37 Healthcare Systems for Children

38 Medicaid (Medi-Cal) California’s Medicaid program Health insurance for low-income families and individuals

39 Fee for Service Medi-Cal Go to any doctor who accepts Medi-Cal Don’t need a referral to see a specialist Eligibility – children who receive SSI are in foster care Most children aren’t eligible for this

40 Medi-Cal Managed Care HMO Most common kind of Medi-Cal Only choice for most children Primary care provider gatekeeper need referral to see a specialist

41 Medi-Cal Managed Care Different Plans Los Angeles LA Care HealthNet Orange County Cal Optima All Medi-Cal programs are managed care

42 Automatically Qualify for Medi-Cal if you are in…  SSI/SSP (Supplemental Security Income/State Supplemental Program)  CalWORKs (California Work Opportunity and Responsibility to Kids).  Refugee Assistance  Foster Care or Adoption Assistance Program  TANF (Temporary Assistance to Needy Families)

43 Medi-Cal for Children with Disabilities Medi-Cal even if families make too much to qualify Share of cost Waiver

44 Share of Cost Medi-Cal For people with disabilities who make too much money for regular Medi-Cal  pay a certain amount (share of cost) each month that you receive medical care before Medi-Cal begins to pay

45 Waiver For some children who are medically fragile or have developmental disabilities Does not count parents’ income in deciding eligibility

46 Eligibility for Medi-Cal Income Few resources United States Citizen or documented resident

47 Important Points about Medi-Cal Many ways to qualify for Medi- Cal a child with a disability may qualify even if the rest of the family doesn’t It can be very confusing to figure out if you or your child qualifies Eligibility is different depending on the age of the child and whether he/she has a disability

48 Important Points about Medi-Cal You can get help with things like finding out if your child is eligible, filling out applications or problems at places like the Consumer Health Center of Los Angeles

49 Denti-Cal Program for dental care. Provides regular cleaning and check-ups needed dental work Orthodontia

50 Eligibility for Denti-Cal Eligible for Medi- Cal Over age 3

51 Important points about Denti-Cal List of dentists who accept Denti-Cal from CHDP Covers orthodontia for children

52 Healthy Families Insurance program for children 0 to 19 years of working families Income too high for Medi-Cal Under 250% FPL No health insurance

53 Paying for Healthy Families Monthly premium family size, income and amount of services you need Different plans cost between $4 - $15 a month (per child) The most you can pay is $45 per month.

54 Paying for Healthy Families co-pay each time you receive services Usually $5 No charge for preventive services, like yearly check-ups

55 Eligibility for Healthy Families Children age 0 – 19 Working families Under 250% FPL ($3,928 for a family of 4). United States Citizen or documented resident California resident

56 Important Points about Healthy Families Comprehensive health care Several choices of Healthy Families plans look at each plan and pick the one that bests meets your child’s needs Check to see which doctors belong to which plans Look at what medications are covered Decide if you need vision coverage as well as health care

57 Healthy Kids Los Angeles Comprehensive health insurance for children 0 to 19 who don’t qualify for Medi-Cal or Healthy Families Free or low-cost

58 Paying for Healthy Kids Premium ranges from 0 - $12 per child a month Maximum of $24 a month Co-pay for some services

59 Eligibility for Healthy Kids Children ages 0 to 19 Living at or below 300% FPL Living in Los Angeles County

60 Eligibility for Healthy Kids Ineligible for no-cost, full-scope Medi-Cal, Healthy Families, Access for Infants and Mothers (AIM) or job-based health insurance program, and not covered by Kaiser Child Health Plan.

61 Important Points About Healthy Kids Insurance can be used by children who are undocumented Includes dental and vision There is a maximum enrollment waiting list if full Healthy Kids programs in other counties

62 Other publicly funded insurance for children KP Child Health Plan Low-cost health care for children 0 – 19. up to 300% FPL for children who don’t qualify for Medi-Cal Healthy Families or insurance paid in any part by an employer

63 Other publicly funded insurance for children California Kids Comprehensive primary health care services to children ages 2 through 18. Provides insurance for kids who don’t qualify for Healthy Families, up to 300% FPL Not taking applications at this time

64 Child Health and Disability Prevention Program (CHDP) Early Periodic Screening Diagnosis and Treatment (EPSDT) A well-child screening program for infants, children and teens Well child exams diagnosis and treatment Free services

65 Eligibility for CHDP Children with Medi-Cal from birth to age 21 Children from low-income families birth to age 19 not eligible for Medi-Cal below 200% FPL Children in Head Start and State Preschool programs (generally ages 3-5).

