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  California’s Family Health Insurance Programs

 

This table provides general information on California's family health insurance programs. Click the following link to download the Family Health Insurance table in a PDF format.

Program

Eligibility

Services Covered

Cost to Participate

Medi-Cal for Children

California’s Medicaid program guarantees coverage of a specified set of benefits for all children who meet its eligibility and income requirements.

• Income requirements: Up to 200% FPL for age 0 – 1; up to 133% FPL for age 1 up to 6; up to 100% FPL for age 6 – 19.

• U.S. citizen or legal resident and a California resident.

• Undocumented and certain other immigrants may still receive emergency and pregnancy-related services if a California resident.

Comprehensive health – including inpatient/outpatient, preventive care, prescription drugs, lab – and dental, vision, mental health and substance abuse services.

No cost.

Healthy Families

California’s version of the State Children’s Health Insurance Program (SCHIP) provides subsidized insurance for children in families with incomes up to 250 percent of FPL and not eligible for no-cost Medi-Cal. The program is administered at the state level by the Managed Risk Medical Insurance Board (MRMIB).

• Income requirements: 200 – 250% FPL for age 0 – 1; 133 - 250% FPL for age 1 up to 6; 100% - 250% FPL for age 6 – 19.

• Not eligible for no-cost Medi-Cal.

• U.S. citizen or legal immigrant (some exceptions granted) and a California resident.

• Without job-based coverage for 3 months prior to applying for the program.

Comprehensive health, dental, vision, mental health and substance abuse services.

• $4 to $9 per month per child; maximum $27 monthly premium.

• $5 co-pay on some non-preventive services.

Child Health and Disability Prevention (CHDP)

CHDP is administered by the state and counties and provides free services to low-income children and youth for early detection and prevention of disease and disability. CHDP became a gateway to Medi-Cal and Healthy Families in July 2003 with an automated application initiated by the CHDP provider that provides up to 60 days full scope Medi-Cal coverage. There are no immigration requirements for this temporary Medi-Cal benefit period. However, children already enrolled in Medi-Cal with limited scope benefits due to their immigration status are not eligible for temporary full-scope coverage.

• Children, age 0 – 21, who have chronic and/or serious health problems with family income under $40,000 OR out of pocket medical expenses expected to be more than 20% of family income

• Children who have Healthy Families or no share of cost Medi-Cal may be eligible for CCS coverage.

• California resident.

Treatment and case management services, including physician services, hospital care, laboratory work, x-rays, rehabilitation services, pharmaceuticals, and equipment.

Family may have some financial obligation; $25 processing fee.

CCS (California Children's Services)

Administered by the state and counties, CCS provides for medical care for eligible, low-income children who have serious medical problems, including acute injury and illness, genetic diseases, chronic conditions or physical disabilities, congenital defects and major injuries due to violence and accidents.

Age 0-21: Children who have chronic and/or serious health problems. Family income must be under $40,000 OR out of pocket expenses of 20% or more of income for qualifying medical conditions.

* Children who have Healthy Families or no share of cost Medi-Cal may be eligible for CCS coverage.
** Child must be a California resident.

Specialized medical care and rehabilitation services for children who are disabled or have a serious illness.

Family may have some financial obligation; $25 processing fee.

Access for Infants and Mothers (AIM)

Administered by the state and counties, CCS provides health coverage to pregnant women and their infants with family income between 200-300% FPL.

• Pregnant women not more than 30 weeks pregnant and their newborns up to age two with a total family income of 200-300% FPL.

• Babies born to moms enrolled in AIM are eligible for enrollment in Healthy Families.

• No private health insurance unless it has no maternity coverage or maternity deductible is >$500.

• Not currently receiving coverage through no-cost Medi-Cal.

• Resident of California for six months prior to applying.

Prenatal visits; hospital delivery; comprehensive health care for the mother through 60 days after pregnancy; full health care coverage for infant up to age 2. • 1.5% of total family income up to child’s 1st birthday; $50 in child’s 2nd year (with proof of immunization).

• $50 application fee.

CaliforniaKids

Provides low-cost primary health care coverage for uninsured children 2 – 18.

• Up to 250% FPL for age 2 - 18; up to 300% FPL for foster children age 18-19.

• Coverage provided to income-eligible children who do not qualify for full-scope Medi-Cal or Healthy Families, regardless of immigration status. Families are not required to provide social security numbers or immigration status information.

Preventive and primary care services; medical office visits; dental and vision care; prescription drugs, mental health services, and needed lab tests. No coverage for hospitalizations or major surgery.

• Monthly premiums of $25 per child

• Co-payments range from $5-$10 for each service.

Kaiser Permanente Cares for Kids Child Health Plan

Provides health care coverage for uninsured children who are not eligible for Medi-Cal, Healthy Families, or employer coverage.

• Age 0-19: 250-300% FPL

• Not eligible for Medi-Cal and Healthy Families and uninsured for at least 90 days.

• Families are not required to provide immigration status information; social security numbers are optional on the application.

Preventive, primary and specialty care, vision, prescription drugs, mental health and substance abuse services, hospital services, lab tests, and dental services.

• Monthly premiums are $8 -$15 per child, depending on family income. Maximum of $45 per month per family.

• Co-payments of $5-$10 for most services.


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