Information About California's State & County Health Coverage Programs (California) - The David Fluker Health Insurance Agency - Gilroy, California

California residents have a wide variety of health insurance plans and programs available. Some plans are provided by private insurance companies and others are available through state programs.

Below, I have summarized the different options available to you and your family. Please note that this information is provided as a general guideline to your options in California. For specific information as it relates to you particular situation, please contact the appropriate agency.

A listing of California programs with contact telehone numbers:

Private Health Insurance
Coverage options through private individual & family health insurance plans and/or employer sponsored health insurance coverage. Please contact my office for further information.

COBRA and CalCOBRA
Continuation coverage option when leaving employment and covered under an employer-sponsored health insurance plan. 18 months federal COBRA which can be followed by 18 additional months under CalCOBRA or 36 months under CalCOBRA for groups 2-19 employees.

HIPAA and Conversion Coverage
HIPAA and Conversion coverage options occur when employer sponsored group health coverage is lost either through exhaustion of continuation or when benefits cease from the employer. Both plans are guaranteed-issue for those qualified to enroll and both accept pre-existing conditions. Please contact my office for further information

California MRMIP
MRMIP is a state program designed for those unable to obtain private health insurance. Subscribers must be declined for or receive a high premium rating (above the MRMIP premium) for individual coverage in order to qualify. Three year maximum then subscribers much elect a "graduate" plan.

Healthy Families
California's Health Families program provides low cost health, dental and vision coverage to uninsured California childred in low wage families. Families pay premiums of between $4-$9 per month per child (maximum of $27 per family) to participate in the program.

Call Healthy Families at 1-800-880-5305

Access for Infants and Monthers (AIM)
The AIM Program is low-cost health care coverage for pregnant women and their newborns. It has been designed for families in the middle income bracket who don't have health insurance and whose income is too high to qualify for no-cost Medi-Cal. AIM is also available to those who have health insurance, but only if the deductible or copayment specifically for maternity services is more than $500.

Call AIM at 1-800-433-2611

CaliforniaKids Healthcare Foundation
CaliforniaKids Healthcare Foundation was founded in 1992 with the mission to provide uninsured children access to basic health care services.

CaliforniaKids is an independent non-profit organization that provides premium-subsidized, comprehensive primary health care services to children ages 2 through 18.
CaliforniaKids is a broad-based community program partnering with corporations, private industry, foundations, health care providers, and community organizations.
CaliforniaKids has served more than 57, 000 children who are not eligible for government-sponsored health care programs and whose parents cannot afford the cost of private medical insurance. These 57,000 children were provided with access to the basic health care services they deserve.

The monthly cost is $20-$35 per child, depending on family income. Co-payments are $5-$15 depending on the service provided by CaliforniaKids.

Kaiser Permanente Cares For Kids Health Plan - 1
1-800-255-5053
Kaiser Permanente Cares For Kids Health Plan provides low-cost health care coverage for uninsured children who are not eligible for no-cost Medi-Cal or Healthy Families. This program covers children under age 19 who live within Kaiser Permanente's California service areas. Cost is $15 per child per month. Co-payments range from $5-$10 for some services. There are no co-payments for prenatal care, well-baby care immunizations, and all lab tests.

Kaiser Permanente Cares For Kids Health Plan - 2
Child Health Plan 2 offers high quality Kaiser Permanente health care coverage as well as optical and dental coverage to low income children not eligible for Medi-Cal or Healthy Families because of their immigration status. Eligible children must live in a certain part of Southeast Los Angeles County.

Who is eligible?
Uninsured children birth up to age 19 who are not eligible for other public programs because of their immigration status and whose primary income falls below 250% Federal Poverty Level (below $46,000 for a family of four). Children must live in certain areas of Southeast Los Angeles County.

What are the benefits?
Health, optical and dental care services.

Child Health Disability and Prevention Program
916-327-1400
Provides preventive health assessments to eligible infants, children and youth. Serves not only children with obvious health problems, but also children who seem well.

Who is eligible?
Children 0 to age 19 (not receiving full-scope Medi-Cal), up to 200% FPL. Applicants are not asked to provide Social Security numbers or immigration status information.
Children 0 to age 21 (receiving Medi-Cal).

What are the benefits?
Routine physical check-ups:
Growth and development check; all needed shots; dental, vision and hearing screenings; nutrition check-up; health education; and tests for anemia, blood lead, urine, TB and others as needed.
Necessary follow-up treatments for medical conditions identified in the CHDP screen.
Hospitalizations are not covered.
How much does it cost?
All services are provided at no cost.
To apply...

