DPSS ePolicy

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The Military Verification and Referral Form - MC 05, must be used by Eligibility Workers (EWs) to request information from the County Veterans Service Offices (CVSO).  The MC 05 is used when a Medi-Cal applicant or beneficiary has declared that they are either:  a veteran, veteran’s spouse or widow, dependent child or the parent of a veteran.

Medi-Cal EWs were previously instructed to use the Veteran’s Benefits Verification and Referral Form CW 5 to refer applicants or beneficiaries to the CVSO.

The Department of Health Care Services (DHCS) is now instructing counties to use the Military Verification and Referral Form - MC 05 during this process.

Effective July 1, 2016, the Military Verification and Referral Form - MC 05 must be used by staff during the eligibility determination process for Medi-Cal Only cases to determine if the household is eligible to receive military benefits.

Staff is required to discontinue use of the CW 5 - Veteran's Benefits Verification and Referral form for Medi-Cal Only cases.  However, staff may continue using the CW 5 for CalWORKs, CalFresh or General Relief cases.

The Military Verification and Referral Form - MC 05, is used for:

• New Medi-Cal applicants or beneficiaries who declare, in writing or verbally, that they are a veteran, veteran’s spouse or widow, dependent child or the parent of a veteran or;
  
  
• New Medi-Cal applicants who also request assistance under other benefit programs (such as:  CalFresh, CalWORKs, or General Relief), even if the CW 05 was issued to establish eligibility for the other programs.
  
  Example:  A veteran is applying for General Relief (GR), CalFresh (CF) and Medi-Cal.  Per GR and CF requirements, the EW must complete the CW 05.  Per Medi-Cal policy requirements, the EW must also complete the MC 05.  This case record must include a CW 5 and a MC 05.

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