1. (a) The county shall determine financial eligibility under provisions of Section 123870 of the Health and Safety Code within 30 days of receipt of documentation needed.
2. (b) The county shall determine whether the family is exempt from financial eligibility determination for treatment services under provisions of Section 123900(f) of the Health and Safety Code, and shall so enter in the exemption section of the eligibility worksheet.

3. (c) The county shall record the following information in the income source section of the eligibility worksheet as applicable to each applicant/client:

   1. (1) Name of the parent or party making application.
   2. (2) Income source documents used to determine financial eligibility.

4. (d) The county shall record the following information in the income for year section of the eligibility worksheet:

   1. (1) The adjusted gross income as reported in California tax form 540 or 540A or equivalent.
   2. (2) The number of persons dependent on the family income.

   3. (3) Whether the applicant/client is being referred to Medi-Cal.

      1. (A) The county may extend the 30 day time limit during the Medi-Cal application process.
      2. (B) If the county refers the applicant/client to Medi-Cal, such referral shall be in writing and shall include notice of section 123995 of the Health and Safety Code.

5. (e) The estimated family out-of-pocket cost of care for the year for the applicant/client when the adjusted gross income exceeds $40,000.

   1. (1) The amount of 20 percent of the adjusted gross income.
   2. (2) Anticipated services for the year and estimated out-of-pocket costs.
6. (f) Family's financial eligibility determination.

Note: Authority cited: Sections 20, 100275, 123805, 123870 and 123990, Health and Safety Code. Reference: Sections 123870, 123900, 123990 and 123995, Health and Safety Code.

History

1. Change without regulatory effect pursuant to Section 100, Title 1, California Code of Regulations adding new section filed 3-9-90 (Register 90, No. 13). For prior history, see Title 17, Part I, Subchapter 3, Sections 2890-2923, not consecutive.

2. Change without regulatory effect relocating article 5 heading from preceding section 41670 to preceding section 41510.4, adopting new article 4 heading, renumbering former section 41670 to section 41510.4 and renumbering former section 42050 to section 41670, including amendment of section and Note, filed 1-28-2009 pursuant to section 100, title 1, California Code of Regulations (Register 2009, No. 5).