California Department of Social Services - State Hearings
Division
Notes from the Training Bureau - June 12, 2000
Item 00-06-01H CDHS ACWDL 00-24 -- April 13, 2000 (Synopsis): Access for Infants and Mothers (AIM) Applications |
Access for Infants and Mothers (AIM) Applications
The AIM program is administered by the Managed Risk Medical Insurance Board. It provides comprehensive health care to uninsured moderate income (200 to 300 percent of the FPL) pregnant women and their newborns. The AIM application is a mail-in application.
In determining eligibility for AIM, AIM contractors use many of the same income deductions used by Medi-Cal. When the AIM application is denied because the applicant's income is below 200% of the FPL, that application is deemed sufficient to serve as an application for pregnancy related services only under Medi-Cal.
Effective February 1, 2000, AIM contractors were instructed to begin forwarding any AIM applications to the county that were denied because the applicant had income below 200% of the FPL. The county is required to process the AIM application as a Medi-Cal application for pregnancy related services only. AIM applications denied for reasons other than income below 200% of the FPL are not supposed to be forwarded to counties.
The AIM application does not provide sufficient information to allow a county to determine eligibility for full scope Medi-Cal. The AIM application includes the applicant's authorization to forward the application to the county for processing as a Medi-Cal application.
Once the forwarded AIM application has been received by the county and determined to be complete, the county must notify the applicant in writing that the AIM package has been received and will be processed as a Medi-Cal application for pregnancy related services only.
This ACWDL gives counties further instructions on how to process forwarded AIM applications including how to proceed if the applicant wants full scope Medi-Cal.
Note: Since AIM is not a Medi-Cal program, an ALJ has no jurisdiction to review whether the AIM application was correctly denied as an AIM application. However, an ALJ would have jurisdiction to determine whether the county correctly determined Medi-Cal eligibility pursuant to an AIM application that was forwarded to the county to be processed as a Medi-Cal application.