How to be Medi-Cal Eligible in California After Receiving a Professional Corporation Medi-Cal Denial Letter

It’s very frustrating when you are qualified to be a licensed clinical social worker, then end up being rejected by Medi-Cal insurance due to “failure to comply with the requirements specified”. Sure, you could be licensed to practice as an LCSW, however, it’s upsetting to know it’s not enough to qualify for the Medi-Cal insurance. And that’s exactly the case of two of our clients – receiving a Professional Corporation Medi-Cal Denial Letter, after complying with the requirements to what the clients believed to be complete.

There are several reasons why the clients were rejected, but the cited reason here is the fact that the clients were not registered as a Professional Corporation (PC). According to the Moscone-Knox Professional Corporation Act, it’s a violation to provide professional services without being organized as a Professional Corporation pursuant to Corporations Code Section 13401. Once you get hit with that type of violation, you have the right to appeal to the Department of Health Care Services (DHCS) and wait for several months to get a result or have Incorporation Attorney handle the work for you, to be Medi-Cal eligible in California. That said, let’s explore these options.

What is Medi-Cal?

Medi-Cal is a program made for children and adults with limited income and resources – offering free or low-cost health coverage. It covers low-income adults, families with children, seniors, pregnant women, children in foster care, and former foster youth up to age 26.

How to Apply as a Licensed Clinical Social Worker for Medi-Cal Eligibility in California? 

To apply, you need to complete the Medi-Cal Provider e-Form Application. In conjunction with that, it should be in accordance with the California Code of Regulations (CCR) — meeting the requirements specified in Title 22, Sections 51000.30 through 51000.55. Failure to meet applicable standards for participation will result in denial of the application for enrollment.  

What is a Professional Corporation?

Organized under the General Corporation Law, a professional corporation is a corporation allowed to legally render professional services in a single profession, issued with a certificate of registration from the regulatory governmental agency for the profession. Essentially, establishing a PC lets you practice in the professional world.

Why is a Professional Corporation Required for an LCSW in California?

If you’re wondering why you need a PC even when you’re an LCSW in California, here’s why. Aside from the fact that it cements your credibility to practice as a professional clinical social worker, the government recognizes a PC as a legal entity because it has gone through the regulatory boards. That said, you’re safe from potential sanctions and penalties under the California Corporation Code.

The government agency must make sure that you are legally fit to render professional services under its rules and regulations, including passing the regulatory boards for LCSW.

I Received a Professional Corporation Medi-Cal Denial Letter, What’s Next?

In the case of our clients, they failed to meet one of the requirements – which is to be registered as a Professional Corporation. As a result, they received a PC Medi-Cal Denial Letter. But inside the letter, states the clients’ detailed violation, and the option to appeal to the Director of DHCS or the Director’s designee.

What If I Choose to Exercise My Rights to Appeal?

If you feel like DHCS made an unfair or unlawful decision, pursuant to W&I Code Section 14043.65, you could exercise your right to appeal, thus initiating a review of the department’s action in denying your application at the time the denial was made. This would determine if the department’s denial should be upheld, continued, or reversed, in whole or in part.

Submitting an appeal will require a written appeal along with all the pertinent documents and all other relevant evidence within 60 days of the date of the notice. DHCS would then review the appeal and issue a decision within 90 days of the receipt of the appeal.

Whether it’s you or the clients, waiting for several months with no assurance isn’t really an enticing option.

Seeking Help from Incorporation Attorneys After Receiving a Medi-Cal Denial Letter Because You Aren’t a Professional Corporation.

Between running a business and all the work that makes you qualified, you shouldn’t have to deal with the stress of having the wrong business entity. Instead, you can seek legal assistance from Incorporation Attorneys. Since the denial letter stated that the client needed to be registered as a Professional Corporation, their business needs a whole different process and new paperwork to be the correct business entity. Incorporation Attorney knows all the ins, outs, twists, and turns of a professional corporation, and can guide you smoothly through the process.

Our professional team helps clients to be legally registered as PC, without having to worry if your business entity is the right choice or if it is set up correctly. We take care of all the little details within the California law, to ensure that our clients will be able to practice their professions. Just contact +1 (714) 634-4838 to seek our legal assistance.