Pay a monthly premium based on net countable income, andMeet all other non-financial Medi-Cal eligibility requirementsAre There Special Programs for Parents Who Lose Medi-Cal Because of Full-Time Employment or Receipt of Child Support Payments?
Yes. Transitional Medi-Cal provides no costs Medi-Cal for up to 2 years for families who are no longer eligible for CalWORKs or Section 1931(b) Medi-Cal because of increased earnings from employment.
Families who are no longer eligible for CalWORKs or Section 1931(b) Medi-Cal due to the collection or increased collection of child support payments may receive up to four months of no cost Medi-Cal.
OTHER HEALTH CARE PROGRAMS
What is the Healthy Families Program?
Healthy Families Program is a low-cost health coverage program for children ages 0 through 19. A new program will be implemented in the near future that will allow the parents of these children to also participate in the Healthy Families Program. There are different health plans for different areas.
Healthy Families Program offers:
• Low-cost comprehensive health, dental and vision insurance
• Choice of health, dental and vision insurance plans
• Low monthly premiums from $4 per child to a maximum of $27per family.
• No co-payment (a co-payment is the amount of money an insured or covered person must pay for some health care services or type of service) for preventive services (such as immunizations). $5 co-payment for non-preventive services (such as going to the doctor due to illness).
• For children without health insurance and children with Medi-Cal with a share of cost.
• Available for single or two-parent working families
• Property (such as savings or cars) is not counted.
To apply for this program, you may obtain a mail-in application by calling toll-free, 1 (888) 747-1222 . You can be referred to a trained Certified Application Assistant in your community to help you complete the application. You can also apply by marking “Yes” on Question 36 of your Medi-Cal application.
What Is the Access for Infants and Mothers (AIM) Program
The Access for Infants and Mothers (AIM) program provides health care to uninsured pregnant women whose income is too high to qualify for no-cost Medi-Cal.
To qualify for AIM, you must be less than 30 weeks pregnant when you apply. AIM benefits include:
• Prenatal visits
• Hospital delivery
• Full health care services during the pregnancy and for 60 days following the child’s birth.
• Full health care services for the baby from birth to age two.
For more information and an application, call 1 (800) 433-2611 .
What is the Baby Cal?
Baby Cal encourages pregnant women and their families to get early and ongoing prenatal care and to practice healthy behaviors throughout the pregnancy (no smoking, drinking or drugs).
For information about Baby Cal call 1 (800) BABY-999 ( 1 (800) 222-9999 ) or click here.
What is the Women, Infants and Children Supplement Nutritional Program (WIC)?
The WIC program is for pregnant women, breast-feeding women, infants and children under five (5) years of age who have a medical/nutritional risk and are low-income. Due to limited federal funds, not everyone eligible for the WIC program will always receive services.
The WIC program provides:
• Coupons for food
• Nutritional counseling
• Nutrition education classes
• Breast feeding help.
For more information, call your local county health department, or look under “WIC” in the white pages of your phone book.
What is the Family Planning Services Program?
With Family Planning Services you will:
• Receive information and education on your options for birth control
• Discuss with your provider the birth control method that is best for you
• Receive Family Planning Services at low or no cost.
With Family Planning Services you can:
• Receive continued follow-up care
• Prevent unplanned pregnancies
• Plan when to have your next child.
Family Planning Services can give you:
• Birth control supplies for men and women
• Pregnancy tests
• Breast and cervical cancer screening
• Tests and treatment for sexually transmitted infections (STI)
• Education, testing, and counseling for HIV, the virus known to cause AIDS.
If you are low-income or are receiving Medi-Cal, Family Planning Services are available at no cost. You can get Family Planning Services from:
• Your regular Medi-Cal health care plan, doctor, or community clinic.
• Or, any other doctors or clinics that accept Medi-Cal.
• Health care providers who participate in Family Planning, Access, Care and Treatment (PACT).
For information about Family Planning Services, call 1 (800) 942-1054 .
Are There County-Operated Health Care Programs?
Yes. Individuals who are not eligible for Medi-Cal may qualify for a health care program offered by the county in which they live. Call your county social services office for more information.
What is California Children Services (CCS)?
California Children Services (CCS) financially assists low-income families who are unable to afford necessary medical care for children with serious medical problems. CCS arranges and pays for diagnostic evaluations, if required, without regard to the family’s income and resources. The CCS program covers almost all serious medical conditions that can be improved or stabilized, including:
• Birth defects
• Chronic illness
• Genetic disease
• Handicaps which are present at birth or develop later
• Injuries due to accidents or violence.
To apply for this program, contact your county health department.
What is the Child Health and Disability Prevention (CHDP) Program?
The Child Health and Disability Prevention (CHDP) Program is a health promotion and prevention program serving California’s infants, children, and teens. The CHDP Program provides periodic preventive health assessments to:
• Children under age 21 with Medi-Cal < br />• Non-Medi-Cal eligible children from birth to age 19 with family incomes at or below 200 per cent of the Federal Income Guidelines and no source of health care coverage for preventive health care services
• Children enrolled in Head Start and state preschool programs.
Children identified with suspected problems after a health assessment are referred for necessary diagnosis and treatment. Many problems can be prevented, corrected, or reduced in severity by prompt diagnosis and treatment.
