update 2016-6: medi-cal - the county of santa clara · page 4 update 2016-6: medi-cal santa clara...

Santa Clara County Social Services Agency page 1

Date: 03/22/16

References: None

Cross-References: None

Clerical: No

Handbook Revision: No

Update 2016-6: Medi-CalCCHIP

Policy County Children’s Health Initiative Program (CCHIP) is a health insurance program in Santa Clara, San Francisco and San Mateo. CCHIP provides medical, dental and vision to children age 0-19 with family income between 266% to 322% Federal Poverty Level (FPL).

Eligibility Criteria Eligible clients must be:

• A resident of Santa Clara, San Francisco or San Mateo counties

• Age 0 up to 19th birthday

• Uninsured and not eligible for Medi-Cal

• A United States citizen, national, or lawfully present immigrant

Eligible clients may not have employer-sponsored coverage available and the combined family income must be between 266% to 322% FPL.

Contribution & Copayments

Families are required to pay a portion of the health coverage cost to participate in CCHIP, the rest of the coverage is paid for by the State and federal government.

The families’ required contribution depends on the household income and household size but ranges from $21 per month to a maximum of $63 per month.

A copayment may be required for some services. Depending on the family income the copayment may be $5, $10, $15 or more. The maximum out-of-pocket amount for services in one benefit year is $250/household.

Update 2016-6: Medi-Cal

Note:There are no copays for immunizations and preventive services.

Application Clients can enroll children into CCHIP at any time, there is no open enrollment period. The application process is the same for Medi-Cal, APTC/CSR, and QHP. The client can apply online, by phone, by mail or in person.

FAQs Q1. Does CCHIP meet MEC?

A1. Yes, CCHIP meets MEC.

Q2. Can a client have both CCHIP and Non-MAGI without a Share of Cost (SOC)?

A2. No, the FPLs are not the same for CCHIP and zero SOC Non-MAGI MC.

Q3. Can a client have both CCHIP and Non-MAGI MC with a SOC?

A3. Yes, SOC is not considered MEC, a client can have both CCHIP and SOC MC.

Q4.Can a client have both CCHIP and MAGI MC?

A4. No, the FPLs for these programs are not the same.

Q5. Can a client have CCHIP and APTC?

A5. No, if a client is eligible for CCHIP, they are not eligible for subsidized coverage, APTC or CSR. The client can choose QHP instead of CCHIP, at the full premium.

Q6. What aid code will the client receive for CCHIP and where will it appear in MEDS?

A6. The CCHIP aid code is 2C and will appear in MEDS on a special segment.

Note:If the client also has SOC MC the SOC MC aid code will appear on INQM in MEDS and the CCHIP aid code 2C will appear on INQ1.

Q7. What is County Eligibility Worker (EW) responsibility for CCHIP clients?

Update 2016-6: Medi-Cal page 3

A7. EWs are not responsible for case management with CCHIP. The Santa Clara County CCHIP - Children’s Health Initiative (CHI) will inform the client of enrollment, effective date of coverage, and billing information. The client will receive notification of eligibility, discontinuance from the program, and annual renewal determination from the CalHEERS system.

However, the no “wrong door” policy applies to CCHIP. EWs will assist clients with the application online, in person, by phone or by mail.

Note:There is only one plan in each of the three CCHIP counties, eligible clients will be enrolled in that plan.

EWs will not confirm enrollment in CCHIP, confirmation comes directly from CHI.

If a client provides verifications to the EW, the EW will save the documents in IDM and update the CalWIN case with the verification status. If verifications remain pending, CHI will follow up with the client.

Q8. What notifications will the client receive when they are approved, denied or discontinued from CCHIP?

A8. Eligibility and/or denial notices for CCHIP and/or APTC will come from Covered California.

The client will receive notification of enrollment, start date of coverage, or discontinuance by the client’s CCHIP county of residence (CHI in Santa Clara County).

Q9. Will the client be automatically enrolled in CCHIP once the determination is made in CalHEERS or is there a batch process?

A9. Eligibility for CCHIP is determined with aid code 2C, enrollment is completed by the CCHIP county of residence (CHI in Santa Clara County).

Q10. What happens when the clients income increases above 322%?

A10. CCHIP children will receive 12 months of uninterrupted coverage. If the income increases above the limit, the child will remain active on CCHIP until the end of the certification year.

Contact Information

The CCHIP offices in Santa Clara, San Mateo and San Francisco are listed below, clients should contact the CCHIP of residence for coverage questions.

Update 2016-6: Medi-Cal

Santa Clara Children’s Health Initiative 770 S Bascom Ave. San Jose, CA 95128

1 (888) 244-5222 1 (408) 808-6180

San Mateo San Mateo County Health Coverage Unit Children's Health Initiative 801 Gateway Blvd. Suite 100 South San Francisco, CA 94080

1 (650) 616-2002

San Francisco San Francisco Healthy Kids P.O. Box 194327 San Francisco, CA 94119 1 (415) 615-5700 In-Person Assistance: 7 Spring Street San Francisco, CA 94104 Monday-Friday, 8:00 am to 5:30 pm

Implementation This Update is effective immediately upon receipt.

Other Programs

This Update only applies to the MC Program.

Attachments

• DHCS CCHIP Informing Notice that went to clients in February 2016.

• Fact Sheet for County Eligibility Workers (CEWs) County Children’s Health Initiative Program (CCHIP) Basics

Update 2016-6: Medi-Cal page 5

DENISE BOLAND, DIRECTOR, Department of Employment and Benefit Services

Contact Person(s): Pamela Bianchi, Application & Decision Support Specialist, (408) 755-7540

update 2016-6: medi-cal - the county of santa clara · page 4 update 2016-6: medi-cal santa clara...

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