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1. How do I make sure my child keeps his/her health and dental coverage while still in HFP?
Answer: Until you receive a letter telling you your child’s coverage has moved to Medi-Cal, your child will continue to receive his/her medical, dental, mental health, substance use disorder, and vision care through HFP. To make sure you do not have a break in coverage, please continue to pay your monthly HFP premiums, respond to your Annual Eligibility Review notice, and notify HFP of any address or phone number changes. For changes to address and phone number, please call 1-866-848-9166.
2. Will my child lose benefits when he/she turns 19 years old?
Answer: If your child has moved to the Medi-Cal program, when he/she turns 19 years old, a redetermination will be made to see if he/she qualifies for a different Medi-Cal program that covers children up to 21 years old.
3. What happens if my income changes?
Answer: If your child transitioned from HFP to Medi-Cal and your income changed, you need to report the change to your county eligibility worker within ten (10) days. To report changes online, register at www.benefitscal.com.
4. What will happen to my premium?
Answer: If you now make a premium payment to HFP, after your child moves to Medi-Cal your premium may stay the same, decrease, or go away. You must keep paying your premiums for now. Watch your mail for more information on your premiums.
5. What will happen to the premiums I paid in advance to HFP?
Answer: If you prepaid, your premiums will be reimbursed for the months you are no longer in a HFP plan.
6. What if my premiums were prepaid by a sponsor? Can the payments be transferred from HFP to Medi-Cal?
Answer: No. The prepaid premiums will be reimbursed to your sponsor. If your sponsor would like to continue sponsoring you, they will need to re-enroll with DHCS once a process is developed in August of 2013. Please contact the Premium Payment Section at 1-800-880-5305 Monday – Friday 8 a.m. through 8 p.m. or Saturday 8 a.m. through 5 p.m. for when you can re- enroll as a sponsor.
7. Will premium amounts in HFP differ from Medi-Cal?
Answer: Yes, the premium amounts in Medi-Cal are different from the current premium amounts in HFP.
8. What are the premium amounts in Medi-Cal?
Answer: There are no premiums for children with family incomes up to 150 percent of the Federal Poverty Level (FPL) ($2,442/month for a family of three, after taking into consideration applicable income deductions and disregards). For children with incomes above 150 percent of FPL, up to and including 250 percent of FPL ($4,069/month for a family of three, after taking into consideration applicable income deductions and disregards), the monthly premium amount in Medi-Cal will be $13 per child up to a maximum of $39 for a family with three or more children. FPL amounts are updated every April.
9. How can premiums be paid? Will the same payment methods (e.g. mail, phone/online, in person, or electronic fund transfer [EFT]) be available for premium payment under Medi-Cal?
Answer: Medi-Cal offers the same premium payment methods and discounts as were available under HFP. Please click on the link to the DHCS website for information on premium payment methods and how to enroll: http://www.dhcs.ca.gov/services/Pages/Medi-CalPremiumPayments.aspx or call 1-800-880-5305, Monday – Friday 8 a.m. through 8 p.m. or Saturday 8 a.m. through 5 p.m. for more information.
10. What happens if I do not pay my premiums each month?
Answer: If you do not pay your premiums for 2 months in a row, your county worker will review your case to determine if you qualify for another Medi-Cal program. If you do not qualify for another Medi-Cal program, and you have not paid your overdue premiums, you will receive a Notice of Action (NOA) stating your child’s Medi-Cal may be discontinued.
11. Will my child’s annual review date change after he/she transitions from HFP to Medi-Cal?
Answer: No, the annual review date for your child will not change. When it is time for your child’s annual review, you will receive forms from Medi-Cal to review, sign, and send back by a specific date.
12. In the past my child was referred to HFP because our income was too high for no-cost Medi-Cal and we had a high share-of-cost (SOC). What has changed to now allow my child to be in Medi-Cal without a SOC?
Answer: Medi-Cal has expanded its program by including children up to the age of 19 with family income up to and including 250 percent FPL, also known as the Optional Targeted Low Income Children’s program (OTLICP). There are no asset limits for these children in OTLICP. As a result, it has allowed children, who were previously referred to HFP, to now be served by Medi-Cal. In some instances, children may be required to pay premiums. (See #8 above - What are the premium amounts in
13. If a child is currently covered by HFP and has a SOC under Medi-Cal, does the SOC continue after he/she transitions to Medi-Cal?
Answer: After the child transitions to Medi-Cal, the child will be covered by Medi-Cal using the HFP determination and will not have a SOC for Medi-Cal until the child’s family reports a change in circumstances, at the child’s annual eligibility review date, or the child’s 19th birthday. At that time, the Medi-Cal program determines the child’s eligibility for all Medi-Cal programs with and without SOC.
14. How does a parent’s immigration status affect a child’s Medi-Cal eligibility?
Answer: The parent’s immigration status does not impact the child’s Medi-Cal eligibility, when only the child is applying for Medi-Cal eligibility. Immigration status is required only for the individual applying for Medi-Cal coverage.
15. Will Medi-Cal adopt HFP’s rule to enable a parent to apply for the child despite the parent not living in the home with the child?
Answer: Medi-Cal allows anyone to submit an application for a child with a need for Medi-Cal coverage. However, consistent with current policy, when the application is signed by the parent not living in the home (non-custodial parent), the county has to obtain a statement of facts signed by the custodial parent that provides information about the custodial parent’s household. The date of application would be the date that the application was received from the non-custodial parent. Medi-Cal eligibility is based on the circumstances of the custodial parent who has care and control of the child. It is the custodial parent who will receive the benefits and notices for the children once the application is processed by the county. If the county does not receive the signed application from the custodial parent, a denial notice is sent to the non-custodial parent.
16. What is Presumptive Eligibility (PE) and are premiums charged during PE?
Answer: PE is temporary full-scope Medi-Cal benefits provided to children under age 19, while the county makes a complete Medi-Cal determination. PE is determined by a qualified provider for children who meet screening criteria based on family size and income. Medi-Cal premiums are not required during the PE coverage time because the county has not yet made a final Medi-Cal eligibility determination. PE is also referred to as Accelerated Enrollment (AE). AE may be granted by the Single Point of Entry (SPE) for children whose application is submitted to the SPE for initial screening and not directly to a county office for processing.
17. Will Medi-Cal’s application process and documentation requirements stay the same for the new the OTLICP? Please note: the OTLICP is the new Medi-Cal program that was created to provide coverage to children who were previously eligible for HFP.
Answer: There will be no changes to the application process and documentation requirements for the OTLICP.
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