County Medical Services

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CMS Frequently Asked Questions

 

 

Frequently Asked Questions

Q: What is County Medical Services (CMS)?
A: CMS is not health insurance; it is a program of last resort for eligible adults, which covers only necessary medical services. CMS uses a network of Community Health Centers, private physicians and local hospitals to provide the services. A listing of CMS providers can be found in the CMS Patient Handbook. You can find the CMS Patient Handbook by selecting "CMS Handbooks" in the drop down menu.

Applying For CMS

Q: How do I apply for CMS?
A: Call 1-800-587-8118 to schedule an eligibility appointment with a County CMS worker at a designated Public Health Center or community clinic at a location convenient for you.
   
Q: Can I apply for CMS online?
A: No, you must call (800) 587-8118 to make your CMS appointment for an interview with a County CMS worker.
   
Q: Can I make an appointment online for CMS?
A: No, you must call (800) 587-8118 to make your CMS appointment for an interview with a County CMS worker.
   
Q: Do I have to make an appointment to go in and apply?
A: Yes, all applications are taken in person by appointment only.
   
Q: What do I need to bring with me when I apply?
A: You will need to bring identification, proof of US citizenship or legal alien status, proof of residency (such as a rental agreement), verification of income you received (such as pay stubs), and verification of property you own (such as bank statements). Your CMS worker will advise you if additional verifications are needed.
   
Q: What if I don't have everything for the eligibility appointment?
A: You should still go to your CMS eligibility appointment. Your CMS worker will review your application and give you a complete list of items necessary to complete the eligibility process. Your CMS worker will give you a specific timeframe in which to provide outstanding items.
   
Q: I lost my CMS Handbook, how can I receive another one?
A: The CMS Patient Handbook is available online. You can find the CMS Patient Handbook by selecting "CMS Handbooks" from the drop down menu on the CMS home page.
   

Requirements For CMS

Q: What are the Requirements For CMS?
A: Minimum Eligibility Criteria:
  • Have an immediate or long-term medical need
  • Be 21 through 64 years of age
  • Be a U.S. citizen or an eligible alien, and be able to provide documentation of U.S. citizenship or legal alien status.
  • Be a resident of San Diego County
  • Sign lien forms for services covered by CMS
  • Meet CMS financial requirements or receive General Relief
   
Q: What are the income guidelines for CMS?
A: The income guidelines vary depending upon the number of people in your family. If your family income is between 0-165% of the Federal Poverty Level (FPL), then you may be eligible for CMS at no cost. If your family income is more than 165% of FPL, you may apply for a CMS Hardship and you may be eligible for CMS with or without a Share of Cost.
   
Q: What is acceptable CMS verifications for citizenship?
A: Examples of acceptable verification include:
  • U.S. Passport issued without limitations
  • Certificate of Naturalization (N-550 or N-570)
  • Certificate of U.S. Citizenship (N-560 or N-561)
  • U.S. Birth Certificate issued by the State, Commonwealth, Territory or local Jurisdiction
   

CMS Coverage

Q: I have CMS, can I use it with any doctor?
A: No, when you were certified for CMS you were asked to choose one of the community health centers as your primary care provider. You should go to the community health center you selected for your care.
   
Q: Does County Medical Services cover medications?
A: CMS covers medications that are on the CMS approved list. If your medication is not on the approved list, your primary care physician may submit a treatment authorization request (TAR) to CMS for review.
   
Q: What if it is not a CMS covered prescription?
A: If your physician prescribes a medication that is not covered by CMS, your primary care physician may submit a Treatment Authorization Request (TAR) to CMS for review.
   
Q: Where can I get my prescriptions filled?
A: Prescriptions must be filled by a CMS contracted pharmacy or by your primary care provider. If you fill your prescription at a pharmacy that does not contract with CMS or you fill a prescription that CMS did not approve, you are responsible for paying for the medication yourself. A list of CMS Pharmacies can be found in your CMS Patient Handbook. You can also find the CMS Patient Handbook by selecting "CMS Handbooks" in the drop down menu.
   
Q: Does CMS cover dental services?
A: CMS covers emergency dental care ONLY at a CMS dental clinic. CMS does not provide complete dental care such as routine check-ups, cleaning, or dentures.
   
Q: Where can I see a dentist?
A: A complete list of authorized dentists is listed in your CMS Patient Handbook. You can also find the CMS Patient Handbook by selecting "CMS Handbooks" in the drop down menu.
   

Share of Cost (SOC)

(applies only to those who have applied for the CMS Hardship)

Q: What is Share of Cost (SOC)?
A: SOC is the amount that you must pay or be obligated to pay toward the cost of CMS covered health care services (including CMS approved prescriptions) each month you receive CMS services. This is different from the Reimbursement Agreement and Lien described below, which might not be collected until some time in the future.
   