Call the CHDP program in your local health department for more information on how and where to apply or call the California Department of Health Services at 916-327-1400.

Medi-Cal for Children
1-800-880-5305
Provides comprehensive health insurance for low-income children in California.
Who is eligible?
Children from birth up to age 21.
U.S. Citizen, legal resident and certain other immigrants may receive full-scope Medi-Cal.*
California Resident.

Children who meet the following income eligibility levels:
Birth up to 1: up to 200% FPL
Age 1 up to 6: up to 133% FPL
Age 6 up to 19: up to 100% FPL
Age 19 up to 21: up to 92% FPL

Resources such as property and cars do not count for children and pregnant women who are eligible for No-Cost Medi-Cal. They also do not need to complete a personal interview and can mail in their application. Families can also claim income deductions, such as child care and work-related expenses. Even children who already have insurance can enroll in Medi-Cal to get services not provided by their current insurance.

*Undocumented and certain other immigrants at this point may still get 'restricted' Medi-Cal for emergency and pregnancy-related services.

What are the benefits?
Full-scope Medi-Cal covers:
Comprehensive health, dental and vision services.
Children have a right to all care a doctor says they need, including needed mental health and substance abuse services. Minor Consent, or Sensitive Services provides treatment for sexually transmitted infections, drug and alcohol abuse, sexual assault, family planning, pregnancy and pregnancy-related services. Parental consent is not required.

How much does it cost?
FREE:
No monthly premiums.
No monthly co-payments.
What's NEW about Medi-Cal?

Low-income parents with children qualify for No-Cost Medi-Cal. Eligible parents must have incomes below 100% of poverty. Parents may also own assets which are counted based on family size ($3,000 for a family of one to two; add $150 for each additional family member). For more information or to apply, parents should contact their local welfare office.
Med-Cal applicants can apply by mail using a simplified application.

To apply:
Call, toll-free, 1-888-747-1222 for a mail-in application for children, their parents and pregnant women who qualify for No-Cost Medi-Cal and to find an organization in your neighborhood who can help you apply. A family may also apply at the local welfare office for both children and adults.

California Children's Services (CCS)
916-327-1400
Provides treatment and case management services for children under 21 years of age with serious medical problems such as chronic illnesses, genetic diseases, physical handicaps, major injuries due to violence and accidents, congenital defects, and conditions requiring treatment in neonatal intensive care units.

Who is eligible?
Children who have chronic and/or serious health problems.
Children up to age 21.
Residents of the county in which services are sought.
Adjusted gross family income below $40,000; or out-of-pocket health care expenses of 20% of family income or more.
What are the benefits?
Physician care, hospitalizations, laboratory services, x-rays, rehabilitation services, medications and medical supplies, durable medical equipment and case-management.
How much does it cost?
Complete coverage of cost except for initial enrollment or assessment fee.
To apply...
Call your local county health department for more information on how and where to apply or call the California Department of Health Services at 916-327-1400.

California Medi-Cal
Medi-Cal is California's Medicaid health care program. The program pays for a variety of medical services for children and adults with limited income resources.
Medi-Cal is supported by federal and state taxes. You can apply for Medi-Cal benefits regardless of sex, race, religion, color, national origin, sexual orientation, marital status, age, disability, or veteran status. If you are found (or determined) eligible, you can continue to get Medi-Cal as long as you continue to meet the eligibility requirements.
You may automatically be eligible for Medi-Cal if you receive cash assistance under one of the following programs:
SSI/SSP (Supplemental Security Income/State Supplemental Program)
CalWORKs (California Work Opportunity and Responsibility to Kids). Previously called Aid to Families with Dependent Children (AFDC).
Refugee Assistance
Foster Care or Adoption Assistance Program.
Even if you don’t receive cash assistance, you may be eligible for Medi-Cal if you are one of the following:
65 or older
Blind
Disabled
Under 21
Pregnant
Diagnosed with breast or cervical cancer
In a skilled nursing or intermediate care facility.
Refugee status during a limited period of eligibility. Adult refugees may or may not be eligible depending upon how long they have been in the U.S.
Parent or caretaker relative of a child under 21 and
The child’s parent is deceased or doesn’t live with the child, or
The child’s parent is incapacitated, or
The child’s parent who is the primary wage earner is unemployed or underemployed.

