California Department of Social Services - State Hearings Division
Notes from the Training Bureau - September 7, 2001

SB 87 mandated that the DHS in collaboration with counties and advocate groups create a request for information form for Medi-Cal beneficiaries to complete. The MC 355 form is both a request for information and a Medi-Cal information cover letter.

Per SB 87, counties are precluded from requesting information from a Medi-Cal beneficiary that has previously been provided, not subject to change or not absolutely necessary. As stated in ACWDL 01-36, counties are to initiate a Medi-Cal eligibility review at annual redetermination and when there is a change in beneficiary circumstances that affect Medi-Cal eligibility. ACWDL instructs counties to follow the ex parte process and telephone contact requirements to complete Medi-Cal eligibility review. When a county is unable to obtain the necessary information through the ex parte or telephone review process, it must send out the MC 355 form.

Effective July 1, 2001, a county must use the MC 355 form rather than any other document if the county has been unable to obtain necessary information through the ex parte or telephone review processes.

This ACWDL provides a copy of the MC 355 form and also provide counties with instructions on when and how to use this form.