The County Medical Services Program (CMSP) provides health coverage for uninsured low-income adults that are not otherwise eligible for other publicly funded health care programs like Medi-Cal. In California, 35 counties participate in the CMSP program. In this post, we will explain in detail CMSP in California, who is eligible, what it covers, how to apply, and the most frequently asked questions.
What is the County Medical Services Program (CMSP)?
California’s counties, by law, are the health care providers of last resort for residents age 18 and older who cannot afford healthcare.
This group of residents is called Medically indigent adults (MIAs).
For those who don’t qualify for Medi-Cal or Covered California, the county MIA programs are the main source of healthcare.
These include adults without children and undocumented residents.
Types of MIA Programs
County MIA programs fall into two categories: The California Medical Service Program (CMSP) counties and the Medically Indigent Service program (MISP) counties.
There are 35 states that participate in the CMSP program.
This post is about the CMSP program.
What is CMSP in California?
The County Medical Services Program (CMSP) provides limited-term health (up to 6 months) coverage for uninsured low-income adults that are not otherwise eligible for other publicly funded health programs.
The purpose of CMSP is to provide essential health care services to indigent adults who are not eligible for benefits under the Medi-Cal program or Covered California and whose income is insufficient to pay medical bills while still meeting their basic needs.
Most members receive a benefit that provides coverage of medically necessary inpatient, outpatient, vision, dental, and prescription drug services
Thirty-five, primarily rural, California counties participate in CMSP.
Who is eligible for CMSP?
Eligibility for CMSP is determined by each participating county.
However, generally, eligibility for CMSP is very similar to the Medi-Cal program with the additional requirement of a denied application for a marketplace plan through Covered California during open enrollment prior to the approval of CMSP.
Here are the detailed eligibility requirements:
- Adults between 21 and 64 years old.
- Legal residents & undocumented individuals
- Persons cannot be eligible for Medi-Cal, Covered California, or Medicare
- Coverage is available in 35 participating counties
- Applicants can qualify with:
– Incomes up to 300% FPL (Medi-Cal is up to 138%)
– Reduced monthly-cost-sharing
Income limits for CMSP Health Benefit
Here are the income limit requirements for CMSP in California.
To qualify for CMSP, your income cannot be more than 300% of the Federal Poverty Level (FPL).
We have listed below the 2022 FPL by household size.
As you can see, for a single individual, the CMSP income for 2022 is:
- Monthly – up to $3,398
- Annual – up to $40,770
|Persons in Household||300% of FPL||300% of FPL|
|For each person over 8 add:||$14,160||$1,180|
How to Apply for CMSP
You must apply for CMSP benefits through the county social services department/ human services agency in the county where you live.
However, you must be determined ineligible for Medi-Cal benefits first.
Contact your county’s social services department/ human services agency for information about the CMSP application process and what documents you need.
FAQs about CMSP in California
Here are the most frequently asked questions about the CMSP in California.
What does the CMSP Health Benefit Cover?
The CMSP benefits include many of those covered by the Medi-Cal program, with the exception of pregnancy-related services, long-term care, and services provided by chiropractors, acupuncturists, and psychologists.
- No cost health care benefits:
– Up to three (3) office visits for primary care, specialty carer or physical therapy
– preventative health screenings & lab tests
– Prescription drugs with a $5 copay (up to $1500 in benefits per enrollment term)
- Services provided by contracting community health centers, clinics & other providers
- Up to six months of benefit coverage
- Eligibility can be renewed
How do I find CMSP Providers – Medical and Dental?
To find a primary care provider, specialist, or other participating medical or dental provider that participates in the CMSP provider network, you can:
- Contact Advanced Medical Management at (877) 589-6807.When you call, they will advise you which providers are available in your geographic area and how to get connected with the care you need.You must get all services, except emergency services, from a healthcare provider participating in the CMSP provider network.
- Search the provider directory located on the Advanced Medical Management website. Click here to be taken to the website.
- Download a copy of the provider roster (updated monthly). Click here for the current roster.
What is the Difference between CMSP and Medi-Cal?
Medi-Cal benefits offer free or low-cost medical and dental services to eligible residents.
It is California’s Medicaid program and is funded by the federal government and the state of California.
The County Medical Services Program (CMSP) is a county-funded program that provides temporary health care coverage for eligible residents who do not qualify for Medi-Cal or Covered California.
When you apply with the county for health care coverage, the caseworker will check your eligibility for coverage.
Which Counties Participate in CMSP?
Thirty-five counties (35) currently participate in the County Medical Services Program. They are:
- Del Norte
- El Dorado
- San Benito
CMSP in California Summary
We hope this post on CMSP in California was helpful.
If you have further questions about CMSP or Medi-Cal, please let us know in the comments section below.
Be sure to check out our other articles about Medi-Cal and California Medicaid program, including: