Full
Medi-Cal

Medi-Cal
877-597-4777

Call Health & Nutrition Hot Line (1-877-597-4777) to request a mail-in application or apply at DPSS or neighborhood clinics & hospitals

Children: YES

Adults: YES

Qualified Immigrants*: YES

Coverage Programs may offer a variety of health, dental, vision, and mental health plans from which to choose, includes hospitalization

Eligibility

Anyone who is getting SSI, CalWORKs, foster care, adoption assistance, or certain immigrants receiving Entrant or Refugee Cash Assistance benefits

Age < 1: Up to 200% FPL

Ages 1-5: Up to 133% FPL

Ages 6-19: Up to 100% FPL

Children whose income is too high for free Medi-Cal can get Share of Cost Medi-Cal - even if they also have Healthy Families. This is helpful because Medi-Cal covers more services than Healthy Families.

Age +65: 100% FPL

Parents or caretaker relatives who are either single parents, unemployed, or under-employed” “Countable income (with allowances for child care & working expenses)

·     1 person income $749

·     5 persons $1795

·     8 persons $2842 , etc.

Legally blind or disabled by Social Security standards): 100% FPL

Working Disabled: 250% FPL (May call Working Disabled Coordinator at 1(626) 854-4987)

Property limit: 1 person: $2000, 2 persons: $3000; family of 5: $3450

Legal Resident

Having other health insurance does not disqualify

Qualified Immigrants*: YES

Monthly Cost  $0 or (for those with income > $600 for 1 adult or > $934 for 2 adults) share of cost

Restricted Medi-Cal

RestrictedMedi-Cal

Call Health & Nutrition Hot Line (1-877-597-4777) to request a mail-in application or apply at DPSS or neighborhood clinics & hospitals

Children: YES

Coverage

·  emergencies

·  prenatal, delivery, and postpartum pregnancy related care (Some doctors can provide immediate pregnancy-related services beforeyou file a Medi-Cal application)

·  breast or cervical cancer (see the Breast Cancer Early Detection Program)

·  dialysis or total parenteral hyperalimentation

·  tuberculosis, etc.

·  minor consent. substance abuse, outpatient mental health, family planning, diagnosis and treatment of STDs, treatment after sexual assualt

Eligibility

·  Pregnant Women: 200% FPL

·  Breast cancer: $1702

·  Minor Consent; children under 21 living at home.  Only child’s income and resources are counted

Unqualified Immigrants*: YES

Monthly Cost$0

Healthy Families

Healthy Families Program 800-880-5305 888-747-1222 www.healthyfamilies.ca.gov (Program subject to change based on final state budget.) 

Children: YES

Pregnant women: Adults: YES

Coverage: Offers health, dental, mental health, and vision services. (but not substance abuse treatment). Children with pre-existing conditions are not excluded and can receive coverage for services that are medically necessary.

Eligibility

·  Must not be covered by an employer sponsored plan now or in the last 3 months (with exceptions). Not eligible for no Share of Cost Medi-Cal.

·  250% FPL

·  Adult women are covered during pregnancy up to delivery.

Qualified Immigrants*: YES

Monthly Cost$4-$15 per child depending on income and choice of plan, with a $45 family maximum; $5 co-pay for doctor visits and prescriptions (Co-payments are subject to change based on the state’s final budget); some check-ups are no-cos

Healthy Kids

Healthy Kids(County-based programs) 888-452-5437 (local number) 888-318-8188 (Program subject to change based on continued funding for ages 6-18 )

Coverage: Includes mental health covervage

Eligibility

·  Income between 0%-300% of the FPL.

·  Must not be covered by an employer sponsored plan now or in the last 3 months (some exceptions).

·  Children must be between the ages of 0-5.

·  Program subject to change based on continued funding for ages 6-18 .

·  Not eligible for no-cost full-scope Medi-Cal or Healthy Families.

Unqualified Immigrants*: YES

Monthly Cost Monthly premiums are $0-$6. Along with $5 co-pay for most outpatient services.

CHDP

Children’s Health and Disability Prevention (CHDP) 800-993-2437 800-993-CHDP http://www.dhs.ca.gov/pcfh/cms/CHDP

Coverage: Only covers general check ups required for school, sports, camps, etc. (Does not cover hospital, medicines, or any emergencies)

Eligibility

Ages <1 up to 19

200% FPL

Also, children in Headstart, State Preschool programs, and Foster Care.

