Many Californians who use public services like SSDI (Social Security Disability Insurance), CalWorks (AFDC), or CalFresh are also enrolled in Medi-Cal and, possibly, the Self-Determination Program (SDP). Many of these programs cover similar products and services, so it can be confusing to understand where the money needs to come from when you have certain medical expenses.
A large percentage of SDP participants receive Medi-Cal benefits, but you are not required to be enrolled in both programs at the same time. However, Californians who are new to the SDP must apply for Medi-Cal because the SDP is a payer of last resort.
What does being a payer of last resort mean? Consider a piece of durable medical equipment, such as a power wheelchair. An SDP participant may only use funds from their individual budget to pay for the wheelchair if Medi-Cal does not cover the costs. If the wheelchair is eligible for reimbursement under Medi-Cal, then those funds must be used regardless of whether reimbursement is also available under the SDP.
What is Medi-Cal?
Medi-Cal is the name for California’s Medicaid program, which helps qualified individuals and families receive health care coverage.
While many people simply think of Medi-Cal as coverage for those with lower income, it also provides services for older adults, people with disabilities, at-home caretakers, and other groups.
Medi-Cal benefits often include reimbursement for services like:
- Hospitalization and ambulatory care
- Prescription medications
- Maternity care
- Chronic disease management
- Mental health services
- Physical and occupational therapy
Can You Be Enrolled in Medi-Cal and Not the Self-Determination Program?
Yes. The Self-Determination Program is voluntary. People who otherwise qualify for the SDP might feel their needs are met through Medi-Cal and other public services. Others might stick with the traditional method of receiving regional center services.
The opposite is also true — many SDP participants are not eligible for Medi-Cal. Fortunately, regional center representatives can help determine eligibility and help you apply if necessary.
Are There Any Key Similarities Between the Two Programs?
Although the SDP is designated as a payer of last resort relative to Medi-Cal, many regional centers receive some funding from Medi-Cal. For instance, some home- and employment-based services people receive through regional centers are actually paid for by Medi-Cal under a specific type of waiver. Some SDP services might be familiar to those who already receive Medi-Cal coverage and are looking into the SDP.
Generally, those who qualify for both Medi-Cal and the Self-Determination Program have many, if not most, of their medical needs covered between the two programs. As a payer of last resort, the SDP can act as a type of safety net for services unavailable for reimbursement through other public programs.
How NeuroNav Can Help Californians
It helps to have a dedicated, experienced independent facilitator when navigating the Self-Determination Program—especially when you are eligible for multiple public services.
An independent facilitator from NeuroNav can advocate for SDP participants at every stage of the process, from developing an individual program plan (IPP) to making important updates as your needs and goals change.
Our team can help you get the most out of the SDP so you can concentrate on living your dreams. Sign up for a free consultation today to get started.
