ELIGIBILITY FOR SACRAMENTO COUNTY MEDICALLY INDIGENT SERVICES PROGRAM (CMISP)
4600 Broadway, Ste. Sacramento, CA 95820-1527 Telephone 916 874 9238
You may be eligible for CMISP benefits if you:
· Are a resident of Sacramento County
· Are not eligible for full scope Medi-Cal benefits
· Have a current medical need
· Cannot pay for the medical care you need
· Complete a CMISP application
· Meet current income guidelines
· Meet property guidelines
Examples of personal property are jewelry, stocks,
bonds, savings and checking accounts, accessible
retirement accounts, and cash value of life insurance policies.
Examples of real property are land, buildings,
mortgages, notes and deeds of trust. Call the Department of Human Assistance (DHA)
Eligibility Information Line at (916) 874-2072 you have any questions about income or property rules.
· May be determined by the Sacramento County Department of Human Assistance (DHA)
· May be approved up to twelve (12) months at a time
· Eligibility may be discontinued at any t ime if
eligibility rules are not met
· May reapply if a medical problem exists
To apply for CMISP coverage, you:
· Must have a current medical need
· Must be referred for an eligibility determination by
* A medical or dental clinic run by the Sacramento County Department of Health and Human Services
* Or by an emergency room that contracts for outpatient services under the CMISP program or by a hospital that contracts for inpatient services under the CMISP program
1-27-05 last update
After DHA receives your application, you:
· Will receive a notice within two to four weeks telling you if your eligibility is approved or denied. If your application is approved, you:
· Must read all papers sent to you by CMISP
· May be eligible up to twelve months at a time assuming all eligibility requirements are met
· Must tell everyone who gave you care of your eligibility
· May reapply for CMISP if you still have a medical need at the end of twelve months
· Must repay the Program in the event of a Worker’s
Compensation, insurance or accident claim settlement
· You must pay your share if cost of you have one
The CMISP program covers necessary medical services for eligible Sacramento County residents who have no other resource for medical care. “Necessary medical services are those needed to treat acute life or limb threatening conditions, or remedy substantial pain and infection, and emergency medical services, including services that protect life, prevent significant disability and prevent significant deterioration of health. Not all medical services are covered.
SERVICES NOT COVERED BY CMISP INCLUDE:
· Services rendered before eligibility is determined or without authorization
· Services from a provider who has no agreement with the County to provide services
· Hospital emergency room care for non-emergency conditions. “Emergency medical services are services required immediately in order to lesson severe pain or to prevent disability or death”.
· Cosmetic surgery.
· Transplants including bone marrow, stem cell, or tissue transplants
· Treatment for mental disorders, alcoholism or drug addiction. The Sacramento County Division of Mental Health or Division of Alcohol and Drug
Programs may provide services not covered by CMISP.
· Hearing aids, eyeglasses, and eye appliances (except for initial pair after cataract surgery for adults).
· Treatment for military service-connected conditions.
· Chiropractic care.
· Family planning, fertility testing and medical management, and sterility study or treatment
· Prayer or spiritual healing
· Acupuncture or acupressure
· Hospice Care
· Long term care placement (SNF placement)
· Allergy testing, and injections
· Routine, school, pre-employment or naturalization physical exams
· Procedures, which the Sacramento County Medical Systems Director determines to be experimental or
which are not demonstrated to be effective for the condition, involved
· Services, which the Sacramento County Medical
Systems Director determines to fall outside of accepted community standard of care
· Second opinion unless specifically requested by
Sacramento County Medical Case Management