When the county determines that you are eligible, you will receive an approval notice, and shortly after, a State of California Benefits Identification Card (BIC). This is a plastic card with your name, identification number, and a magnetic strip on it. CMSP members will also receive a CMSP identification (ID) card from AMM. All CMSP members receive a CMSP Member Guide in the mail that contains information about how to use CMSP benefit coverage. To receive CMSP benefits you will need to go to a CMSP network provider to receive all services, except emergency services. If you receive non-emergency services from a medical provider who is not a part of the CMSP provider network, you will be responsible for paying for those services. It is your responsibility to present your BIC and your CMSP ID card to the provider when you get services.
When you go to the doctor, pharmacist, or other medical provider, they will; verify your eligibility for CMSP, check if a Share of Cost (SOC) applies and if so, and how much is remaining on the SOC, and determine if there are other applicable restrictions or limitations.
In some situations your doctor may want you to take a certain drug or receive a service that requires additional authorization. When this is the case, your doctor will need to submit the appropriate pre-service review form to Advanced Medical Management for medical services that require prior approval. Your doctor will need to submit a Medication Request Form (MRF) to MedImpact for medications that require prior authorization.
Can I get CMSP for services received before I applied?
Applicants for CMSP may request one month of “retroactive” CMSP coverage. Applicants should talk with their county eligibility worker about applying for this coverage.
What else should I know?
Your beginning and end date for your CMSP benefits will be provided to you as a part of the Notice of Action (NOA) you get regarding your eligibility for CMSP. You may not receive another notice regarding the end date for your benefits. It is your responsibility to reapply for CMSP during the last month of your eligibility term if you would like to continue your CMSP eligibility into another term.
How do I learn more about the Path to Health program?
The Path to Health Pilot Project started in February 2019. Undocumented residents of any CMSP county that are 26 years and older and enrolled in emergency service only (restricted scope) Medi-Cal can apply through participating health centers. For more information, please visit https://mypathtohealth.org or https://caminoalasalud.org.
How do I learn more about the Connect to Care program?