state of california health and human services agency ...2 (209)754-6872 06 *-----121312* 06 colusa...
TRANSCRIPT
State of California—Health and Human Services Agency
Department of Health Care Services
RICHARD FIGUEROA GAVIN NEWSOM ACTING DIRECTOR GOVERNOR
DATE:
TO:
October 10, 2019
Medi-Cal Eligibility Division Information Letter No.: I 19-22
ALL COUNTY WELFARE DIRECTORS ALL COUNTY MEDI-CAL PROGRAM SPECIALISTS/LIAISONS ALL COUNTY ADMINISTRATIVE OFFICERS
SUBJECT: Pickle Tickler Type 52 Notice of Action Address Database
The purpose of this Medi-Cal Eligibility Division Information Letter is to provide counties with the current Pickle Tickler Type 52 Notice of Action (NOA) address database and to request county updates.
Pursuant to the Lynch v. Rank lawsuit, the Pickle Tickler Type 52 NOA is mailed annually to the home address of individuals who currently receive Title II Retirement, Survivors, and Disability Insurance payments, and were determined ineligible for the Pickle Program, immediately following discontinuance from Supplemental Security Income/State Supplementary Payment programs.
In December of each year, the Department of Health Care Services mails Type 52 NOAs as described above. The county contact information listed on the bottom of the NOA aids potential Pickle Program eligible individuals in requesting county assistance to apply for the Pickle Program. In conducting your review and/or updates, please be mindful of the fact this contact information is widely distributed. To avoid errors with county contact information, please provide your county updates to the attached list, in writing, no later than Friday, November 1, 2019 by email to [email protected].
If you have any questions or if we can provide further information, please contact Sara McDonald at (916) 345-8061 or by email at [email protected]
Original Signed by
Linda Nguyen, Chief Policy Development Branch Medi-Cal Eligibility Division
Enclosure
Medi-Cal Eligibility Division 1501 Capitol Avenue, MS 4607
P.O. Box 997413, Sacramento, CA 95899-7413 (916) 552-9200 phone • (916) 552-9477 fax
Internet Address: www.dhcs.ca.gov
TO: ALL COUNTY WELFARE DIRECTORS, ALL COUNTY MEDI-CAL PROGRAM SPECIALISTS/LIAISONS, ALL COUNTY ADMINISTRATIVE OFFICERS
1
PICKLE TYPE 52 ADDRESS
01 *------------------------121312* 01
Alameda County
Social Services Agency
24100 Amador St.
Hayward, CA 94544
Attn: Medi-Cal Program Specialist
(510) 670-5770
02 *------------------------052507* 02
Alpine County
Health & Human Services
75 A Diamond Valley Rd
Markleeville, CA 96120
530-694-1335
03 *------------------------121312* 03
Amador County
Department of Social Services
10877 Conductor Blvd, Suite 200
Sutter Creek, CA 95685
Attn: Bethany Cammisa
(209) 223-6550
04 *------------------------121312* 04
Butte County DESS
P.O. Box 1649
Oroville, CA 95965
Attn: Mickey Mrakuzic
(530) 879-3550
05 *------------------------121312* 05
Calaveras Health and
Human Services Agency
509 E St. Charles Street
San Andreas, CA 95249
Attn: Brian Galicia
2
(209) 754-6872
06 *------------------------121312* 06
Colusa County
Department of Health & Human Services
251 E Webster St
Colusa, CA 95932
Attn: Alexandra Elguez
(530) 458-0262
07 *------------------------010599* 07
Contra Costa County
Employment & Human Services Dept.
40 Douglas Drive
Martinez, CA 94553
(925) 608-4939
Attn: Medi-Cal Program Analyst
08 *------------------------121312* 08
Del Norte County
Pickle Coordinator
880 Northcrest Dr.
Crescent City, CA 95531
707-464-3191
Attn: Pickle Coordinator
09 *------------------------121312* 09
El Dorado County
Health and Human Services Agency
3368 Lake Tahoe Blvd. Suite 100
South Lake Tahoe, Ca 96150
(530) 573-3230
Attn: Jill Johnston
10 *------------------------052507* 10
County of Fresno
Department of Social Services
P.O. Box 1912
3
Fresno, CA 93718
(559) 600-1377
11 *------------------------121312* 11
Glenn County
Health and Human Services Agency
PO Box 611/420 E Laurel St
Willows, CA 95988
Attn: Amanda Castillo
530-934-1403
12 *------------------------121312* 12
Humboldt County
Dept. of Health & Human Svcs.
