Cal. Code Regs. tit. 22 § 50262.6

Current through Register 2024 Notice Reg. No. 49, December 6, 2024

Section 50262.6 - Special Zero Share of Cost Program for Children of Age Six Up to Age Nineteen (100 Percent Program)

(a) Children who have attained six years of age but have not attained nineteen years of age are eligible to receive Medi-Cal benefits under the 100 Percent program if the following conditions are satisfied:

(1) The net nonexempt Medi-Cal Family Budget Unit (MFBU) income of otherwise eligible children shall not exceed 100 percent of the federal poverty level as defined in Section 50041.5.

(2) In determining net nonexempt income of the MFBU, all deductions and exemptions applicable solely to AFDC-MN persons or families, as provided in Article 10 of this chapter, shall be allowed except health insurance premiums.

(3) A child may not reduce MFBU income to the 100 percent level by meeting a share of cost.

(4) When determining eligibility for the 100 Percent Program, property shall be disregarded in accordance with Section 50401(c).

(5) Notwithstanding Section 50014, children are defined for this program as persons under 19 years of age.

(b) Period of Eligibility:

(1) The period of eligibility for the 100 Percent program shall begin no earlier than the first day of the month of the child's sixth birthday unless the child is an inpatient for whom medical services are provided during a continuous period that began before his/her sixth birthday and he/she remains eligible under Sections 50262 or 50262.5. Once the continuous inpatient stay ends, the child must be evaluated for the 100 Percent program if he/she has not attained age nineteen.

(2) The period of eligibility for the 100 Percent program shall end on the last day of the month in which the child attains age nineteen unless the child is an inpatient for whom medical services are provided during a continuous period that began before his/her sixth birthday. In that event, the period of eligibility continues under the 100 Percent program until the end of the stay for which the inpatient services are furnished so long as the child would have remained eligible under the 100 Percent program but for attaining the age of nineteen.

(c) Scope of Benefits:

(1) An otherwise eligible child shall receive full Medi-Cal benefits if the child is a United States citizen or meets the requirements of Section 50301. If the child does not meet the requirements of this section, services shall be restricted to treatment of emergency medical conditions and pregnancy related services only.

(2) Services provided under this section shall not be subject to any share of cost requirements.

Cal. Code Regs. Tit. 22, § 50262.6

1. New section filed 10-26-95 as an emergency; operative 10-26-95 (Register 95, No. 43). A Certificate of Compliance must be transmitted to OAL by 2-23-96 or emergency language will be repealed by operation of law on the following day.
2. Certificate of Compliance, as to 10-26-95 order including editorial correction of subsection (b)(2), transmitted to OAL 2-21-96 and filed 3-20-96 (Register 96, No. 12).
3. Amendment of subsection (a), new subsections (a)(4) and (a)(5), and amendment of subsection (b)(1) and NOTE filed 4-2-98 as an emergency; operative 4-2-98. Submitted to OAL for printing only pursuant to Welfare and Institutions Code section 14148.75 (Register 98, No. 16). A Certificate of Compliance must be transmitted to OAL by 9-29-98 or emergency language will be repealed by operation of law on the following day.
4. Amendment of subsection (a), new subsections (a)(4) and (a)(5), and amendment of subsections (b)(1) and NOTE refiled 4-15-98 as an emergency, including additional amendment of subsection (a)(4); operative 4-15-98. Submitted to OAL for printing only pursuant to Welfare and Institutions Code section 14148.75 (Register 98, No. 16). A Certificate of Compliance must be transmitted to OAL by 10-12-98 or emergency language will be repealed by operation of law on the following day.
5. Editorial correction of HISTORY 3 and HISTORY 4 (Register 98, No. 47).
6. Certificate of Compliance as to 4-15-98 order transmitted to OAL 10-9-98 and filed 11-18-98 (Register 98, No. 47).

Note: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions Code. Reference: Sections 14005.1, 14005.23, 14007.5, 14050.1 and 14148.75, Welfare and Institutions Code; and Title 42, Sections 1395(a)(3)(E), 1396 a(a)(10)(A)(i)(VII), (e)(7), (l), 1396b(v) and 1396(l)(1)(D), United States Code.

1. New section filed 10-26-95 as an emergency; operative 10-26-95 (Register 95, No. 43). A Certificate of Compliance must be transmitted to OAL by 2-23-96 or emergency language will be repealed by operation of law on the following day.
2. Certificate of Compliance, as to 10-26-95 order including editorial correction of subsection (b)(2), transmitted to OAL 2-21-96 and filed 3-20-96 (Register 96, No. 12).
3. Amendment of subsection (a), new subsections (a)(4) and (a)(5), and amendment of subsection (b)(1) and Note filed 4-2-98 as an emergency; operative 4-2-98. Submitted to OAL for printing only pursuant to Welfare and Institutions Code section 14148.75 (Register 98, No. 16). A Certificate of Compliance must be transmitted to OAL by 9-29-98 or emergency language will be repealed by operation of law on the following day.
4. Amendment of subsection (a), new subsections (a)(4) and (a)(5), and amendment of subsections (b)(1) and Note refiled 4-15-98 as an emergency, including additional amendment of subsection (a)(4); operative 4-15-98. Submitted to OAL for printing only pursuant to Welfare and Institutions Code section 14148.75 (Register 98, No. 16). A Certificate of Compliance must be transmitted to OAL by 10-12-98 or emergency language will be repealed by operation of law on the following day.
5. Editorial correction of History 3 and History 4 (Register 98, No. 47).
6. Certificate of Compliance as to 4-15-98 order transmitted to OAL 10-9-98 and filed 11-18-98 (Register 98, No. 47).