Unqualified Immigrants*: YES

Monthly Cost No cost

CCS

California Children’s Services

800-288-4584

Coverage  .

Eligibility

·  Ages < 1 to 21

·  Eligible major medical conditions caused by accidents, diseases, and congenital or

·  developmental disabilities

·  Los Angeles County resident

·  $40,000 a year, or may be greater depending on their CCS-related medical expenses

·  There is no family income limit for children who need services to confirm a CCS eligible medical condition; or were adopted with a known CCS eligible medical condition;

Children: YES

Unqualified Immigrants*: YES

Family PACT

Family PACT (Family Planning)
800-942-1054

Coverageprovides comprehensive family planning services

Eligibility up to 200% FPL 

Adults: YES

Monthly Cost$0 or share of cost

Kaiser Permanente Child Health Plan

Kaiser Permanente Child Health Plan
800- 464-4000

Children: YES

Coverage: Offers health, dental, and vision services.

Eligibility

·  Applicants income can range up to 300% of the FPL.

·  Must not be eligible for employer based coverage

·  Must not be eligible for no-cost full-scope Medi-Cal or Healthy Families.

Unqualified Immigrants*: YES

Monthly Cost$8-$15 per child per month ($45 max per family), co-pays range from $5-$35 for some services with a $250/child or $500 for two or more children maximum

AIM

Access for Infants & Mothers (AIM)

800-433-2611  

Children: YES

Adults: YES

CoverageProvides comprehensive medical care for mother (not just maternity); mothers continue coverage up to 60 days after delivery; after birth, infant is eligible for enrollment into Healthy Families (they are not automatically enrolled, mom must notify Healthy Families Program)

Eligibility

·  201%-300% FPL for AIM

·  If you are pregnant, your income can be up to 300% FPL

·  Pregnant less than 31 weeks

·  Live in California for at least 6 months

·  Legal immigration status

·  Insurance deductibles or co-payments over $500 may qualify for AIM

·  Any pregnant woman can be “presumed  eligible” at certain clinics and given  limited pregnancy-related Medi-Cal  immediately, without proving pregnancy  or providing information on property,  car, or resources. She will still have to turn in a regular  Medi-Cal application and provide proof  of income by the end of the next month if she wants to continue her Medi-Cal.

Unqualified Immigrants*: YES

Monthly Cost 1.5% of family annual income

Veterans Benefits

(877) 222-8387

Y

CoverageInformation on a full range of medical benefits available to veterans, regardless of your income and even if the health problem is not related to military service

Eligibility up to 200% FPL 

Children: YES

Monthly Cost$0 or share of cost

Ability To Pay

ATP will cover your deductible for private insurance, but will not cover inpatient Medicare deductibles and Medi-Cal Share of Cost

Coverage

·  ATP provides no-cost or low-cost medical care at county hospitals and clinics for anyone whose Medi-Cal, Medicare, or other insurance won't cover the full cost of needed medical care. A person receiving no cost care also receives medicines at no cost.

Eligibility

·  Anyone on "General Relief" will get both inpatient and outpatient care at no cost

·  You may qualify for free outpatient care if your Family Net Income is:

o         1 $1,135

o         ~

o         5 $2,681, etc.

·  You may qualify for free hospital care if you get General Relief, or through ATP if your Family Net Income is

o         1 $616

o         ~

o         5 $1,276 

·  Otherwise, share of cost

Children: YES

Monthly Cost$0 or share of cost

Outpatient Reduced-cost Simplified Application

ORSA won't pay for "inpatient" services, but it pays for all outpatient care, including medicines, tests and lab work.

?

Coverage

Eligibility 

Children: YES

Monthly Cost$0 or share of cost

Family size
(Household)

100%

133%

200%

250%

300%

1

$867

$1,153

$1,733

$2,167

$2,600

2

1,167

1,552

2,333

2,917

3,500

3

1,467

1,951

2,933

3,667

4,400

4

1,767

2,350

3,533

4,417

5,300

5

2,067

2,749

4,133

5,167

6,200

6

2,367

3,148

4,733

5,917

7,100

7

2,667

3,547

5,333

6,667

8,000

8

2,967

3,946

5,933

7,417

8,900