social services agency. If you still disagree with the county’s action, you may file for a State Hearing by completing the back of the Notice of Action the county sends you or by calling the toll free number.
  • If your child(ren) is not eligible for free Medi-Cal, they may be able to get health coverage through the low-cost Healthy Families Program (HFP). Make sure you indicate on your application that we can send your information to the HFP if your child(ren) is found ineligible for free Medi-Cal.Anyone can help you with the application process — a family member, friend, or anyone else of your choice.How Long Does It Take?Forty-five (45) days are allowed to process a Medi-Cal application not involving a disability. If you are applying for Medi-Cal based on a disability, your application process may take up to 60 days or longer depending on how quickly you complete the disability information and how quickly your doctors and hospitals submit your medical records. To avoid delays in the processing of your case, submit all information requested of you as soon as possible. Ask your eligibility worker for help if you are having trouble obtaining information. If you have an immediate medical need, such as pregnancy, indicate this need on your application and your application may be processed more quickly.

    Do I Have To Pay For Medi-Cal?

    It depends.

  • If your income is less than Medi-Cal limits for your family size, you will receive Medi-Cal services at no cost to you. (Refer to All County Welfare Directors Letter (ACWDL) 02-13 to view the Income Limit Chart.)
  • If your income is more than Medi-Cal limits for your family size, you will have to pay a certain amount only in the month you have medical expenses. The amount that you pay is called your share of cost (SOC). When you pay or promise to pay that amount, we say that you have met your SOC. Once you have met your SOC, Medi-Cal will pay the rest of your covered medical bills for that month. For example, if your SOC is $50, you must first pay or obligate (obtain your providers agreement to make payments on the SOC) $50. Your provider will enter the amount you paid or obligated into the Department’s database. Your case will certify when the amounts you paid or obligated equal the amount of your share of cost. Once your share of cost is certified; providers checking your eligibility will advised that you are eligible and covered services may now be billed to the Medi-Cal program. Please note, expenses incurred by ineligible members of your family may be used to meet the share of cost of eligible members.If one spouse lives in a nursing home, Medi-Cal allows the spouse remaining in the home to keep all of the income he/she receives in his/her name regardless of the amount. If that amount is below $2,232 per month, then the spouse in the nursing home can give income to the spouse at home to bring the spouse at home up to $2,232 per month. Be sure to ask your county social service agency for an MC Information Notice 007 for more information on income.Who Can I Contact If I Have A ProblemIf you are enrolled in a Medi-Cal health plan, you should contact a member services representative at your plan. If you are not satisfied with their response, you can contact the state Ombudsman, Medical Board, Department of Aging or Office of Patient Advocate at the following numbers.

    Medi-Cal Managed Care – Office of Ombudsman – 888.452.8609

    Medical Board of California – 800.633.2322

    California Department of Aging – Long-Term Care Ombudsman Program 800.231.4024

    Office of the Patient Advocate – 866.HMO.8900

    What Is The Difference Between Medi-Cal, Medicaid & Medicare

    Medi-Cal is California’s version of the federal Medicaid program which helps low-income individuals and families receive medical care. Medicare is the federal program that provides individuals 65 or over with medical care.

    Click Here To View The Medi-Cal Site

    Click Here To View Additional Q & A

    Source: California Department of Health Servcies – Medical Care Services Web Site

 

Link: http://www.socialsecurity.gov/ssi/text-understanding-ssi.htm

What Is Supplemental Security Income (SSI)?

SSI stands for Supplemental Security Income (SSI). The Social Security Administration (SSA) administers this program. SSI pays monthly benefits to people with limited income and resources who are disabled, blind, or age 65 or older. Blind or disabled children, as well as adults, can get SSI.

HOW IS SSI DIFFERENT FROM SOCIAL SECURITY BENEFITS

  • Unlike Social Security benefits, SSI benefits are not based on your prior work or a family member’s prior work.
  • SSI is financed by general funds of the U.S. Treasury—personal income taxes, corporation taxes and other taxes. Social Security taxes withheld under the Federal Insurance Contributions Act (FICA) do not fund the SSI program.
  • In most States, SSI beneficiaries also can get Medicaid (medical assistance) to pay for hospital stays, doctor bills, prescription drugs, and other health costs.
  • SSI beneficiaries may also be eligible for food stamps in every State except California. (California includes the cost of food in the SSI benefit calculation.) In some states, an application for SSI also serves as an application for food assistance.
  • SSA pays SSI benefits on the first of the month for the entire month.
  • To get SSI, you must be disabled, blind, or at least 65 years old and have “limited” income and resources.IN addition, to get SSI, you must
  • be a resident of the United States, and
  • not be absent from the country for more than 30 days; and
  • be either a U.S. citizen or national, or in one of certain categories of eligible non-citizens.HOW IS SSI LIKE SOCIAL SECURITY
  • Both programs pay monthly benefits.
  • The medical standards for disability are the same in both programs for individuals age 18 or older. There is a separate definition of disability for SSI children under age 18.
  • SSA administer both programs.THIS INFORMATION IS GENERAL. FOR MORE INFORMATION, CALL 1-800-772-1213 (TTY 1-800-325-0778), OR CONTACT YOUR LOCAL SOCIAL SECURITY OFFICE.