66 Important points about CHDP CHDP can pay for services like Sports and camp physicals Mental health services Expanded dental services

67 Children’s Programs for Special Populations

68 California Children’s Services (CCS) Program for children and youth serious and/or chronic medical conditions 0 – 21

69 CCS pays for services that are provided at special care centers pays for special equipment only pays for services for child’s CCS eligible condition

70 CCS Medical Therapy Program (MTP) provides therapy services, such a physical therapy, or occupational therapy Medical Therapy Units (MTUs) are at schools No income requirement

71 Eligibility for CCS Birth – age 21 CCS eligible condition For general CCS Family income under $40,000 or Expect to pay over 20% of income for treatment of CCS eligible condition For MTP only No income eligibility

72 Eligibility for CCS Permanent resident of California Do not need to be documented Parents live in the county where you apply

73 Important Points about CCS Anyone can make a referral Can pay for diagnostic services Some children may qualify for MTP services but not general CCS.

74 County Department of Mental Health (DMH) For children with Serious Emotional Disturbance (SED) such as severe depression or bi-polar disorder. not for people with developmental disabilities or substance abuse unless they also have an SED.

75 Mental Health Programs Care can include therapy, medication, hospitalization and other services

76 AB 3632 (school aged children) For students receiving special education Who need more mental health services than provided by special education

77 Eligibility For general DMH services 0 – 18 Financially eligible for Medi-Cal Diagnosed with or thought to have an SED

78 Eligibility AB3632 Receiving or thought eligible for special education services Needs higher level of mental health services than typically provided by special education

79 Mental Health Programs Mental Health services for children who don’t have a SED Medi-Cal, Healthy Families, EPSDT or private pay

80 Other related programs for children

81 In Home Supportive Services (IHSS) An alternative to out-of- home care, nursing homes or board and care facilities Two Types Residual program Personal Care Services Program (PCSP)

82 Residual Program helps pay for services to help children remain safely in their own home For children with disabilities (including blindness) Who don’t need personal care or paramedical services Must meet SSI/SSP disability criteria

83 Personal Care Services Program (PCSP) helps pay for services to help children remain safely in their own home Covers similar services Provides personal care and/or Paramedical services Doesn’t fund protective services Must receive SSI to qualify

84 IHSS Services can be provided by A hired care provider A parent can be the provider for a child with a severe disability only if the parent is can’t work full-time because of the child’s needs and there isn’t an appropriate caregiver available.

85 IHSS Services include housecleaning, preparing meals, laundry, grocery shopping, personal care services taking people to medical appointments, and protective supervision for people with cognitive disabilities

86 Eligibility for IHSS United States citizens or qualified aliens; and California residents. Live at home Current recipients of SSI/SSP (PCSP) or Current recipients of SSI/SSP (Residual) Are eligible for SSI/SSP but their family income is too high May have share of cost are eligible for SSI/SSP, including income, but don’t get SSI Get Medi-Cal and meet SSI/SSP disability criteria. Limited resources

87 IHSS You can qualify for both Residual and PSCP If service is covered by both programs, it will be funded by PSCP

88 Supplemental Security Income (SSI) not a healthcare system provider federal program that gives a monthly payment automatically eligible for fee for service Medi-Cal

89 Eligibility for SSI SSI for Children Under age 18 or Under age 22 and still receiving special education services Low income Limited resources

90 Eligibility for SSI Citizen or documented resident Diagnosis on the eligible list or Has marked or severe functional limitations

91 Important Points about SSI There are different requirements for children and adults You must meet financial eligibility SSI provides a cash payment and makes you eligible for fee for service Medi-Cal

92 Regional Center & Health Care Services Serves people with developmental disabilities Not a healthcare provider Can help their clients get some of the healthcare services they need.

93 Important Points about Regional Center & Health Care Services May fund healthcare services related to the developmental disability, They are the payer of last resort