Q: How much will my SOC bill be?
A: Your worker will determine the amount of your monthly SOC, and you will be notified of this amount and how it was calculated.
   
Q: Am I required to pay my SOC every month?
A: Only if you receive CMS services every month. You will not be responsible for paying your SOC in months you do not receive CMS services. Please do not send payments to CMS until you receive a statement.
   
Q: How do I pay my SOC?
A: You will be billed the amount of your SOC or the amount of CMS services, whichever is less. You will not be billed for any months in which you do not receive CMS services. The billing statement will include the address where to send the monthly payments. Do not send payments to CMS until you receive a billing statement. Do not send cash. The County will not accept cash payments.
   
Q: Is interest added on to what I owe?
A: No
   
Q: When will I be required to make payments?
A: When you receive a bill from the County it is due. If you have questions regarding SOC billing and collection, you can call our SOC bill representative at 1-877-702-6508.
   
Q: I just saw my physician, when will I receive a statement?
A: Once all claims are received from your health care provider.
  • If your Share of Cost has been satisfied for the month, a monthly   statement will be sent.
  • If your Share of Cost is not satisfied for the month, a quarterly statement will be sent.
   
Q: Can I pay the SOC with credit cards?
A: Yes, the County accepts Master Card, Visa, and Discover. You may also make payments with personal checks, cashiers checks or money orders. The County does not accept cash payments.
   
Q: Why did I receive a statement?
A: Based on your recent CMS and CMS Hardship applications, you were approved CMS with a Share of Cost. You received a statement because you received CMS services and are responsible for paying your Share of Cost.
   

Reimbursement Agreement

(applies only to those who have applied for the CMS hardship)

Q: What is the purpose of the Reimbursement Agreement?
A: It allows the County to seek reimbursement from you for:
  • Your monthly SOC obligation for those months which you received CMS services, and/or
  • Any health care related costs CMS paid on your behalf.
   
Q: When can I be required to make payments to the County?
A: While you are eligible for CMS you will receive a bill from the County for your SOC for each month you receive CMS services. You are obligated to pay the SOC when you receive a bill. After you are no longer eligible for CMS, you will receive a bill from the County for the balance due on your account for all amounts paid by CMS on your behalf stating that payments are due.
   
Q: If I sign the Reimbursement Agreement do I still have to sign the Lien?
A: If you are applying for a CMS Hardship, then yes, you must sign both documents.
   
Q: What is the difference between the Lien and the Reimbursement Agreement?
A:
  • The Lien attaches to real property to secure the amounts owed to the County for payments made by CMS on your behalf.
  • Reimbursement Agreement--Once you are no longer eligible for CMS, the County may bill you for the balance due on your account and seek reimbursement from your assets or surplus income.
   
Q: Can you take my inheritance and/or lottery winnings with the Reimbursement Agreement?
A: Yes, if you have surplus money from these sources after meeting your support needs and those of your family. If part of what you inherit is a home that you, your spouse, your minor children, or any dependent child of any age who is incapable of self-support because of a mental or physical disability lives in, the County cannot foreclose on that home.
   
Q: When do I have to reimburse the County?
A: When you stop getting CMS or when you die. The County can collect reimbursement from those assets you obtained after you applied for CMS, if there is surplus after meeting the support needs of yourself and your family.
   
Q: How will signing the Reimbursement Agreement with the County affect my credit?
A: Signing the Reimbursement Agreement will not affect your credit. It is not a recordable document.
   
Q: Will my wages be garnished?
A: No, unless the county obtains a judgment and you fail to pay the judgment. Even then, the County may only garnish your wages if you have surplus money after meeting the support needs of yourself and your family.
   
Q: How long does a Reimbursement Agreement last?
A: Until you have fully repaid the amount you owe the County.
   
Q: Does the Reimbursement Agreement include my children's assets (property, lottery winnings...)?
A: No.
   
Q: Can my children be held responsible for repaying the County?
A: No.
   
Q: Do I have to repay the County just because I get a new job?
A: No.
   
Q: Is interest added on to what I owe?
A: No, unless the County obtains a judgment.
   
Q: Can I pay what I owe the County with credit cards?
A: Yes, the County accepts Master Card, Visa, and Discover. You may also make payments with personal checks, cashiers checks or money orders. The County does not accept cash payments.
 
   
Q: Why am I receiving a bill from the County?
A: When you applied for CMS benefits, you signed the form CMS-106 Agreement to Reimburse the County of San Diego.  By signing the form, you agreed to repay all the money paid by CMS on your behalf for your care.  The bill is the amount you now owe the County.  
 