Family Pact
1-800-942-1054
Provides comprehensive family planning services to low-income men and women in California.
Who is eligible?
California residents with a family income at or below 200% FPL (*Almost all teens living in California can be served under this program because income is determined based on the teen as a family of one, and even insured teens are eligible if they must keep care confidential).
No other family planning health insurance.
What are the benefits?
Contraceptive methods
Emergency Contraception
STI testing and treatment
Pregnancy testing and counseling
Sterilization
HIV testing
Hepatitis B immunization
Limited male and female cancer screening
Education and counseling
How much does it cost?
Co-payments for services range between $0 and $5, depending on the student’s income.
To apply…
To find a Family PACT provider in your area, you may call, toll-free, 1-800-942-1054.

Indian Health Program
916-930-3945
Provides no-cost comprehensive health insurance for Native American children in California.
Who is eligible?
Children with documentation of Native American tribal membership.
What are the benefits?
Comprehensive health care
Vision care
Dental care
Other services, depending on local Indian Health program
How much does it cost?
All services are free.
To apply…
Call your local county health department for more information on how and where to apply or call the California Area Indian Health Service at 916-930-3945.
You may also visit the California Area Indian Health Service Web site, which includes a listing of all local Indian Health programs.

Vision Service Plan (VSP) - Sight For Students
Program
1-888-290-4964
Provides free eye exams and glasses for uninsured children across the country. May also include vision therapy, surgery and contacts if medically necessary as determined by a VSP contracted eye doctor.
Who is eligible?
Child is 18 years or younger (Children who are 18 years old must be attending high school.)
Child is not enrolled in Medi-Cal or any other vision insurance plan.
Child or parent is U.S. citizen or resident alien with a social security number.
Child has not used the program in the last 12 months.
Family income is below 200% FPL ($36,800 for a family of four).
What are the benefits?
Comprehensive eye exam.
Glasses, including the following as prescribed by a VSP contracted doctor: oversize lens, polycarbonate, high index, photochronic, ultra violet protection, solid tints and dyes, plastic gradient dye, scratch resistant coating, color coating, edge treatments, vision therapy if medically necessary for the patient's visual welfare, low vision, and contacts if medically necessary for the patient's visual welfare.
How much does it cost?
FREE:
No premiums.
No co-payments.
To apply...
Call toll-free, 1-888-290-4964.

