§ 50161. Statement of Facts Form.
22 CA ADC § 50161Barclays Official California Code of Regulations
22 CCR § 50161
§ 50161. Statement of Facts Form.
(b) A public agency, applying on behalf of a child who may be eligible as an MI child who is not living with a parent or relative and for whom a public agency is assuming financial responsibility in whole or in part, shall complete the Application and Statement of Facts for Child in Foster Care Supported by Public Funds, MC 250.
(d) A person applying for Medi-Cal and requesting retroactive coverage shall complete the appropriate Statement of Facts for the current month and the Supplement to Statement of Facts for Retroactive Coverage/Restoration, MC 213, for the retroactive months. If only retroactive coverage is requested, a Statement of Facts, MC 210, shall be completed for one retroactive month for which Medi-Cal is requested and the MC 213 shall be completed for each additional retroactive month.
(e) An applicant or beneficiary who has a form CA 2 which has been completed within the last 12 months and which is on file with the county department need not complete the MC 210, unless the county department determines that the applicant's or beneficiary's circumstances have changed to such a degree as to require a new Statement of Facts.
(f) Any person requesting a restoration of Medi-Cal-only eligibility shall complete the Supplement to Statement of Facts for Retroactive Coverage/Restoration, form MC 213, unless the county department determines that the applicant's circumstances have changed to such a degree as to require a new MC 210, or unless a new MC 210 is required as part of redetermination of eligibility under Section 50189.
Credits
Note: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions Code. Reference: Section 14005.4, Welfare and Institutions Code.
History
1. Amendment of subsection (c) filed 12-15-77; effective thirtieth day thereafter (Register 77, No. 51).
2. Amendment filed 8-7-78; effective thirtieth day thereafter (Register 78, No. 32).
3. Amendment of subsection (b) filed 8-8-80; effective thirtieth day thereafter (Register 80, No. 32).
This database is current through 6/21/24 Register 2024, No. 25.
Cal. Admin. Code tit. 22, § 50161, 22 CA ADC § 50161
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