healthcare systems for children
DESCRIPTION
Healthcare Systems for Children. Medicaid (Medi-Cal). California’s Medicaid program Health insurance for low-income families and individuals. 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 - PowerPoint PPT PresentationTRANSCRIPT
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Healthcare Systemsfor Children
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Medicaid (Medi-Cal)
California’s Medicaid program
Health insurance for low-income families and individuals
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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
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Medi-Cal Managed Care
HMOMost common kind of
Medi-CalOnly choice for most
childrenPrimary care provider
• gatekeeper• need referral to see a
specialist
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Medi-Cal Managed Care
Different Plans Los Angeles
• LA Care• HealthNet
Orange County• Cal Optima
• All Medi-Cal programs are managed care
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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)
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Medi-Cal for Children with Disabilities
Medi-Cal even if families make too much to qualifyShare of costWaiver
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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
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Waiver
For some children who are medically fragile or have developmental
disabilities Does not count parents’
income in deciding eligibility
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Eligibility for Medi-Cal
Income
Few resources
United States Citizen or documented resident
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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
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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
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Denti-Cal
Program for dental care. Provides
regular cleaning and check-ups
needed dental work Orthodontia
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Eligibility for Denti-Cal
Eligible for Medi-Cal
Over age 3
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Important points about Denti-Cal
List of dentists who accept Denti-Cal from CHDP
Covers orthodontia for children
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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
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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.
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Paying for Healthy Families
co-pay each time you receive services Usually $5 No charge for preventive
services, like yearly check-ups
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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
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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
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Healthy Kids Los Angeles
Comprehensive health insurance for children 0 to 19who don’t qualify for Medi-Cal
or Healthy Families Free or low-cost
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Paying for Healthy Kids
Premium ranges from 0 - $12 per child a month Maximum of $24
a month Co-pay for some
services
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Eligibility for Healthy Kids
Children ages 0 to 19
Living at or below 300% FPL
Living in Los Angeles County
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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.
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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
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Other publicly funded insurance for children
KP Child Health PlanLow-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
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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
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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
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Eligibility for CHDP
Children with Medi-Cal from birth to age 21
Children from low-income families birth to age 19not eligible for Medi-Cal
• below 200% FPL Children in Head Start and State
Preschool programs (generally ages 3-5).
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Important points about CHDP
CHDP can pay for services like Sports and camp physicals Mental health services Expanded dental services
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Children’s Programs for Special Populations
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California Children’s Services (CCS)
Program for children and youth
serious and/or chronic medical conditions
0 – 21
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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
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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
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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
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Eligibility for CCS
Permanent resident of California Do not need to be documented
Parents live in the county where you apply
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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.
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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.
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Mental Health Programs
Care can include
• therapy, • medication, • hospitalization
and • other services
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AB 3632 (school aged children)
For students receiving special education Who need more mental
health services than provided by special education
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Eligibility
For general DMH services 0 – 18
Financially eligible for Medi-Cal
Diagnosed with or thought to have an SED
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Eligibility
AB3632 Receiving or thought eligible for
special education services Needs higher level of mental
health services than typically provided by special education
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Mental Health Programs
Mental Health services for children who don’t have a SED Medi-Cal, Healthy Families, EPSDT or private pay
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Other related programs for children
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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)
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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
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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
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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.
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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
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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
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IHSS
You can qualify for both Residual and PSCP If service is covered by both
programs, it will be funded by PSCP
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Supplemental Security Income (SSI)
not a healthcare system provider
federal program that gives a monthly payment
automatically eligible for fee for service Medi-Cal
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Eligibility for SSI
SSI for ChildrenUnder age 18 or
• Under age 22 and still receiving special education services
Low incomeLimited
resources
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Eligibility for SSI
Citizen or documented resident
Diagnosis on the eligible list or
• Has marked or severe functional limitations
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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
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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.
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Important Points about Regional Center & Health Care Services
May fund healthcare services related to the developmental disability,
They are the payer of last resort