Benefits Program

All Goverment Program benefits and Application form, income limits, documents etc.
All Goverment Program benefits and Application form, income limits, documents etc.
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NOTICE

California Healthy Families Program Benefits

The California SCHIP program provides affordable health insurance to children and teens living in California who are not eligible for Medi-Cal. Generally, the monthly premium for children is determined by the income and size of the family. Mandatory monthly premiums range between $4 and $17 per child, however, the fee does not exceed a maximum of $51 for all underage children in a family enrolled in the Healthy Families Program.

Members must pay a $5 co-pay each time they visit a doctor or receive other medical services. Services such as preventive health care are not charged. These fees should never exceed $5 for the benefit of children. Each family is required to pay a maximum of $250 in co-payment benefits per year. (i.e. for health care services from 1 July to 30 June each year). 

Remember to save all co-payment receipts made when receiving health care services. Never forget to notify your health plan if you reach the maximum $250 for a coverage benefit year. You will not be required to pay a $5 co-pay for health care services until the beginning of your next benefit year of coverage.

What is California Healthy Families (SCHIP)?

Healthy Families is low cost insurance for California children and teens. It provides health, dental and vision coverage to children who do not have insurance and do not qualify for free Medi-Cal.

Program Enrolment, Length and Renewal

After every 12 months, you will be required to fill a renewal form to determine if you still meet the qualification guidelines so that your premiums can be adjusted accordingly. A renewal form will be mailed to you 3 months before the 12 month renewal period expires. The health plan verifies the size of your family and income through the renewal notice. 

Remember, you can always change your health plans during open enrollment period which runs from April 15th to May 31st of each year. Once you choose a new insurance plan during the open enrollment period, all children in the household are automatically transferred to the new insurance plan. Coverage in the new plan starts every July 1st.

Purpose of the California Healthy Families Program

The California Healthy Families Program, now integrated into Medi-Cal under the California Advancing and Innovating Medi-Cal (CalAIM) initiative, was established with several key purposes:

  • Provide Affordable Health Coverage: The primary goal of the program was to offer low-cost health insurance coverage to children and pregnant women who did not qualify for Medi-Cal but couldn't afford private health insurance. This aimed to ensure that these individuals had access to essential health services.
  • Promote Access to Preventive Care: The program focused on promoting preventive care measures, including regular check-ups, vaccinations, and screenings. By providing access to preventive services, the program aimed to improve the overall health and well-being of enrolled individuals.
  • Support Maternal and Child Health: One specific focus of the program was to support the health needs of pregnant women and children. This included prenatal care for expectant mothers and a range of health services for children to ensure healthy development.
  • Reduce Uninsured Rates: The program played a role in reducing the number of uninsured individuals, particularly among children and pregnant women. By providing an affordable option for those who didn't qualify for Medi-Cal, it helped extend health coverage to a broader segment of the population.
  • Improve Health Outcomes: By facilitating access to essential health services, the program aimed to contribute to improved health outcomes for enrolled individuals. Regular access to medical care and preventive services can lead to early detection and management of health conditions.

For the most current and accurate information, individuals are encouraged to check with the California Department of Health Care Services or other relevant state agencies.

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California Healthy Families Program Benefits

The California Healthy Families Program transitioned to Medi-Cal under the California Advancing and Innovating Medi-Cal (CalAIM) initiative. The benefits provided under the California Healthy Families Program were focused on offering affordable health coverage to eligible children and pregnant women. Here are some general aspects of the benefits typically associated with the program:

  • Doctor Visits: Coverage often included visits to primary care physicians and specialists for routine check-ups, illness, and other health concerns.
  • Hospital Services: Inpatient and outpatient hospital services may have been covered, including surgeries, diagnostic tests, and other medically necessary treatments.
  • Immunizations and Preventive Care: The program aimed to cover a range of preventive services, including vaccinations, screenings, and other measures to promote overall health and well-being.
  • Prescription Medications: Coverage likely included prescription medications prescribed by a healthcare provider.
  • Maternity Care: Pregnant women enrolled in the program typically received coverage for prenatal care, delivery, and postpartum care to support maternal and child health.
  • Vision and Dental Services: Some vision and dental services may have been covered under the program to address the comprehensive health needs of enrollees.
  • Mental Health Services: Coverage likely included mental health services, counseling, and therapy to support the mental well-being of enrollees.

