DPSS ePolicy

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The Medi-Cal Dialysis/Special Treatment Programs (STPs) are special programs designed to help individuals who are in need of either renal dialysis or Parenteral Hyperalimentation, also known as Total Parenteral Nutrition (TPN).

These STPs are available to people with higher incomes and resources to avoid impoverishment due to their medical condition and to facilitate the individual’s ability to continue working.

There are no income or property limits for SPT clients.  Instead of being determined ineligible due to income or property limits, STP clients must either pay or assume legal responsibility for a fixed percentage of their countable income and assets; and may not need to spend down their property in order to receive assistance.

There are two types of Medi-Cal STPs:

• Special Treatment Program Only (STP-O)
• Special Treatment Program Supplemental (STP-S)
   

Special Treatment Program Only (STP-O)

This program is for persons who do not qualify for Modified Adjusted Gross Income (MAGI) Medi-Cal due to high income or Non-MAGI Medi-Cal due to excess property.  Under this program, individuals are eligible to receive dialysis or TPN services only, not full regular Medi-Cal benefits.  These are persons who:

• Receive or are in need of dialysis or Parenteral Hyperalimentation/TPN services;
• Would be eligible under Non-MAGI Medi-Cal except for having too much property; and
• If under age 65, are not eligible for renal dialysis Medicare coverage.

Note:  Persons aged 21 through 64 who receive or need TPN services are not required to meet Medi-Cal disability criteria.  These persons are not to be referred to the Disability Determination Services Division (DDSD).

Special Treatment Program Supplemental (STP-S)

This program is for persons who are eligible to Non-MAGI Medi-Cal with a Share of Cost (SOC) who need dialysis or Parenteral Hyperalimentation/TPN services.  These are persons who:

• Receive or are in need of dialysis or Parenteral Hyperalimentation/TPN services;
• Are gainfully employed or self-employed and earn a gross income in excess of the Maintenance Need for one person; and
• Are approved or would be eligible for Non-MAGI Medi-Cal with a SOC.

Note:  Persons aged 21 through 64 who receive or need TPN services are not required to meet Medi-Cal disability criteria.  These persons are not to be referred to the Disability Determination Services Division (DDSD).

Financial eligibility for STPs is determined differently than regular Medi-Cal programs.  STP eligibles must either pay or assume full legal responsibility for a percentage of the cost of dialysis or parenteral hyperalimentation and related services.  This amount is termed "Percentage Obligation" and is based upon the annual net worth of the Medi-Cal applicant/beneficiary.

Retroactive Medi-Cal eligibility is not provided under the Medi-Cal STPs.

Terms and Descriptions

Parenteral Hyperalimentation

Also known as Total Parenteral Nutrition (TPN) provides total nutrient replacement through a catheter positioned in the chest for persons who are unable to eat and digest food.

Annual Net Worth

The total market value of all property and gross income received for a 12 month period by the applicant/beneficiary.

Percentage Obligation

The percent of the cost of dialysis or Parenteral Hyperalimentation/TPN and related services for which a Medi-Cal Special Treatment Programs beneficiary must either pay or assume full legal responsibility.

Medi-Cal dialysis/STP applicants:

• Are exempt from the Deficit Reduction Act (DRA) requirements;
• Are required to comply with the annual renewal process;
• Are required to apply for Medicare;
• Are not eligible for Retro-active MC eligibility;
• Should not receive the IRS Health Coverage form 1095-B from DHCS.

Medi-Cal dialysis/STP applicants must meet all other eligibility criteria specified under current regulation (e.g., cooperation, California residence, institutional status and transfer of property requirements).

Medicare Application Requirements

Customers applying for the Medi-Cal Dialysis/Special Treatment Programs, must meet the following Medicare Application requirements:

1. Dialysis customers must apply for Medicare within 10 days of their Medi-Cal dialysis/SPT application. 
2. Parenteral Hyperalimentation Program/TPN customers must apply for Medicare as part of their application process, if they are receiving Social Security Title II Disability benefits.
3. There is no State Buy-In for special treatment program cases.

Note:  Applicants who fail to apply for Medicare within the prescribed time period, except for good cause, shall have the application denied under the specific Medi-Cal STP.

Dialysis/SPT clients who have applied for Medicare must provide their Eligibility Worker (EW) with a copy of the Social Security statement of Medicare status within ten (10) days of receipt of the statement.

Customers who have not received a Social Security statement of Medicare status within three (3) months of their Medicare application, should check with Social Security Administration and keep the EW informed as to the delay.

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