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County Medical Services Program (CMSP) 

The County Medical Services Program (CMSP) provides limited-term health coverage for uninsured low-income, indigent adults that are not otherwise eligible for other publicly funded health programs. Thirty-five, primarily rural California counties participate in CMSP. The CMSP Governing Board, established by California law in 1995, is charged with overall program and fiscal responsibility for the program.

Eligibility requirements address such areas as: age limits, residency and citizenship, personal property limits, motor vehicle limits, real property limits, responsibility of family members/relatives, need standard, and share-of-cost. Other program requirements address such matters as use of the Beneficiary Identification Card (BIC), prior authorization for selected services, CMSP member copayments and monthly share-of-cost, liability for payment for health care services by other insurance, and fair hearings. Eligibility is determined in accordance with the CMSP Eligibility Manual.

 

From January 1, 2012 through December 31, 2013, the CMSP Governing Board operated a Low Income Health Program pilot project, Path2Health. The Path2Health pilot project ended on December 31, 2013 and Path2Health enrollees were transitioned to Medi-Cal eligiblity on January 1, 2014.

The Governing Board approved a revised CMSP Eligiblity Manual on December 11, 2013. The revised CMSP Eligiblity Manual is effective January 1, 2014.

 

When CMSP members are eligible for other benefit programs, including other publicly funded health coverage, such as Medi-Cal or Covered California, or programs like the AIDS Drug Assistance Program, or Family PACT, CMSP is the secondary payer to these programs. Click here for more information.

 

A wide array of inpatient and outpatient benefits are provided through CMSP. Covered services are subject to prior authorization requirements, medical necessity and clinical guidelines, provider network requirements, and/or benefit limits may apply.

Specific services that are NOT covered by the program include:

 

  • Pregnancy-related services (contact your county eligibility office); infertility services (contact F-PACT); long-term care facility services (contact your county eligibility office); chiropractic services; acupuncture services; optometry services (including eyeglasses and contact lenses); mental health and substance abuse counseling services provided by a psychologist, MFT, LCSW, or substance use disorder counselor; cosmetic services; sexual reassignment services; public transportation such as airplane, bus, car, or taxi rides; and, methadone maintenance services
  • All services provided outside of the State of California and designated border state areas
  • Services provided by providers that do not participate in the CMSP network administered by Anthem Blue Cross (excluding emergency services) and the MedImpact Healthcare Systems pharmacy network
  • Organ transplants for persons who are eligible for CMSP emergency services only under aid code 50

If a CMSP member needs or desires medical care which is not covered by CMSP, the member must pay for the care or make other arrangements with the provider.

Treatment Authorization

CMSP is administered by Anthem Blue Cross Life & Health Insurance Company. Please note the following requirements for treatment authorization:

Claims for CMSP services are subject to treatment authorization requirements and utilization limits administered by Anthem Blue Cross or its subcontractors on behalf of CMSP. In general, all medical service authorizations are to be sent to Anthem Blue Cross. Dentists and dental clinics are required to submit authorizations to DentaQuest. The CMSP Provider Operations Manual (POM) is provided by Anthem Blue Cross to all providers that contract to be a part of the Anthem Blue Cross provider network for CMSP. The POM describes how to obtain service authorizations and how to bill for services.

Prior authorization for CMSP prescription drug services that are delivered through a retail pharmacy are handled by MedImpact Healthcare Systems, Inc. (MedImpact).

A wide array of inpatient and outpatient benefits are provided through CMSP. Covered services are subject to prior authorization requirements, medical necessity and clinical guidelines, provider network requirements, and/or benefit limits may apply.

Specific services that are NOT covered by the program include:

  • Pregnancy-related services (contact your county eligibility office); infertility services (contact F-PACT); long-term care facility services (contact your county eligibility office); chiropractic services; acupuncture services; optometry services (including eyeglasses and contact lenses); mental health and substance abuse counseling services provided by a psychologist, MFT, LCSW, or substance use disorder counselor; cosmetic services; sexual reassignment services; public transportation such as airplane, bus, car, or taxi rides; and, methadone maintenance services
  • All services provided outside of the State of California and designated border state areas
  • Services provided by providers that do not participate in the CMSP network administered by Anthem Blue Cross (excluding emergency services) and the MedImpact Healthcare Systems pharmacy network
  • Organ transplants for persons who are eligible for CMSP emergency services only under aid code 50

If a CMSP member needs or desires medical care which is not covered by CMSP, the member must pay for the care or make other arrangements with the provider.

Treatment Authorization

CMSP is administered by Anthem Blue Cross Life & Health Insurance Company. Please note the following requirements for treatment authorization:

Claims for CMSP services are subject to treatment authorization requirements and utilization limits administered by Anthem Blue Cross or its subcontractors on behalf of CMSP. In general, all medical service authorizations are to be sent to Anthem Blue Cross. Dentists and dental clinics are required to submit authorizations to DentaQuest. The CMSP Provider Operations Manual (POM) is provided by Anthem Blue Cross to all providers that contract to be a part of the Anthem Blue Cross provider network for CMSP. The POM describes how to obtain service authorizations and how to bill for services.

Prior authorization for CMSP prescription drug services that are delivered through a retail pharmacy are handled by MedImpact Healthcare Systems, Inc. (MedImpact).