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Ramsell/ADAP refusing to recognize Medi-Cal documents
Aug 27, 2012

I re-enrolled for ADAP this year. I've been on it for the last 12 years. I was told I had to apply for Medi-Cal and was given the LA address to go to. I called Medi-Cal for an office closer to my home, and was advised by Medi-Cal I could apply online. I did so. I've been receiving letters from Medi-Cal about my newest caseworker (my case has had 3 different caseworkers so far).

My pharmacy called complaining that they billed ADAP for dispensing my HIV meds & the bill was denied, because I had not provided evidence of my applying to Medi-Cal, despite my providing copies of every letter I received from Medi-Cal.

ADAP refuses to accepts these copies because the letters don't show the date I applied for it. I was told to go to the Medi-Cal office & get written confirmation of the date I applied for it. I did this & was told by the Medi-Cal caseworker that they wouldn't have record of that, because I applied on-line.

I am now a ship without a rudder. I feel like I'm being toyed with by ADAP & have a pharmacist demanding I pay him $1300 for my last month's HIV medications. Do I have any options here? I don't know what to do.

Response from Mr. Chambers

Medi-Cal, unlike Social Security, requires you to apply at "your" Medi-Cal office based on your address, even if one is closer.

My first question would be what are your chances of receiving Medi-Cal? If you have over $2,000 in the bank, the ADAP enroller should be willing to accept that as proof you will be declined for Medi-Cal. Also, if you are on Medicare, showing your Medicare card with proof of drug coverage under Medicare should get your ADAP renewed. If you are working, show a recent paycheck stub.

Assuming you have to get the proof from Medi-Cal, do any of the letters confirm that you have applied? If so, go to your ADAP enroller and, together, you should be able to get ADAP to accept that as proof you applied, even if there isn't a date. Have you discussed this with your ADAP enroller? If he or she is the one telling you they can't accept the letters, then you should contact Ramsell (California's ADAP administrator) or ADAP in Sacramento directly.

If the letters don't confirm your application, your Medi-Cal office should be willing to provide written confirmation of that, even if they can't put a date on it (which is somewhat questionable). If they refuse, ask to speak to a supervisor.

Hopefully, your ADAP enroller will help you with this.

Good luck, Jacques

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