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California Department of Healthcare Services

Know the Benefits 

The GHPP provides complete services to its clients. Unlike other programs, the GHPP covers services even it is not related for the treatment of the GHPP eligible medical condition. The approval of these services is subject for individual review based on medical need.

GHPP services include the following:

 

Special Care Center (SCC) Service

The GHPP Special Care Centers are a system that:
  • Provides coordinated care to clients with specific genetic conditions
  • Multi-disciplinary and multi-specialty teams which consists of doctors, nurses, social workers, and other health team members
  • Provides family centered planning
  • Facilitates timely and appropriate care

The GHPP SCCs are located throughout California and usually connected with tertiary level medical centers. Each SCC must comply with the GHPP program standards to become an approved provider.

The  GHPP Special Care Centers consist of:

 

Hospital Stay

An acute hospital stay is a benefit of the GHPP. Continued authorization of hospital stay is subject for review. However, the following admission will not be covered by the GHPP:
  • Sub acute facility admission
  • Skilled nursing home admission
  • Intermediate care facility admission

 

Outpatient Medical Care

Outpatient medical care services consist of:

  • Primary care physicians (PCPs)
  • Specialty physicians such as cardiologists, endocrinologists, orthopedists
  • Infusion centers
  • Transfusion centers, such as for blood transfusions
  • Diagnostic Centers, such as X-ray, MRI, etc

These services must be coordinated with the client’s special care center. With the exception of the PCP, all other services must have a referral submitted by the Special Care Center. The provider of the outpatient care must have a  Medi-Cal provider ID number.

 

Pharmaceutical services

Pharmaceutical benefits include the following:

  • Medications prescribed by your doctor (Oral, topical, Subcutaneous, etc)

  • Home infusion therapy, such as intravenous antibiotics

Certain medications are not covered by the GHPP such as:

  • Certain over the counter medications such as multivitamins

  • Herbal Supplements

  • Medications not approved by the Food and Drug Administration

  • Medications that are not included in the Medi-Cal formulary

  • Some of the medications if you are enrolled with Medicare Part D 

If you are enrolled with Medicare Part D, you lose your drug coverage through the GHPP.  Medicare Part D Frequently Asked Questions

 

Surgeries

Surgeries include:

  • In-patient surgeries, such as hip repair

  • Out-patient surgeries, such as cyst removal

  • Organ transplants, such as a lung transplant

Approval for surgery will be reviewed individually for medical necessity. The GHPP may not cover a surgery if there is no documented medical need.

 

Nutrition Products and Medical Foods

Approval of nutrition products is based on criteria of which all must be met first before these products are authorized.

Nutrition products include:

  • Replacement formulas/products, such as Phenex-2, Phenyl Free-1

  • Elemental formulas, such as Peptamen Jr

  • Calorie dense products, such as Ensure, Boost plus, Two Cal HN

  • Nutrition additives, such as Polycose, MCT oils, Duocal 

  •  Medical foods, such as low protein foods

Metabolic formula and medical foods are only a benefit for clients with a metabolic disorder.

 

Durable Medical Equipments (DMEs)

GHPP benefits includes the rental, repair, or purchase of durable medical equipments. Example of DME’s include:

  • Home oxygen delivery, such as oxygen concentrator, portable tanks

  • Medical DME, such as portable commode, feeding pumps, Intrapulmonary Percussive Ventilator machines

  • Rehab DME, such as wheelchairs, scooters

  • Orthotics such as Ankle Foot Orthosis

Each DME has different criteria for approval.  The provider of the DME must have a Medi-Cal provider ID number.

 

Other Services

Other services that are covered by the GHPP are:

  • Home health services, such as skilled nursing visits

  • Therapy services, such as Physical Therapy, Occupational Therapy, and Speech Therapy

  • Mental health services, such as psychotherapy counseling

  • Medical supplies, such as insulin syringes, diapers, etc.

These services also have criteria to be followed for approval.  The provider of these services must have a Medi-Cal provider ID number.

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