Social Services Branch
929 Koster St
Eureka, CA 95501
877-410-8809
13 *------------------------121312* 13
Imperial County
Dept. of Soc. Svcs.
2995 S. 4th St., Ste.105
El Centro, CA 92243
Attn: Alex Gamboa
(760) 337-7422
14 *------------------------121108* 14
Inyo County
Social Services
920 N Main St
Bishop, CA 93514
Attn: Yvonne Freeman
(760) 872-1394
4
15 *------------------------121312* 15
Kern County
Department of Human Services
P. O. Box 511
Bakersfield, CA 93302
Attn: Applications
661-631-6807 Application Line
877-410-8812 Customer Assistance Tele-Center
16 *------------------------121211* 16
Kings County
Human Service Agency
1440 W. Lacey Blvd., Bldg. #8
Hanford, CA 93230
Attn: Amalia Cabadas
(559) 852-2279
17 *------------------------121312* 17
Lake County Department of
Social Services
P.O. Box 9000
Lower Lake, CA 95457
Rachael Dillman
(707) 995-4290
18 *------------------------010599* 18
Lassen County
Community of Social Services
P.O. Box 1359
Susanville, CA 96130-9902
530-251-8152
19 *------------------------121312* 19
Los Angeles County DPSS
Medi-Cal Program Section
17171 East Gale Ave
5
City of Industry, CA 91745
Attn: Pickle Coordinator
1-866-613-3777
20 *------------------------121211* 20
Madera County
Dept. of Social Services
720 E. Yosemite Ave.
Madera, CA 93638
559-675-2300
21 *------------------------121312* 21
Marin County
Dept. of Health & Human SVS
P.O. Box 4160
San Rafael, CA 94903
Attn: Laura Hettwer
877-410-8817
22 *------------------------121211* 22
Mariposa County
H
5362 Lemee Lane
Mariposa, CA 95338
(209) 966-2000
23 *------------------------121312* 23
Mendocino County HHSA
737 S. State St.
Ukiah, CA 95482
Attn: Medi-Cal Specialist
(707) 463-7809
24 *------------------------121312* 24
Merced County
Human Services Agency
P.O. Box 112
6
Merced, CA 95341
Attn: Pickle Coordinator
(209) 385-3000
25 *------------------------121312* 25
Modoc County
Department of Social Services
120 North Main Street
Alturas, CA 96101
530-233-6501 ext. 1324
Attn: Karena Nield
26 *------------------------121108* 26
Mono County
Department of Social Services
PO Box 2969
Mammoth Lakes, CA 93546
760-924-1789
27 *------------------------011211* 27
Monterey County, DSES
1000 South Main St, Suite 208
Salinas, CA 93901
Attn: Mary Hiebner
(831) 755-4406
28 *------------------------121312* 28
Napa County
Health & Human Services Agency
2751 Napa Valley Corporate Dr.
Napa, CA 94558
Attn: Barbara Colt
(707) 253-3818
29 *------------------------052507* 29
Nevada County Human Services
7
Social Services Department
P. O. Box 1210
950 Maidu Avenue
Nevada City, CA 95959
530-265-1340
30 *------------------------121211* 30
Orange Co. Social Svcs. Agency
Santa Ana Regional Center
Lobby B
1928 South Grand Ave
Santa Ana, CA 92705
(800) 281-9799
31 *------------------------121312* 31
Placer County
Human Services
Medi-Cal Program Specialist
PO Box 20400
Auburn, CA 95604-0400
(888) 385-5160
32 *------------------------121312* 32
Plumas County
Department of Social Services
270 County Hospital Rd Suite 207
Quincy, CA 95971
Attn: Suzanne Wilson
530-283-6441
33 *------------------------121312* 33
Riverside Co. DPSS
4060 County Circle Drive
Riverside, CA 92503
Attn: Pickle Coordinator
(800)274-2050
34 *------------------------011211* 34
8
Sacramento County
Department of Human Assistance
P.O. Box 487
Sacramento, CA 95812-9874
Attn: Pickle Coordinator
(916) 874-3100
35 *------------------------121312* 35
San Benito County
Human Services Agency
1111 San Felipe Rd Suite 206
Hollister, CA 95023
Attn: Pickle Coordinator
831-630-5126
36 *------------------------121312* 36
San Bernardino County
Transitional Assistance Dept
