County Medical Services Program (CMSP)
The County Medical Services Program (CMSP) provides health coverage for low-income, indigent adults in thirty-four, primarily rural California counties. 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 (06-30-10).
When CMSP members are eligible for other benefit programs, including other health insurance coverage or programs like the AIDS Drug Assistance Program, or Family PACT, or the Breast and Cervical Cancer Treatment Program, CMSP is the secondary payer to these programs.
Characteristics of CMSP program administration include:
Healthcare providers contract with Anthem Blue Cross to participate in the Anthem Blue Cross/CMSP Provider Network. Only providers participating in the Network may receive payment for non-emergency health care services provided to CMSP members.
CMSP provides payment for emergency health care services provided to CMSP members by Network providers and all other providers of emergency services in California and in the designated areas of the border states of Oregon, Nevada and Arizona.
CMSP provides NO coverage for any health care services provided outside of California and the designated areas of the border states of Oregon, Nevada and Arizona.
All treatment authorization requests for medical, dental and vision services are processed by Anthem Blue Cross or its dental and vision service subcontractors.
Anthem Blue Cross utilizes the Milliman Practice Guidelines, supplemented by Wellpoint Practice Guidelines, to review and consider Treatment Authorization Requests.
Payment for medical, dental and vision services is processed by Anthem Blue Cross and its dental and vision services subcontractors in accordance with current HIPAA standards. Both paper and electronic billings are processed.
MedImpact Health Systems Inc. (MedImpact) administers the CMSP prescription drug benefit, including the processing of prior authorization requests and claims payment.
Eligibility for CMSP is determined by the county social services departments in the thirty-four participating CMSP counties in accordance with eligibility rules set by the Governing Board.
Applicants can now apply for CMSP online through C4Yourself, an online application system that allows individuals to apply for medical care (Medi-Cal and CMSP), CalFresh (formerly known as Food Stamps), and CalWorks. This online service is available in 32 of the 34 CMSP counties (all CMSP counties except Solano and Sonoma County). It is safe, secure and easy to use. To start an application, go to C4Yourself and click on Apply for Benefits.