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⭒ CANHR Advocate Did You Know Articles

Medi–Cal Claim Detail Reports can be requested prior to an anticipated Estate Claim

If a Medi–Cal beneficiary passes away having been on Medi–Cal after the age of 55 or in a nursing home for many years, it is nearly impossible to make a rough estimate of how much was spent on his/her care during that period. Many people will not see an itemized bill from Medi–Cal until they receive an Estate Claim from the Medi–Cal Recovery Program. This can be up to three years after Medi–Cal was notified of the beneficiary’s death.

The claim amount is based on the amount spent on the beneficiary’s care or the value of the beneficiary’s estate, whichever is less. While some may try to estimate the amount spent on care, others prefer to avoid any element of surprise in the Recovery process. That element of surprise can be avoided by filling out a form from the Department of Health Care Services and requesting a “Claim Detail Report” for a cost of $25.

The DHCS form 6236 is entitled “Request to Access Protected Health Information” and form 6237 is entitled “Request to Access Protected Health Information by Parent, Guardian, or Personal Representative.” Both forms can be downloaded from Click on “Privacy” under “Categories” to find 6236 and 6237. If you had been on Medi–Cal, but are no longer on Medi–Cal, use form 6236 to find out the amount of benefits paid for your care. If you are seeking information for someone else’s estate, use form 6237. Attaching the death certificate, a check for $25, proof of identification, and the requested information in the form will get you copies of records for the requested dates of service. If you inherited a home from a Medi–Cal beneficiary who still owned the home when he/she passed away, this form can help you prepare for a potential Estate Claim.