Medi-Cal Case Examples

The following are examples of Medi-Cal cases:

Example #1: Medi-Cal

Household Composition

Adult mother receiving Medi-Cal for herself and a child.

Situation

The only child turns 21 and is no longer eligible for Medi-Cal. The mother still qualifies for Medi-Cal.

Case Structure

The same case would be used for mother’s Medi-Cal case.

Case Name

Case name would remain the same.

Example #2: Active Family Case

Household Composition

Mother and/or father with an 18 year old child.

Situation

Last eligible child turns 18 years old and is on GA. Parents wish Medi-Cal to continue for all.

Case Structure

Family case to remain open (with 18-year-old) for Medi-Cal. Eighteen (18)-year-old's GA case to remain open.

Case Name

Family case will remain in either the mother or father’s name, depending on who applied.

Example # 3: Medi-Cal Long Term Care (LTC)

Household Composition

Aged adult male in LTC facility. Spouse and child under 21 living at home.

Situation

Mother comes in to apply for Medi-Cal for all three individuals.

Case Structure

There will be two separate cases. Dad will be in his own adult case. Mother and child will be in their own family case.

Case Name

Mother’s case will be in her name. Father’s case will be in his name.

Exception: Even though the mother applied for the father, the case would be put in the father’s name since she was applying on his behalf.

Example # 4: Needy Caretaker Case

Household Composition

Mother, Father, their two children and mother’s nephew.

Situation

Father is working full-time, therefore there is no linkage for parents. Both children are receiving Medi-Cal. Nephew moves into home and mother (aunt) is requesting Medi-Cal for him.

Case Structure

The child will be added to the existing case. Either the mother (aunt) or father (uncle) may receive Medi-Cal for the child as needy caretaker relatives.

Case Name

The case will remain in the same case name, either the mother’s (aunt’s) or father’s (uncle’s), depending on who applied first.

Reminder: In CDS, the nephew could not be added to the existing case. The nephew would have had to have been set up under his mother’s case name. The rule about receiving aid under the mother’s case name and number no longer applies. The child must be added to the  aunt’s case. CalWIN will automatically separate the child into his own MBU.

Cases are to be combined into the female's case number, regardless of the programs received.

Case Name

Case name will remain in the female’s name.