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Accessing Affordable Healthcare in California with the County Medical Services Program

By IntFormalities
Published on June 24, 2024
Estimated reading time: 7 minutes

Though California can be expensive for low—and middle-income earners, the state provides various public-funded benefits to support qualified residents. The County Medical Services Program (CMSP) is one of the state-level medical programs with benefits you can enjoy if you live in The Golden State. CMSP’s goal is to provide low-income earners in California with affordable health coverage at no or little cost. But how does CMSP work for covered California residents, and who is eligible for the county medically indigent services program? This guide provides all the information you need. 

A doctor attentively converses with an elderly woman, providing medical guidance and support thanks to the County Medical Services Program.
California residents in 35 participating counties enjoy the County Medical Services Program.

What Is the CA County Medical Services Program?

The County Medical Services Program is a publicly-run health insurance program for uninsured, low-income California adults. The health coverage program is open to eligible residents who do not qualify for other state and federal medical care programs like Medi-Cal or other Medicaid benefits

How Does CMSP Work?

The CMSP program provides coverage to qualified adults between 21 and 64 who are not on Supplemental Security Income/State Supplementary Payment (SSI/SSP) or Medi-Cal. In other words, the County Medical Services Program isn’t the same as Medi-Cal. 

According to the CMSP drug formulary, the program covers only FDA-approved outpatient drugs for qualified people. It does not support non-FDA-approved drugs or medications used for in-patient care. There are no cost-sharing requirements for the supported prescriptions outside a member’s monthly Share of Cost (SOC). The SOC is the beneficiary’s monthly deductible paid out of pocket. The amount depends on your provider and other medical expenses. For instance, you may get a prescription drug coverage with a $5 copay for each prescription 

Every CMSP member who has SOC can get prescriptions from a supported pharmacy, and the pharmacy will pay for the medication. Visit the CMSP prescription drug benefit website for more information on its supported medication. 

Source: CMSP Website.

CMSP also covers members’ emergency healthcare services from supported and non-supported healthcare providers within California and qualifying state border areas, including Arizona, Nevada, and Oregon. To qualify for immediate medical attention under CMSP, you must have a medical condition that:

  • Places your health at serious risk 
  • Seriously impairs your bodily functions 
  • May cause severe or permanent dysfunction to any body organ 
  • Can result in other serious medical issues 

If you qualify for CMSP, call 911 or go to the nearest emergency room in case of a medical emergency. You can also contact Advanced Medical Management (AMM) for follow-up care after the emergency. 

Who Is Eligible for CMSP in California?

CMSP is available to low-income earners in California who need healthcare support regardless of their immigration status. The requirements for CMSP eligibility include:

  • Being an adult between 21 and 64 years old 
  • Being a legal resident of California’s 35 CMSP-supported counties 
  • Earning an annual income of $61,320 or below (300% Federal Poverty Level or less)
  • Entering a monthly SOC agreement to pay part of their monthly income towards medical and prescription drug expenses 

Note that CMSP is different from the Connect to Care program, which has a lower income requirement between $28,208 and $61,320. 

Source: CMSP Website 

What Are the Requirements for Claiming CMSP Healthcare Coverage?

Before claiming CMSP, you must be an adult between 21 and 64, live and work in California, and be confirmed ineligible for other state-funded healthcare programs, including Medi-Cal. 

When applying for CMSP, your county will tell you what information to provide to determine your eligibility. However, the standard requirements include:

You may also be required to provide additional information or resources based on your circumstances. These include proof of assets to verify your stocks, mutual funds, bonds, and other investments or proof of disability. 

How To Apply for CMSP

If you reside in any of California’s 35 CMSP-qualifying counties, you can apply for CMSP health benefits through the accredited providers listed on the AMM website, via your County Social Services Department/human services agency, or by calling the County Medical Services Program phone number at (916) 649-2631 to find participating medical and dental providers in your county. 

If you’d rather apply online, you can do so via the BenefitsCal website using the steps below:

  • Visit the website by clicking the link above and create an account
  • Find the section on healthcare programs 
  • Choose “CMSP” from the available options 
  • Click on the application link 
  • Fill in the required information, including your name, address, and SSN
  • Submit your application and wait for feedback via email or your BenefitsCal account 

Note that your county ultimately determines your eligibility. 

How To Find a County Medical Services Program Near Me

CMSP is available in 35 California counties to support low-income residents with affordable health coverage. If you qualify for the CMSP program based on the eligibility requirements, you can find healthcare providers within the CMSP network by visiting the AMM website. Here, you will see a detailed list of County medical services program providers and can choose one near you.  

Alternatively, you can call the County Medical Services Program phone number at (916) 649-2631 to find participating medical and dental providers in your county.  

Can Non-Residents Apply for CA CMSP?

The CMSP program in California is only open to residents. Only low-income adults in California’s supported counties who meet the eligibility requirements above can qualify for the healthcare coverage program and access CMSP benefits. 

If you live outside California, contact your state’s social services department for information on the state and federal-sponsored healthcare programs available to you. 

How Is CMSP Different from Medi-Cal? 

CMSP and Medi-Cal are publicly funded healthcare coverage programs for qualified low-income adults in California. The state and federal governments sponsor Medi-Cal, while CMSP is strictly state-owned for adults between 21 and 64. 

Unlike CMSP, Medi-Cal is California’s Medicaid program. Individuals who can benefit from the Medi-Cal health insurance program include families with seniors, children, foster care, persons with disabilities, pregnant women, and people with diseases like HIV/AIDS, cancer, and tuberculosis. 

Get Access To Subsidized Healthcare 

CMSP offers beneficiaries affordable health coverage in participating counties. We’ve highlighted what the program entails and its requirements in this guide. You can find more information about the CMSP application or assistance for applicants and CMSP members here

FAQs

1. What is the income limit for CMSP?

The income limit for CMSP applicants is $61,320 or less. The income requirement is less than or equal to 300% of the FPL

2. How long does the CMSP coverage last?

The CMSP program provides short-term health coverage for uninsured adults with limited income for up to 6 months. However, to enjoy CMSP benefits, you must apply and qualify for the program. 

3. What other programs can I get if I don’t qualify for CMSP?

If you’re declared ineligible for CMSP after applying or live outside the supported counties, you can apply for other health and dental services insurance options for California residents. These include Connect to Care, Covered California, or Medi-Cal benefits. 

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