   
Q: Can I make payment arrangements?
A: Yes, you can make arrangements by contacting:
    County of San Diego
    Office of Revenue Recovery
    P.O. Box 129037
    San Diego, CA  92112
    (619) 515-6200
 
   
Q: Can I get a copy of the reimbursement agreement I signed?
A: Yes, you can request a copy of the signed reimbursement agreement by sending your signed request to:
    County Medical Services
    P.O. Box 85222 MS 0557E
    San Diego, CA  92186
 

Liens

Q: Do I have to sign a Lien agreement?
A: Yes, Everyone who applies for CMS starting April 11, 2008, is required to sign a Lien. If you applied for CMS before April 11, 2008, you do not have to sign a Lien. If you are confined to the hospital for tuberculosis ("TB"), you may not have to sign the Lien. If you are confined to the hospital for TB and you are also receiving services not related to TB, you may not have to sign the Lien. If you are in the hospital for other reasons, but not confined to the hospital for TB, the fact that you have TB does not exempt you from signing the lien.
   
Q: What is the purpose of the Lien?
A: It attaches to real property to secure the amounts you owe the County for amounts paid by CMS on your behalf. It allows the County to seek reimbursement for such amounts from your real property.
   
Q: If I sign the Lien, will I be forced to move out of my home?
A: No.
   
Q: If I sign the Lien, do I have to sell my home?
A: No.
   
Q: I am a renter and own no real property. Do I have to sign the Lien?
A: Yes. The Lien will attach to real property you may own on the future.
   
Q: Can you take my inheritance and /or lottery winnings with the Lien?
A: No, the Lien is effective only against your real property.
   
Q: Will my wages be garnished?
A: No.
   
Q: Can the County foreclose on the lien on my home while my family lives in our home?
A: No. The County cannot foreclose on your home during your lifetime or your spouse's lifetime. The county also cannot foreclose on your home while your minor children live in your home or during the lifetime of any dependent child of any age who lives in the home who is incapable of self-support because of a mental or physical disability.
   
Q: Can I sell my home and buy another one?
A: Yes, you can sell your home and buy another one as long as the County's Lien is transferred to the new home. The County will release the Lien on the original home and transfer it to the new home, provided that it finds its security will not be impaired.
   
Q: Can I refinance my home?
A: Yes, as long as the County's Lien is not compromised, you can refinance. You can also use your home for security to borrow money for the purpose of making improvements on your home as long as the County finds that its security will not be impaired.
   
Q: How will signing the Lien affect my credit?
A: The recording of a Lien is a matter of public record, and will appear on credit reports the same way mortgage or other loan is listed.
   
Q: How long does the Lien last?
A: Until you have repaid the amount owed to the County.
   
Q: If I sign the Lien, does it prevent me from buying real property in the future?
A: No, but the Lien would attach to any real property you buy in the future.
   
Q: Does the Lien include my children's real property?
A: No.
   
Q: What if I own my home with someone else?
A: The Lien will not attach to the other person's interest in the home.
   
Q: When will I be required to make payments on the Lien?
A: After you are no longer eligible for CMS you may be required to make payments to the County. Such payments would reduce the amount secured by the Lien.  The County cannot require you to use equity in your home to pay the Lien.  If you sell your home and do not buy a new one that you, your spouse, your minor children, or any dependent child of any age who is incapable of self-support because of a mental or physical disability lives in, or if you refinance your home the lender or the County may require you to pay all or a portion of the amounts owed the County.  Also, if real property is purchased after the Lien is signed, the Lien will have priority (based on recording date) over a Deed of Trust issued by the lender.  A lender may require that the Lien be satisfied before making the loan.
   
Q: Do I have to repay CMS if I get a new job?
A: No.
   
Q: Is interest added on to what I owe?
A: No.
   
Q: For married couples, do both spouses have to sign the Lien?
A:

Yes, the applicant and spouse both have to sign the lien in front of either a Deputy County Clerk or Notary Public so that the form can be properly witnessed.  If you are no longer residing with your spouse and are unable to obtain your spouse's signature notify your worker.  Your worker will advise you of alternate documentation that CMS may accept.

   
Q: For married couples who are separated or divorced, do both spouses have to sign the Lien?
A:

No. Only the applicant needs to sign the Lien, but legal documentation regarding the separation or divorce must be provided. If you are unable to provide legal documentation, notify your worker.  Your worker will advise you of alternate documentation that CMS may accept.

   
Q: If an unmarried couple owns a home together, do both owners have to sign the Lien or just the applicant?
A: Just the applicant.
   
Q: If my spouse is deceased, is documentation required?
A: Yes, a copy of a death certificate or some other evidence of the death must be provided.  If you are unable to provide legal documentation, notify your worker.  Your worker will advise you of alternate documentation that CMS may accept.
   
Q: Can I pay the Lien with credit cards?
A: No, payments to clear a Lien must be made by certified funds.
   
Q: If a married couple applies for CMS on separate occasions, do the lien forms need to be signed again by both applicant and spouse?
A: Yes.

 

For more information send us an email,
or call 1-800-587-8118