It's important to note that the specific benefits and details of the program may have evolved or changed since my last update. Additionally, the transition to Medi-Cal under the CalAIM initiative may have implications for the structure and components of the benefits provided. For the most current and accurate information regarding benefits and coverage, individuals are encouraged to check with the California Department of Health Care Services or other relevant state agencies.

Services and Benefits Offered by California SCHIP

California (SCHIP) covers the following medical services:

  • Physician Services Category - Office and home visits, allergy testing and treatment
  • Preventative Care Category - Routine health tests, family planning services, prenatal care, vision and hearing testing, immunizations, STI testing, health education services, annual pap smear exams and confidential AIDS and HIV testing and counseling
  • Skilled maternity care
  • Inpatient/Outpatient hospital services
  • Prescription Drugs - usually a 30 day supply, 90 day maintenance supply
  • Laboratory and X-ray services
  • Durable Medical Equipment
  • Mental Health
  • Dental & Vision Care
  • Alcohol and substance abuse
  • Physical, Occupational, Speech Therapy
  • Emergency and Non-emergency medical transportation
  • Emergency health care services
  • Home based health care
  • Professional nursing care

California Healthy Families Program Eligibility Requirements

The California SCHIP healthy program only offers affordable insurance for children living in California under the age of 19 and whose family income ranges between 0% and 300% of the Federal Poverty Level (FPL). These families must have been without an employer-sponsored health insurance for a period not less than three months.

Applicants must also be legal citizens or meet the required immigration guidelines. Children born to mothers enrolled in the AIM program are also accommodated in this program. Minors and their siblings without parents qualify on their own; however, guardians and foster parents of such children are exempted from the income guidelines.

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Who is eligible for California Healthy Families (SCHIP)?

To be eligible for this benefit program, you must be a resident of California and a U.S. Citizen, National, or a Non-Citizen legally admitted into the U.S. You must be uninsured (and ineligible for Medicaid) and meet one of the following:

  • 18 years of age and under, or
  • Pregnant, or
  • A primary care giver with a child(ren) 18 years of age and under.

California Healthy Families Program Income Limits

In order to qualify, you must have an annual household income (before taxes) that is below the following amounts:

Household SizeMaximum Income Level (Per Year)
1$36,450
2$49,300
3$62,150
4$75,000
5$87,850
6$100,700
7$113,550
8$126,400

For households with more than eight people, add $12,850 per additional person. Always check with the appropriate managing agency to ensure the most accurate guidelines.

Documents required for California Healthy Families Program

The California Healthy Families Program transitioned into Medi-Cal under the California Advancing and Innovating Medi-Cal (CalAIM) initiative. While specific document requirements may vary based on individual circumstances and eligibility criteria, here are some general types of documents that individuals might be required to provide when applying for Medi-Cal or a similar health coverage program:

Proof of Identity:

  • Driver's license
  • State-issued identification card
  • Passport
  • Birth certificate

Proof of California Residency:

  • Utility bills
  • Rental or lease agreement
  • Mortgage statement
  • Other documents showing a California address

Proof of Income:

  • Pay stubs
  • W-2 forms
  • Tax returns
  • Social Security statements
  • Proof of unemployment benefits

Proof of Citizenship or Immigration Status:

  • U.S. passport
  • Certificate of citizenship
  • Permanent resident card (green card)
  • Other immigration-related documents

Social Security Number:

  • Social Security card
  • Social Security number documentation

Information about Household Members:

  • Names and birthdates of all household members
  • Relationship to the applicant
  • Any other relevant household information

Health Insurance Information:

  • Information about current or previous health insurance coverage
  • Policy numbers and group numbers

Other Relevant Documentation:

  • Proof of disability (if applicable)
  • Court orders or legal documents (if applicable)
  • Documentation related to special circumstances affecting income or eligibility

It's important to note that eligibility criteria and required documents may change, and the information provided here is based on my last knowledge update. For the most accurate and up-to-date information, individuals should contact the California Department of Health Care Services or visit their official website. Additionally, when applying for health coverage, individuals may be directed to submit specific documents based on their unique situation.