County-Based Programs For Children Ineligile for Medi-Cal or Healthy Families

Alameda Alliance for Health - Family Care Program
Alameda County
1-877-371-2222
Provides low cost comprehensive health care coverage for middle-income uninsured children resident in Alameda County.
Who is eligible?
All children who are:
Under age 19
Uninsured
Residents of Alameda County
Families that earn between 250% and 300% of FPL (between $46,000 and $55,200 for a family of four), regardless of immigration status.
What are the benefits?
Complete medical coverage including preventive check up
Specialist care
Inpatient and outpatient hospital services
Mental health care
Alcohol & drug treatment
Vision care
Dental care
Prescription coverage
A 24-hour nurse advice line
Health education and many other services
How much does it cost?
Premiums: paid every month.
$10 per child.
Co-payments:
$5-$10 co-payment for most visits, services and prescriptions
No co-payments for preventive services (like immunizations)
To apply...
Call, toll-free, 1-877-371-2222 and state your interest in the Family Care program. This line is open between 8:00 A.M. and 6:00 P.M., Monday – Friday.
Inland Empire Health Plan County Healthy Kids Program Riverside County
1-866-294-IEHP (4347)
Provides low cost comprehensive health care coverage for low- to middle-income uninsured children who live in Riverside County.
Who is eligible?
All children who are:
Under age 19
Uninsured
Residents of Riverside county for the last 90 continuous days
Families earn 250% FPL or less and
Ineligible for public/private programs, such as Medi-Cal or Healthy Families
What are the benefits?
Comprehensive medical coverage including preventive check up
Specialist care
Inpatient and outpatient hospital services
Mental health care services
Vision care
Dental care
Alcohol/drug abuse services
Prescription coverage
After hours nurse advice line
Health education and many other services
How much does it cost?
Premiums:
No monthly premiums
Enrollees pay an annual application processing fee of either $5 or $20 per family (depending on provider chosen)
Co-payments:
$5 for most visits, services and prescriptions
No co-payments for preventive services (like immunizations)
To apply...
Call Inland Empire Health Plan, toll-free, at 1-866-294-IEHP (4347) and state your interest in the Healthy Kids program. This line is open between 8:00 A.M. and 6:00 P.M., Monday – Thursday and between 8:00 A.M. and 5:00 P.M on Friday.
SacAdvantage Program
Sacramento County
1-877-735-5742
SacAdvantage is a partnership between the County of Sacramento and PacAdvantage that provides small businesses located in Sacramento county subsidies to help employers and employees pay for health care.
What companies are eligible for SacAdvantage?
Small businesses with between 2 and 50 employees
In business for at least 12 months
Have not offered coverage for the previous 12 months
Families earn less than 300% FPL (less than $55,200 for a family of four)
Business is headquartered, and primarily conducted in Sacramento County
What employees and dependents are eligible for SacAdvantage?
Employees and dependents must be uninsured for at least six months.
Employees must be employed full time (>30 hours per week) by their company
Employees must make less than 300% FPL
Employees and dependents must be ineligible for alternate sources of insurance (Medi-Cal, Healthy Families, etc.
What are the benefits?
Complete medical coverage, including all preventive care
Dental care
Vision care
Immunizations
Prescriptions
Hospital care
How much does it cost?
Premiums: Paid every month.
$22 per child per month
Co-payments:
$5 for most visits, services and prescriptions
No co-payments for preventive services (like immunizations)
To join:
Call your local Sacramento County health agent or broker or call PacAdvantage at 877-735-5742. You can also call the SacAdvantage office at 916-876-5825.
San Francisco County Healthy Kids Program
San Francisco County
415-777-9992
Provides low cost comprehensive health care coverage for low- to middle-income uninsured children resident in San Francisco County.
Who is eligible?
All children who are:
Under age 19
Uninsured
Residents of San Francisco County
Families earn less than 300% FPL ($55,200 for a family of four)
Ineligible for Medi-Cal and Healthy Families
What are the benefits?
Complete medical coverage, including all preventive care
Dental care
Vision care
Immunizations
Prescriptions
Hospital care
Mental health services
Substance abuse treatment
Exams for school and sports
How much does it cost?
Premiums: paid every month.
$4 per child per month.
Co-payments:
$5 for most visits, services and prescriptions
No co-payments for preventive services (like immunizations)
To apply...
Call 415-777-9992 to apply. This line is open between 8:00 A.M. and 6:00 P.M., Monday – Friday.

San Mateo Children's Health Initiative
San Mateo County
650-573-3595
Provides low cost comprehensive health care coverage for low- to middle-income uninsured children resident in San Mateo County.
Who is eligible?
All children who are:
Under age 19;
Uninsured;
Residents of San Mateo County;
Families earn 400% FPL ($73,600 for a family of four) or less; and
Ineligible for Medi-Cal and Healthy Families.
What are the benefits?
Complete medical coverage including preventive check up
Vision care
Dental care
Prescription coverage
How much does it cost?
Premiums:
Paid every month.
$4 to $20 per child per month, depending on income. These payments are made on a quarterly basis.
Co-payments:
$5 for most visits, services and prescriptions.
No co-payments for preventive services (like immunizations)
To apply...
Call 650-573-3595 and state your interest in the Children’s Health Initiative program. This line is open between 8:30 A.M. and 5:00 P.M., Monday to Friday.
Santa Clara County Healthy Kids Program
Santa Clara County
1-888-244-5222
Provides low cost comprehensive health care coverage for low- to middle-income uninsured children resident in Santa Clara County.
Who is eligible?
All children who are:
Under age 19
Uninsured
Residents of Santa Clara County
Families earn 300% FPL ($55,200 for a family of four) or less, and
Ineligible for Medi-Cal and Healthy Families
What are the benefits?
Complete medical coverage including preventive check up
Specialist care
Inpatient and outpatient hospital services
Mental health care
Alcohol & drug treatment
Vision care
Dental care
Prescription coverage
A 24-hour nurse advice line
Health education and many other services
How much does it cost?
Premiums: paid every month.
$4 to $6 per child. Monthly premium determined by family income. Maximum monthly contributions range from $12- $18 regardless of how many children enroll in the program.
Co-payments:
$5 for most visits, services and prescriptions
No co-payments for preventive services (like immunizations)
To apply...
Call, toll-free, 1-888-244-5222 and state your interest in the Healthy Kids program. This line is open between 7:30 A.M. and 5:00 P.M., Monday – Friday.