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GHPP Frequently Asked Questions for Clients 

  1. What is GHPP?
  2. Where is GHPP located?
  3. What are the GHPP eligible conditions?
  4. Who can apply for GHPP?
  5. Can I apply for GHPP if I am not 21 years old?
  6. How do I get referred to GHPP?
  7. Does GHPP have an income limitation for eligibility?
  8. What services will I receive from GHPP if I decide to enroll in the program?
  9. Can I appeal if my application to GHPP is denied because my condition is not eligible for the program?
  10. What proof will I need to submit to establish that I am a California resident?
  11. Can I apply to GHPP if I have private insurance?
  12. What type of financial information will I need to submit to GHPP?
  13. Does GHPP provide coverage if I travel out of state/out of country?
  14. What do I do if I want to change my Special Care Center or pharmacy?
  15. My private insurance is terminated. What do I do?
  16. I changed my name (due to marriage) or changed my address what do I do?
  17. How can I dis-enroll from the GHPP?
  18. How can I find a GHPP dental provider?
  19. Do I have to apply to the GHPP every year?
  20. What are the GHPP program requirements after my initial enrollment?
  21. Can GHPP pay for my Medi-Cal share of cost, insurance co-pay or insurance premium?
  22. How do I re-open my case?
  23. Can I appeal my enrollment fee?
  24. Does GHPP accept faxed application?
  25. Can I choose my own Primary Care Physician (PCP)?
  26. Can I self refer to a specialist?
  27. Medicare Part D

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1. What is GHPP?

GHPP stands for Genetically Handicapped Persons Program. It is a statewide program that provides health coverage for Californians primarily 21 years of age and older who have specific genetic diseases.

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2. Where is GHPP located?

The GHPP main office is located in Sacramento, California. GHPP has no county involvement.

The mailing address for GHPP is:

  • Genetically Handicapped Persons Program
    MS 8100, P.O. Box 997413
    Sacramento, CA 95899-7413

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3. What are the GHPP eligible conditions?

The GHPP eligible conditions include:

  • cystic fibrosis
  • hemophilia
  • sickle cell disease
  • thalassemias
  • certain neurological diseases
  • certain metabolic diseases

View the complete list of medical conditions eligible for GHPP.

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4. Who can apply for GHPP?

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5. Can I apply for GHPP if I am not 21 years old?

Yes, you can apply for GHPP. However you must apply first for California Children’s Services.

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6. How do I get referred to GHPP?

Clients are referred to the GHPP by:

  • Doctors
  • Nurses
  • Social Workers
  • Relatives
  • Patient Advocates
  • You can also self refer

Please call GHPP at 1-800-639-0597 if you want to refer yourself or refer a person who has a GHPP eligible condition.

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7. Does GHPP have an income limitation for eligibility?

There is no income limitation. However, some clients may pay a yearly enrollment fee. The enrollment fee is based on the client’s income and family size.

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8. What services will I receive from GHPP if I decide to enroll in the program?

If you are enrolled with GHPP, this program may help you pay for:

  • Doctor visits, hospital stays, surgeries, and organ transplants
  • Medicines, nutrition products, and medical foods (for clients with metabolic problems)
  • Physical therapy, occupational therapy, and home health nurse visits
  • Medical equipments and medical supplies
  • Other services such as dental services, ambulance services, and mental health services

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9. Can I appeal if my application to GHPP is denied because my condition is not eligible for the program?

Yes, you may appeal the GHPP denial.  If you are going to appeal the denial, fax or mail to the GHPP the following:

a. A letter of appeal

b. Medical reports showing that you have a GHPP eligible genetic disease

c. A copy of a DNA test result showing that you have a GHPP eligible genetic disease (if available)

Please note that GHPP has a very specific list of eligible genetic diseases, which means NOT all genetic conditions qualify for GHPP enrollment.

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10. What proof will I need to submit to establish that I am a California resident?

Proof of California residency includes any of the following:

a. California Driver’s License or California State Identification Card

b. Voter Registration form

c. Rental Agreement (if you are renting an apartment, house or room)

d. Utility bill statements such as PG&E, Telephone, and SMUD

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11. Can I apply to GHPP if I have private insurance?

Yes, you can apply for GHPP. However, if you have health coverage through a HMO, GHPP will only pay for the Special Care Center yearly assessment. GHPP is also the payer of last resort which means that your commercial insurance or other health insurance must be billed first before GHPP.

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12. What type of financial information will I need to submit to GHPP?

Financial information may include any of the following:

a. Copy of the 1040 taxes of the previous calendar year

b. Copy of the 540 taxes of the previous calendar year

c. If you were a dependent on your parent’s previous year’s tax return, you must submit the following:

  • Joint income taxes of both parents or if you are living with one parent, a copy of the income tax return of the parent that claimed you as a dependent.

d. If you had no source of income for the previous year, you must submit the following:

  • A letter stating what finances you lived on; for example include the dollar amount that you received for transportation, housing, and food expenses.
  • The letter must be notarized.

