California Welfare and Institutions Code 14009 – (a) Any applicant for, or beneficiary of Medi-Cal, or person …
(a) Any applicant for, or beneficiary of Medi-Cal, or person acting on behalf of an applicant or beneficiary shall be informed as to the provisions of eligibility and, in writing, of their responsibility for reporting facts material to a correct determination of eligibility and spend down of excess income.
(b) Any applicant for, or beneficiary of Medi-Cal, or person acting on behalf of an applicant or beneficiary shall be responsible for reporting accurately and completely within their competence those facts required of them pursuant to subdivision (a) and to report promptly any changes in those facts.
Terms Used In California Welfare and Institutions Code 14009
- Beneficiary: A person who is entitled to receive the benefits or proceeds of a will, trust, insurance policy, retirement plan, annuity, or other contract. Source: OCC
- County: includes "city and county. See California Welfare and Institutions Code 14
- department: means the State Department of Health Services. See California Welfare and Institutions Code 14062
- director: means the State Director of Health Services. See California Welfare and Institutions Code 14061
- Entitlement: A Federal program or provision of law that requires payments to any person or unit of government that meets the eligibility criteria established by law. Entitlements constitute a binding obligation on the part of the Federal Government, and eligible recipients have legal recourse if the obligation is not fulfilled. Social Security and veterans' compensation and pensions are examples of entitlement programs.
- Medi-Cal: means the California Medical Assistance Program. See California Welfare and Institutions Code 14063
(c) If, because of a failure to report facts in accordance with subdivision (b), the beneficiary received health care to which they were not entitled, they shall be liable to repay any overpayment. The amount of overpayment shall be based on the amount of excess income or resources and computed in accordance with overpayment regulations promulgated by the director.
(d) No liability for overpayment shall result from circumstances where there is a failure on the part of an applicant or beneficiary to perform an act constituting a condition of eligibility, if the failure is caused by an error made by the department or a county welfare department, or where the beneficiary reported facts in accordance with subdivision (b) but a county welfare department failed to act on those facts.
(e) When the department determines that an overpayment has occurred, the department shall seek to recover the full amount of the overpayment by appropriate action under state law against the income or resources of the beneficiary or the income and resources of any person who is financially responsible for the cost of their health care pursuant to Section 14008.
(f) The department shall advise the beneficiary of the overpayment, the amount they are liable to repay, and of their entitlement to a hearing on the propriety of the action pursuant to Chapter 7 (commencing with Section 10950) of Part 2.
(g) No civil or criminal action may be commenced against any person based on alleged unlawful application for or receipt of health care services, where the case record of the person has been destroyed after the expiration of the retention period provided pursuant to Section 10851.
(Amended by Stats. 2023, Ch. 42, Sec. 103. (AB 118) Effective July 10, 2023.)