    Click Here For Additional Information

    Source: Social Security Website: Understanding Supplemental Security Income Home Page

 

Link: http://www.ssa.gov/ssi/text-help-ussi.htm

What Organizations Will Help With SSI?

A number of organizations can assist you with an SSI application or appeal. Click on the links below to find out more.

Health Consumer Alliance (HCA)

The Health Consumer Alliance site provides a wealth of health care related information for consumers. Click on http://healthconsumer.org/ to view site.

The site provides information in several languages.

National Senior Citizens Law Center (NSCIC)

The National Senior Citizens Law Center is dedicated to helping older people to live in dignity and freedom from poverty. NSCLC offers a variety of litigation services for advocates, including acceptance of referral as sole counsel in a case, responsibility for a particular segment of a case, or informal consultation with counsel. The hallmark of NSCLC’s litigation service is flexibility. Click on www.nsclc.org to view site.

The site is only available in English.

National Organization of Social Security Claimants’ Representatives (NOSSCR)

Established in 1979, the National Organization of Social Security Claimants’ Representatives is an association of over 3,300 attorneys and paralegals who represent Social Security and Supplemental Security Income claimants. Our members are committed to providing high quality representation for claimants, to maintaining a system of full and fair adjudication for every claimant, and to advocating for beneficial change in the disability determination and adjudication process. Click on www.nosscr.org to view site.

The site is only available in English.

National Immigration Law Center (NILC)

The National Immigration Law Center is a national support center whose mission is to protect and promote the rights and opportunities of low-income immigrants and their family members. NILC staff specialize in immigration law, and the employment and public benefits rights of immigrants. The Center conducts policy analysis and impact litigation and provides publications, technical advice, and trainings to a broad constituency of legal aid agencies, community groups, and pro bono attorneys. Click on www.nilc.org to view site.

This site is only available in English.

Protection and Advocacy, Inc. (PAI)

Protection and Advocacy is dedicated to advancing the human and legal rights of persons with disabilities. The site provides extensive information to assist disabled individuals with legal questions regarding government programs. Click on www.pai-ca.org to view site.

This site is only available in English.

Public Interest Clearinghouse (PIC)

Since 1979, the Public Interest Clearinghouse has provided technical assistance, coordination and advocacy in order to leverage scarce resources and build the capacity of over 100 nonprofit civil and legal aid programs in California. Working with legal aid programs, law schools and students, law firm practitioners, the State Bar, the courts and others in the community, PIC fosters a united community that shares responsibility for fairly, compassionately and effectively meeting the essential legal needs of indigent and under-served people, and for removing barriers to achieving self-sufficiency and meaningful access to justice. Click here to view a directory of California and Nevada Legal Services Programs.

This site is only available in English and Spanish

Link: http://www.ssa.gov/ssi/text-help-ussi.htm

What SSI Benefits Are Available To California Residents?

SSI, or Supplemental Security Income, is a federal program that provides monthly cash payments to people in need. SSI is for people who are 65 or older, as well as for blind or disabled people of any age, including children. SSI benefits may vary by State. The state of California adds money to the federal payment. The single payment you get in the beginning of each month includes both the federal SSI payment and your supplement from California.

To qualify you also must have little or no income and few resources. This means that the value of the things you own must be less than $2,000 if you are single or less than $3,000 if you are married. The value of your home does not count. Usually, the value of your car does not count. And the value of certain other resources, such as a burial plot, may not count either.

To get SSI, you also must apply for any other cash benefits you may be able to get.

Medical assistance

If you get SSI, you usually can get California medical assistance (Medi-Cal) automatically. A separate Medi-Cal application is not necessary. If you have questions about Medicaid, contact your local county welfare office.

Food stamps

SSI recipients in California cannot get food stamps because the state adds money to the amount it adds to the federal SSI payment instead.

However, you may be able to receive food stamps:

  • While your SSI benefit application is pending;
  • If your application for SSI benefits is denied; or
  • if you move to another stateFor more information, contact your local county welfare office.Other social servicesOther services you may be able to get through your local country welfare office include:
  • Special allowance for assistance dogs for people who are blind or have a disability;
  • In-home support services; and
  • Protective services.
  • For more information, contact your local county welfare office.Monthly SSI payment amountsThe amounts include both federal and state payments combined. Not all SSI recipients receive the maximum amount. Your payment may be lower if you have other income. Click HERE to view the benefit amounts for individuals, couples, etc for California for 2004.THIS INFORMATION IS GENERAL. FOR MORE INFORMATION, CALL 1-800-772-1213 (TTY 1-800-325-0778), OR CONTACT YOUR LOCAL SOCIAL SECURITY OFFICE.

    Click Here To Go To The Original Source

    Click Here For Additional SSI Information

    Source: Social Security Website: Supplemental Security Income (SSI) In California, SSA Publication No. 05-11125, February 2004

 

Link: www.socialsecurity.gov/ssi/text-understanding-ssi.htm