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13. Does GHPP provide coverage if I travel out of state/out of country?

No. GHPP will only pay for services that are rendered inside the state of California.

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14. What do I do if I want to change my Special Care Center or pharmacy?

  • Please call the GHPP at 1-800-639-0597 and inform your case manager that you want to change your pharmacy or Special Care Center.
  • If you have hemophilia and want to change your home care pharmacy, you must submit a letter of intent that you want to change your home care pharmacy.
  • GHPP recommends that you limit changing your Special Care Center and other providers to prevent disruption of services that you receive through GHPP.

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15. My private insurance is terminated. What do I do?

If you lose your private insurance, you must do the following:

  • Call the GHPP at 1-800-639-0597 and inform your case manager that your private insurance is terminated.
  • Mail or fax to the GHPP the termination letter from your private insurance.

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16. I changed my name (due to marriage) or changed my address what do I do?

  • Please call the GHPP at 1-800-639-0597 and inform your case manager that your name or address has changed so your record can be updated
  • Mail or fax to the GHPP a copy of your marriage certificate (if you change your name through marriage), a divorce paper,  or a court document indicating that you changed your legal name

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17. How can I dis-enroll from the GHPP?

If you think that GHPP is not adding value to your care, you may dis-enroll from the program at any time.

  • Write a letter to the GHPP that you are dis-enrolling from the program
  • Mail or fax the letter to the GHPP

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18. How can I find a GHPP dental provider?

The best way to find a dental provider in your area is to talk to the Special Care Center Coordinator or Social Worker. They usually have the list of resources that are close to your home. Your dental provider must be a Denti-Cal provider or a Medi-Cal provider. To find a Denti-Cal provider, please visit the Denti-Cal website.

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19. Do I have to apply to the GHPP every year?

Yes. GHPP is a voluntary program. You must complete a yearly enrollment application in order for the GHPP to continue to provide services. The GHPP will send an application packet 1-2 months before the due date of your re-enrollment. If you do not receive the application one week before the due date, please call the GHPP at 1-800-639-0597.

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20. What are the GHPP program requirements after my initial enrollment?

In addition to completing the residential, medical, and financial requirements, you must also do the following to keep your case open to the GHPP:

a. Complete the annual GHPP application

b. Provide proof of your yearly assessment and evaluation from your Special Care Center.

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21. Can GHPP pay for my Medi-Cal share of cost, insurance co-pay or insurance premium?

NO. GHPP can not pay for Medi-Cal share of cost, co-payments or insurance premium.

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22. How do I re-open my case?

In order to re-open your case if it has been closed because you did not meet any or all of the GHPP program requirements, you must complete the program requirements that you failed to meet.

 

Example:

a. Your case is closed because of not paying the enrollment fee. You must pay first the unpaid enrollment fee before the GHPP can send an application to re-open your case.

b. Your case is closed because of not completing your annual Special Care Center (SCC) assessment and evaluation. You must send proof that your annual SCC evaluation was completed or a copy of your appointment information before the GHPP can re-open your case.

c. Your case is closed because of not completing and returning your annual GHPP enrollment application. You must return the completed application before the GHPP can re-open your case.

d. Your case is closed because you moved out of California. You must complete a new GHPP application and provide proof of California residency (see question # 10) in order for the GHPP to re-open your case.

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23. Can I appeal my enrollment fee?

Yes, you can appeal the enrollment fee. To appeal the enrollment fee, you must do the following:

  • Call the GHPP at 1-800-639-0597 and ask for the Staff Service Analyst (SSA), who will tell you what information you need to submit.
  • Complete the enrollment fee appeal letter together with the information you need to submit and mail it back to the GHPP  
  • The GHPP will review the appeal letter. You will be notified if the appeal has been approved or not.

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24. Does GHPP accept faxed application?

No. You must submit/mail the application with your original signature.

However, you can fax documents that relate to your financial information, residential eligibility, and proof of other health coverage such as:

  • Copy of your income taxes
  • California ID or California Driver’s License
  • Utility bill statements
  • Health insurance card
  •  

The GHPP fax number is:

  • 916-440-5318
  •  

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25. Can I choose my own Primary Care Physician (PCP)?

Yes. However, the PCP must be a Medi-Cal Provider/NPI and willing to accept Medi-Cal rate for payment. Inform your PCP that you have GHPP and must obtain prior authorization. Your PCP must also coordinate the care with your Special Care Center. Please indicate in your application your PCP’s name, address, and telephone number. If you change your PCP, please call the GHPP at 1-800-639-0597 to update your records.

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26. Can I self refer to a specialist?

 

No. The referral must come from your Special Care Center (SCC) or PCP. If you think that you need to see a specialist, contact your SCC physician or nurse coordinator to obtain a referral. The specialist must be a Medi-Cal Provider and willing to accept Medi-Cal rate for payment and must coordinate the care with your SCC and PCP.

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Last modified on: 6/19/2013 9:05 AM