Section 50262 - Special Zero Share of Cost Programs for Pregnant Women and InfantsThe following eligibility criteria shall apply to pregnant women, and infants under one year old with a share of cost. As used in this section the terms "woman" and "women" mean any female regardless of age. Counties shall determine eligibility for applicants and beneficiaries under either of the programs described in subsections (a)(1) and (a)(2). Eligibility shall first be determined under subsection (a)(1).
(a) Eligibility criteria: (1) 185 Percent Program. The net nonexempt Medi-Cal Family Budget Unit (MFBU) income of an otherwise eligible pregnant woman, or infant under one year old, shall be above the maintenance income need level but shall not exceed 185 percent of the federal poverty level, as revised annually in accordance with section 673(2) of the Omnibus Budget Reconciliation Act of 1981 (Public Law 97-35).(2) 200 Percent Program. The net nonexempt Medi-Cal Family Budget Unit (MFBU) income of an otherwise eligible pregnant woman, or infant under one year old, shall exceed 185 percent of the federal poverty level as specified in (a)(1) but shall not exceed 200 percent of the federal poverty level, as revised annually in accordance with section 673(2) of the Omnibus Budget Reconciliation Act of 1981 (Public Law 97-35).(3) 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, shall be allowed except health insurance premiums.(4) A pregnant woman or infant may not reduce MFBU income to the 185 or 200 percent level by meeting a share of cost.(5) If the pregnant woman and/or infant meet the requirements of the 200 Percent Program, but have assets which exceed the resource limit, the assets shall be waived for those applicants or beneficiaries in accordance with Section 50401(b).(b) Period of Eligibility: (1) Pregnant woman. Eligibility for the pregnant woman shall begin no earlier than the first day of the month for which pregnancy is verified. Eligibility shall end on the last day of the month of the 60-day period immediately following the last day of pregnancy.(2) Infant. Eligibility for an infant shall end upon attainment of age one, unless the infant is an inpatient for whom medical services are provided during a continuous period which began before his/her first birthday. In that event, the infant shall continue to be eligible until the end of the stay for which the inpatient services are furnished.(3) Retroactive eligibility. Eligibility for a pregnant woman or infant may be established retroactively in any of the three months immediately preceding the month of application as provided in section 50197.(c) Scope of Benefits: (1) A pregnant woman shall be eligible only for pregnancy related services, including services for conditions which complicate pregnancy.(2) An otherwise eligible infant shall receive full Medi-Cal benefits if the infant is a United States citizen or meets the requirements of section 14007.5 of the Welfare and Institutions Code, as added by Statutes of 1988, chapter 1441, Section 3. If the infant does not meet the requirements of this subsection, services shall be restricted to treatment of emergency medical conditions only.Cal. Code Regs. Tit. 22, § 50262
1. New section filed 6-27-89 as an emergency; operative 6-27-89 (Register 89, No. 26). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed on 10-25-89.
2. Certificate of Compliance as to 6-27-89 order including change without regulatory effect of subsection (c)(2) transmitted to OAL 10-25-89 and filed 11-22-89 (Register 89, No. 48).
3. Amendment of subsections (a) and (b) filed 1-23-90 as an emergency; operative 1-23-90 (Register 90, No. 4). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed by operation of law on 5-23-90.
4. Certificate of Compliance as to 1-23-90 order including amendment transmitted to OAL 5-22-90 and filed 6-21-90 (Register 90, No. 33).
5. Editorial correction of subsection (c) printing error (Register 90, No. 33).
6. New subsection (a)(5) filed 5-28-92 as an emergency; operative 5-28-92 (Register 92, No. 22). A Certificate of Compliance must be transmitted to OAL 9-25-92 or emergency language will be repealed by operation of law on the following day.
7. Certificate of Compliance as to 5-28-92 order transmitted to OAL 9-25-92 and filed 10-19-92 (Register 92, No. 43).
8. Change without regulatory effect amending subsection (b)(3) and NOTE filed 6-21-2012 pursuant to section 100, title 1, California Code of Regulations (Register 2012, No. 25). Note: Authority cited: Section 20, Health and Safety Code; and Sections 10725 and 14124.5, Welfare and Institutions Code. Reference: Sections 14007.5, 14148, 14148.1 and 14148.5, Welfare and Institutions Code.
1. New section filed 6-27-89 as an emergency; operative 6-27-89 (Register 89, No. 26). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed on 10-25-89.
2. Certificate of Compliance as to 6-27-89 order including change without regulatory effect of subsection (c)(2) transmitted to OAL 10-25-89 and filed 11-22-89 (Register 89, No. 48).
3. Amendment of subsections (a) and (b) filed 1-23-90 as an emergency; operative 1-23-90 (Register 90, No. 4). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed by operation of law on 5-23-90.
4. Certificate of Compliance as to 1-23-90 order including amendment transmitted to OAL 5-22-90 and filed 6-21-90 (Register 90, No. 33).
5. Editorial correction of subsection (c) printing error (Register 90, No. 33).
6. New subsection (a)(5) filed 5-28-92 as an emergency; operative 5-28-92 (Register 92, No. 22). A Certificate of Compliance must be transmitted to OAL 9-25-92 or emergency language will be repealed by operation of law on the following day.
7. Certificate of Compliance as to 5-28-92 order transmitted to OAL 9-25-92 and filed 10-19-92 (Register 92, No. 43).
8. Change without regulatory effect amending subsection (b)(3) and Note filed 6-21-2012 pursuant to section 100, title 1, California Code of Regulations (Register 2012, No. 25).