Early, Periodic, Screening, Diagnosis and Treatment (EPSDT) services are a benefit provided through the CHDP Program for Medi-Cal children not enrolled in a Medi-Cal managed care plans.
For more information about obtaining services, or for help with getting an appointment and transportation, call the local CHDP program located in your county/city health department.
What is In-Home Supportive Services?
The In-Home Supportive Services (IHSS) program helps pay for services which enable individuals to remain safely in their own homes instead of entering a nursing home or board and care facility. To be eligible, you must be over 65 years of age, disabled, or blind. Disabled children are also eligible for IHSS.
The types of services IHSS can help pay for include:
• Meal preparation
• Grocery shopping
• Personal care services (such as bowel and bladder care, bathing, grooming and paramedical services)
• Accompaniment to medical appointments
• Protective supervision for the mentally impaired.
To apply for IHSS, contact the local IHSS office at your county social services agency.
Does Medi-Cal Offer Breast and Cervical Cancer Early Detection Programs?
Yes. Finding breast or cervical cancer early improves the chances of successful treatment. Regular screening for these cancers is the best way to find the cancer early.
Recommended Screening for Breast and Cervical Cancer:
• Breast Cancer Screening—Beginning at age 40 it is recommended women get a breast examination and a mammogram every 1-2 years.
• Cervical Cancer Screening—Beginning at age 18, women should get regular Pap tests. Individuals covered by Medi-Cal are encouraged to request screening from their health care provider.
Can I Get Breast and Cervical Cancer Screening if I Don’t Get Medi-Cal?
Yes. The California Cancer Detection Programs: Every Woman Counts provides free screening for breast and cervical cancer for uninsured women.
To qualify for these free screening services, women must meet the following requirements:
Be age 40 or older for breast cancer screening; 25 or older for cervical cancer screening
Have no health insurance or have a high insurance deductible or co-payment
Be lower income (at or below 200% of Federal poverty level)
The Family Planning, access Care and Treatment (Family PACT) program also provides free breast and cervical cancer screening services.
Call toll-free 1 (800) 511-2300 , Monday – Friday 9:00 AM – 7:00 PM, to find out if you qualify for these free screening services. We speak English, Spanish, Cantonese, Mandarin, Vietnamese and Korean. If you qualify, you will be referred to a health care provider in your neighborhood.
What If I Need Breast Or Cervical Cancer Treatment?
The Breast and Cervical Cancer Treatment Program (BCCTP) program may be able to help. BCCTP provides, at least, free cancer treatment for people who have breast or cervical cancer.
To qualify for free care, you must:
• Be screened by a BCEDP, BCCCP, or Family PACT provider; and
• Found in need of breast or cervical cancer treatment.
If you have full health insurance then your premiums, co-pays or deductibles must be over $750.
To receive breast or cervical cancer treatment, you may be male or female, of any age and regardless of citizenship or immigration status. Some individuals may be eligible for full Medi-Cal benefits for the duration of their treatment if they meet federal requirements (female, under 65, no health coverage, diagnosed with breast or cervical cancer, and need treatment).
For more information on this program or for the location of a qualified screening provider nearest you, please call 1 (800) 824-0088 .
PROGRAM INFORMATION TELEPHONE NUMBERS For General Information about Medi-Cal:
• Call Electronic Data Systems Customer Service Unit at (916) 636-1980; or
• Call your county social services agency office
For Information About What Medical Services Medi-Cal Covers:
• Call Your Provider (your doctor, dentist, clinic, hospital, etc.)
• For Questions about Dental Services or Medi-Cal Dental Programs: 1 (800) 322-6384
Prepaid Health Plans/Managed Care:
• To Enroll/Disenroll Call MAXIMUS, the State’s Health Care Options Contractor: 1 (800) …
• To File A “Plan Specific” Complaint Call your specific Health Plan
• If You Are Not Satisfied, Call The State Office Of The Ombudsman: 1 (888) 452-8609
Medi-Cal Billing Problems:
• For Problems Or Questions Regarding Medical Bills, Call Electronic Data Systems: (9…
Medi-Cal State Hearing:
• To file a request for a Medi-Cal State Hearing: Call the Public Inquiry and Response Unit at 1 (800) 952-5253; For Hearing Impaired: TDD 1 (800) 952-8349
Third Party Liability:
- Health Insurance Billing and Coding, Premium Payment, Medicare Buy-in: 1 (800) 952-5294
- Casualty, Personal Injury, Probate, Estate, Liens, Workers’ Compensation, Overpayment Recovery: 1 (800) 952-5294.
Medi-Cal Beneficiary Fraud and Abuse: 1 (800) 822-6222
Provider Fraud and Elder Abuse complaint line: 1 (800) 722-0432
SSA or SSI/SSP Information: 1 (800) 772-1213
(For hearing impaired: TTY 1 (800) 325-0778)
Other Health Program Numbers:
- For Healthy Families/Medi-Cal for Children application and/or information: 1 (888) 747-1222
- Access for Infants and Mothers (AIM): 1 (800) 433-2611
- Family Planning Services: 1 (800) 942-1054
- Early and Periodic Screening Diagnosis and Treatment (EPSDT) Program: 1 (800) 433-2611
*Please note, this information is from the Medi-Cal website.