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California Department of Healthcare Services

Find out if I Qualify

You may enroll with GHPP if you are:

Diagnosed with a genetic condition that is covered by GHPP

A resident of California

Financial Eligiblity

Age Criteria

Other Insurance

 

Medical Eligibility

The GHPP covers genetic conditions specified in the California Code of Regulations (CCR), Title 17, Section 2932. There is a specific list of genetic conditions that are eligible for GHPP enrollment.  View the complete list of GHPP eligible conditions.

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Residential Eligibility

Applicants must be residents of California. Proof of California residency includes any of the following:

  • California Driver’s License or California State Identification Card
  • Voter’s Registration
  • Rental Agreement (if you are renting an apartment, house or room)
  • Utility bill statements such as PG&E, telephone, and Sacramento Munincipal Utility District (SMUD)
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Financial Eligibility

There is no income limit for GHPP eligibility. However, applicant may be required to apply for Medi-Cal. Some clients may also be required to pay an annual enrollment fee to GHPP. The amount of enrollment fee is based on income and family size.

 

The GHPP will require you to submit the following financial information:

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
  • If you are living with one parent, a copy of 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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Age Criteria

Applicants must be 21 years of age or older. Persons younger than 21 years of age must

  • Apply first to California Children’s Services
  • Submit a financial eligibility denial from CCS
  • Submit proof showing out of pocket expenses are less than 20% of family income

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Other Insurance

A. Health Maintenance Organization (HMO)

Clients with HMO insurance may apply for GHPP benefits. However, the GHPP will only cover limited services such as:

    1. Annual outpatient Special Care Center assessments, evaluations, and case conferences
    2. Services that are not a covered benefit by the HMO. A written denial from the HMO is required. The denial must assert that the service is a non-benefit. A claims denial for other reasons will not be accepted.
    3. The GHPP does not pay for your HMO co-pay and premium

Please submit a copy of your HMO benefit booklet together with your application.

 

B. Preferred Provider Organization (PPO)

Clients with PPO insurance may apply for GHPP benefits. However, the PPO must be billed first before the GHPP.

    1. If you have a PPO, you must obtain prior authorization from the GHPP. The GHPP will not pay for services that are not prior authorized.
    2. GHPP does not pay for your PPO co-pay or premium. 

Please submit a copy of your PPO benefit booklet together with your GHPP application.

 

C. Medicare A and B

Clients with Medicare A and B may apply for GHPP benefits. However, the Medicare Part A or Part B must be billed first before the GHPP.

    1. If you have Medicare A and B, you must obtain prior authorization from the GHPP. The GHPP will not pay for services that are not prior authorized.
    2. GHPP does not pay for your Medicare co-pay or premium.
    3. Frequently Asked Questions - Medicare Part D

D. Medi-Cal

Clients with Medi-Cal may apply for GHPP benefits. Medi-Cal clients, including those enrolled in a Medi-Cal Managed Care plan, will receive the same services they are receiving from Medi-Cal in addition to the services available through the GHPP. Example of an additional service is Special Care Center services. Once the Medi-Cal clients are enrolled into this program, GHPP will case manage their case.

  

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