The biggest advantage to obtaining full scope Medi-Cal coverage through "Institutional Deeming" is that your child will be eligible for all approved Medi-Cal services, including medical, dental, and even Early and Periodic Screening Diagnosis and Treatment (EPSDT) services. Your child may also be eligible for In- Home Supportive Services (IHSS) which may supplement any respite services you receive from the Regional Center.
"Institutional Deeming" Requirements to Apply for Medi-Cal Coverage
If your child satisfies the requirements (listed below), your regional center service coordinator will send your child’s information to the Medicaid Waiver coordinator who will review the application and submit it to the local Department of Public Social Services (DPSS) Medi-Cal office. If you need help completing the application, the on-site Medicaid Waiver coordinator can typically assist you. Just ask your child's primary service coordinator.
The following criteria must be met for your child to be considered for institutional deeming:
Must be under the age of 18
Must have a qualifying developmental disability diagnosis documented by a medical professional
Have a valid Social Security number
Permanently live at home with his or her family
Be ineligible for Medi-Cal coverage due to their family’s income
Have two or more qualifying conditions in the areas of self-help, motor and/or emotional functioning, special health conditions, or extensive medical needs
Receive at least one qualifying service from your local regional center and use that service at least one time per year
Please note: If your child does not have two qualifying deficits or is not receiving a qualifying service from your local regional center at the mandated minimum of once per year, your child will not be eligible for this program.
Next Steps in Medi-Cal Application
The applying parent will receive a Medi-Cal application from DPSS and it must be completed and returned within 30 days. As part of the application, the applying parent will be asked to provide information about the child's family’s income and other financial resources. DPSS needs this information to confirm that the family income exceeds Medi-Cal requirements. When evaluating your application, DPSS will typically also screen other members of your family for Medi-Cal eligibility.
Once DPSS has completed the evaluation, they will send you a Notice of Action (NOA) with either the start date of eligibility or the reason for the denial of Medi-Cal eligibility. If your child is approved for Medi- Cal coverage, you will receive his or her Medi- Cal identification card in the mail soon after you receive the NOA. Your child’s Medi-Cal number and the date of coverage will be on the card. Coverage will be retroactive to the date of initial application.
The child's local regional center needs to know if he or she qualifies for Institutional Deeming. Since they will not receive a copy of the NOA, be sure to inform the service coordinator about the DPSS decision and, if eligibility is approved, your child’s Medi-Cal number. You should also allow your service coordinator to make a copy of the NOA for your regional center record.
Want to know other ways to apply for Medi-Cal without using institutional deeming? Read this.