825 E Hospitality Ln, 2nd Floor
San Bernardino, CA 92415-0079
(877) 410-8829
Attn: Pickle Coordinator
37 *------------------------011211* 37
County of San Diego
Health and Human Services Agency
Document Processing Center
P.O. Box 85023
San Diego, CA 92186-5023
(866) 262-9881
38 *------------------------121211* 38
San Francisco County
SF Human Svcs Agency/DAAS
2 Gough Street
San Francisco, CA 94103
415-557-6555
9
39 *------------------------121312* 39
San Joaquin County
Human Services Agency
P.O. Box 201056
Stockton, CA 95201
Attn: Neil Stambaugh
(209) 468-1153
40 *------------------------121211* 40
San Luis Obispo County
Department of Social Services
P.O. Box 8119
San Luis Obispo, CA 93403-8119
(805) 781-1893
Attn: Pati Garcia
41 *--------------------011211* 41
San Mateo County
Human Services Agency
400 Harbor Blvd., Bldg. B
Belmont, CA 94002
(800) 223-8383
42 *------------------------052507* 42
Santa Barbara County
Department of Social Services
2125 S Centerpointe Pkwy
Santa Maria, CA 93455
Attn: Lilia Ramirez
(805) 346-7388
43 *------------------------121312* 43
County of Santa Clara
Social Services Agency
PO Box 11018
San Jose, CA 95103-1018
10
Attn: Benefits Service Center
1-877-962-3633 or (408) 758-3600
44 *------------------------121312* 44
Santa Cruz County
Human Services Dept.
P.O. Box 1320
Santa Cruz, CA 95061
Attn.: Maria Bauer, MC Analyst
Customer Phone Service Center
1-888-421-8080
45 *------------------------121312* 45
Shasta County Health & Human
Svcs. Agency, Regional Svc. Cntr.
P.O. Box 496005
Redding, CA 96049-6005
Attn: Pickle Coordinator
(877) 652-0731
46 *------------------------121312* 46
Sierra County Welfare Dept.
P.O. Box 1019
Loyalton, CA 96118
Attn: Lori McGee
(530) 993-6725
47 *------------------------121312* 47
Siskiyou County Health and Human Services Agency
818 S Main St
Yreka, CA 96097
Attn: Alix Byrd
(530) 841-2717
48 *------------------------121312* 48
Solano County
Health & Social Services
P.O. Box 12000 MS 7-100
Vallejo, CA 94590
11
(707) 784-3809
Attn: Kelly Campbell
49 *------------------------121312* 49
Sonoma County
Human Services Department
PO Box 1539
Santa Rosa, CA 95403-1539
Attn: Pickle Coordinator
1-877-699-6868
50 *------------------------121312* 50
Stanislaus County
Community Services Agency
P.O. Box 42
Modesto, CA 95353-0042
251 E Hackett Rd
Modesto, Ca 95358
877-652-0734
51 *------------------------052507* 51
Sutter County
Health and Human Services
P.O. Box 1535
190 Garden Highway
Yuba City, CA 95992-1535
1-877-652-0735
52 *------------------------011211* 52
Tehama County
Dept. of Social Services
P.O. Box 1515
Red Bluff, CA 96080
Attn: Medi-Cal Pickle Coord.
(530) 527-1911
12
53 *------------------------121312* 53
Trinity County
Health and Human Services
P.O. Box 1470
Weaverville, CA 96093-1470
Attn: Tabatha Albers
(530) 623-8245
54 *------------------------112905* 54
Tulare County/Health & Human SVS
TulareWORKs Division
PO Box 671
6330 S. Mooney Blvd, Ste. 106
Visalia, CA 93277
800-540-6880
55 *------------------------082593* 55
Tuolumne County
Dept. of Social Services
20075 Cedar Rd. North
Sonora, CA 95370
209-533-5711
56 *------------------------121312* 56
Ventura County
Human Services Agency
855 Partridge Dr.
Ventura, CA 93003
Attn: Irma Reynoso
(805) 477-5405
57 *------------------------121312* 57
Yolo County
Health & Human Services Agency
25 North Cottonwood St
Woodland, CA 95695
Attn: Sophia Sandoval
13
530-661-2744
58 *------------------------121312* 58
Yuba County Health and
Human Services Dept.
PO Box 2320
Marysville, CA 95901-9987
Attn: Alejandro Rodriguez
530-749-6386
*------------------------------*