Healthcare Systems for Children

1. Healthcare Systemsfor Children

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

3. 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

4. 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

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

6. 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)

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

8. 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

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

10. Eligibility for Medi-Cal • Income • Few resources • United States Citizen or documented resident

11. 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

12. 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

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

14. Eligibility for Denti-Cal • Eligible for Medi-Cal • Over age 3

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

16. 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

17. 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.

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

19. 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 250%

20. 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

21. 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

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

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

24. 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.

25. 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

26. 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

27. 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

28. 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

29. 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).

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

31. Children’s Programs for Special Populations

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

33. 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

34. 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

35. 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

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

37. 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.

38. 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.

39. Mental Health Programs • Care can include • therapy, • medication, • hospitalization and • other services

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

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

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

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

44. Other related programs for children

45. 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)

46. Residual Program • helps pay for services to help children remainsafely 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

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

48. 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.

49. 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

50. 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