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Eligibility Requirements for the California Healthy Families Program

The California Healthy Families Program transitioned into Medi-Cal under the California Advancing and Innovating Medi-Cal (CalAIM) initiative. While the specific eligibility criteria can evolve, here are some general guidelines that were applicable to the California Healthy Families Program and are likely relevant to Medi-Cal:

  • Residency: Applicants must be California residents.
  • Age: The program primarily targeted children and pregnant women. Eligible children were typically under the age of 19.
  • Income: Eligibility was based on income. Families or individuals with income below a certain threshold were eligible for the program. The income limits could vary depending on family size.
  • Immigration Status: U.S. citizens, U.S. nationals, or qualified immigrants (with certain immigration statuses) were generally eligible for the program.
  • Not Eligible for Medi-Cal: Individuals who qualified for Medi-Cal were not eligible for the California Healthy Families Program. The program was designed for those who did not qualify for Medi-Cal but still needed affordable health coverage.
  • Uninsured: Applicants needed to be uninsured or not have access to affordable health insurance coverage.

It's crucial to note that eligibility criteria and program details can change, and the information provided here is based on my last knowledge update. Additionally, with the transition to Medi-Cal under CalAIM, individuals may need to meet the eligibility criteria for Medi-Cal to access health coverage. For the most accurate and up-to-date information on eligibility requirements for health coverage programs in California, including Medi-Cal, individuals should check with the California Department of Health Care Services or visit their official website.

How do I apply for California Healthy Families (SCHIP)?

For an application and instructions, please visit: California SCHIP Application Information, You can ask questions about Healthy Families, have the application form sent to you or apply by phone. You can call Monday to Friday, 8 a.m. to 8 p.m., or on Saturday, 8 a.m. to 5 p.m. The call is free: 1-800-880-5305. 

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How To Apply For California Healthy Families Program

The California Healthy Families Program had transitioned into Medi-Cal under the California Advancing and Innovating Medi-Cal (CalAIM) initiative. If you are looking to apply for health coverage in California, particularly through Medi-Cal, here are general steps you can follow:

  • Visit the Medi-Cal Website: Access the official website of the California Department of Health Care Services or the Medi-Cal program.
  • Create an Account: Depending on the application process in place, you may need to create an account on the online portal. This account will be used to submit and manage your application.
  • Complete the Application Form: Fill out the application form with accurate and up-to-date information. The form will typically include details about your household, income, residency, and other relevant information.
  • Submit Supporting Documents: Depending on your situation, you may be required to submit supporting documents such as proof of identity, residency, income, and other documentation. Be prepared to provide any necessary paperwork.
  • Application Assistance: If you need assistance with the application process, you can contact local assistance programs, community organizations, or county social services offices. They may provide guidance and support.
  • Submit the Application: Once you have completed the application and gathered all necessary documents, submit the application through the designated channels. This could be through the online portal, by mail, or in person at a local social services office.
  • Wait for Notification: After submitting your application, you will typically receive a notification regarding your eligibility status. This may take some time, so be patient.
  • Follow Up: If additional information is needed or if there are any questions about your application, be prepared to respond promptly. Following up on your application status is important to ensure a smooth process.

Remember that program details and application processes may have changed since my last update, and it's essential to check with the California Department of Health Care Services or visit their official website for the most current and accurate information. They may provide updated guidance on how to apply for health coverage programs in the state, including any changes resulting from the CalAIM initiative.

California Healthy Families Program Phone Number

To learn more about California Healthy Families, please visit: SCHIP Application Instructions. Send questions by e-mail to: [email protected] - 1-800-880-5305.