GAU – General Assistance for the Unemployable

MEDICAL CARE SERVICES (MCS) (G01) - Section 1: FAQs and some terms & relationships defined

 

MCS?  Where did GA-U go?

General Assistance Unemployable, known as GA-U, fell victim to State budget shortfalls. Benefits were altered some, and the program re-emerged as Disability Lifeline (DL).  More recently, DL was replaced by Medical Care Services (MCS), though not all references to DL have been updated on that site.  The following information attempts to explain MCS, the collection of medical benefits for short-term disabled [from working] patients    It has been read and approved by a DSHS worker and Disability Lifeline specialist.

What is MCS?

Medical Care Services (MCS) is the collection of medical benefits to persons who are found to be unemployable for 90 days or more due to illness (physical, mental/emotional health) or injury. MCS differs most from GA-U and DL in that it does not provide a cash benefit and instead offers very limited housing assistance (See HEN in the housing section of this site). MCS benefits are also available to persons who are enrolled in the ADATSA program – Alcohol & Drug Addiction Treatment & Support Act.

What are the Benefits?

Again, for emphasis, MCS does not provide a cash benefit. It provides certain medical, dental, mental health and substance abuse treatment related benefits. Within the scope of all benefits available to an MCS enrollee, he or she is only eligible to receive necessary services that are prescribed to treat the issues that are proposed to be the cause of the patient’s incapacity to work. In other words, if you are deemed eligible for MCS benefits because of a crippling case of carpel tunnel don’t expect to get treatment for your plantar fasciitis (or whatever) unless it too prevents you from working and is substantiated as such in your MCS case.

What does it take to be eligible?

A person applying for MCS must be incapacitated. Incapacitated refers to a person who is unemployed from “gainful work” because of a physical or mental/emotional impairment that is expected to continue for at least ninety days from the date the individual applies. The impairments must be diagnosable and, ultimately, substantiated with documented medical evidence. Collecting that documentation is a part of the process. Medical and/or mental health providers are sometimes made available by the State for this purpose. An applicant must be 18 years old or be legally married, and must be financially in need. The maximum amount of income an applicant can have is very low. Citizenship requirements apply and a Social Security Number must be presented. State residency is also required but the specifics are easy to meet if the patient lives in Washington. There are other avenues in very specific situations that can lead to MCS coverage being awarded. So, as with all important assistance programs, do not make the mistake of thinking you are not eligible unless you are fully aware of the fine print. When in doubt, find out!  If you can’t get through to the state’s office at Dept. of Social & Health Services (DSHS) or Health Care Authority (HCA) call Doug at CHOICE Regional Health Network 800-981-2123.

How long is a person eligible before being reviewed?

A person is determined eligible for twelve months before an incapacity review is supposed to happen. DSHS tries to determine how long it will take before the person can work again by reviewing current medical evidence. The person’s benefits are then stopped unless the person provides additional medical evidence that demonstrates that there was no material improvement in the condition.

Will DSHS send me a coupon or a card once I’m covered?

A card. Medical coupons from the Dept. of Social and Health Services (DSHS) aren’t being issued anymore for two reasons. First, they moved from paper coupons to using blue plastic “Provider One” cards. Coupons are no longer being printed. Secondly, DSHS is no longer the State agency distributing the cards or managing the State’s medical programs. The Washington State Health Care Authority (HCA) has taken over managing medical programs. The linguistic implications are that no one will have “DSHS medical” anymore. They’ll have HCA medical. This state’s health and social workers will no longer hear patients talking about their “DH…H…S….or whatever it is.” HCA is just easier to say. Whether or not it becomes easier for those patients to get state coverage, to keep their coverage running smoothly and to communicate with the state regarding their coverage now that HCA is in the driver’s seat remains to be seen.

A Managed Care Program

MCS is a managed care program. Managed care means that a medical insurance company – a “health plan” – operates in between you and your physician. It “manages” the care patients receive or, more specifically, it limits and directs the care physicians are allowed to provide based on factors like cost and care standards.  Community Health Plan of Washington is the “plan” contracted to provide care and services for the MCS program.  Patients with managed care health care are required to have primary care physicians (PCP). New managed care patients who don’t choose a primary care physician for themselves and inform their health plan of their choice are assigned a PCP by the health plan.  Sometimes that works out well enough.  Better actual care can result when a patient tends more closely to his or her options.

Application Process

  1. Complete DSHS “Application for Benefits.” You can do this several ways: 1) Go to the Community Services Office at 6860 Capital Blvd, Tumwater, wait in line and fill out an application with a worker there.
  2. Go to Washington Connectionto fill out an application online or contact CHOICE Regional Health Network at 800-981-2123.  One of their representatives will meeting with you to complete the application, making sure all the ‘t’s are crossed.
  3. In either case, DSHS will require an in-person interview.  You will be contacted to set up that appointment.
  4. At that appointment you may be scheduled again for a Medical/psychological evaluation
  5. You will be determined to be either eligible, ineligible, or more information will be requested.
  6. If denied, file for Fair Hearing, and call CLEAR Legal line: 1-888-387-7111 (be prepared to wait on hold for one hour).
  7. Previously, after filing for a hearing, one could request a medical coverage to gather further medical evidence. That may still be the case and an update on this is on the way.

 


Eligibility Reviews

Frequent eligibility reviews and treatment requirements make a lot of work for the recipient.  Do not be shy about seeking help from an advocate in the community or a DSHS specialist.

Benefits are often wrongly terminated. File for a Fair Hearing!!!

Mental Health

Mental health services through MCS will differ from other DSHS coverage programs.  Don’t assume the care or specific prescriptions will be the same on your MCS coverage as your friend gets through his TANF medical coverage, or even compared to what was available on GA or DL.  Find out!

Also, in most cases you will be required to establish a primary care physician because MCS is a managed care program.  (see Medical)  Know, however, that primary care physicians are increasingly hesitant to prescribe for mental health issues.

Additional Resources

MCS online:

http://hrsa.dshs.wa.gov/mcs/index.shtml

http://www.dshs.wa.gov/manuals/eaz/sections/MedicalAssistance/ps_medprogs.shtml