1 HEALTHY FAMILIES PROGRAM TO MEDI-CAL TRANSITION . FREQUENTLY ASKED QUESTIONS. These Frequently Asked Questions (FAQs) are meant for use by a general audience and will be updated periodically. FAQs targeted for FAMILIES are incorporated into notices that the Department of Health care Services (DHCS) sends out to them in preparation for their TRANSITION to MEDI-CAL . These notices, FAQs, and a benefit comparison chart can be found on the DHCS HEALTHY FAMILIES PROGRAM (HFP). TRANSITION to MEDI-CAL website at: GENERAL INFORMATION - HFP TRANSITION TO MEDI-CAL . 1. Why is HFP transitioning to MEDI-CAL ? Answer: A new law in California says that children in HFP will move to MEDI-CAL . The move will take place over one year, starting no sooner than January 1, 2013. 2. What is MEDI-CAL ? Answer: MEDI-CAL is California's Medicaid PROGRAM . It provides medical, dental, mental health, alcohol and drug use treatment, and vision care to millions of Californians.
2 You can learn more about MEDI-CAL at 3. Is HFP still open for enrollment? Answer: Yes. HFP will continue to enroll babies who are on the Access for Infants and Mothers (AIM) PROGRAM into HFP. Beginning no sooner than January 1, 2013, HFP will stop enrolling all other children, who are not on AIM. Health-e-App, the on- line HFP Application will continue to accept new AIM applications. The Health-e-App website is To request a paper application or to start an application by phone, call: 1-800-880-5305. HFP will continue to process plan transfer requests, monthly premium payments, Annual Eligibility Reviews, and enrollment of infants whose mothers are enrolled in AIM. 4. When will HFP stop accepting applications? Answer: HFP will stop accepting applications once the TRANSITION to MEDI-CAL begins which will be no sooner than January 1, 2013, except applications for babies, who are on AIM. 5. When will my child TRANSITION from HFP to MEDI-CAL ?
3 Answer: It depends on where you live and what your child's health plan is. Children in HFP will not move to MEDI-CAL before January 1, 2013. Children will move from HFP to MEDI-CAL in four phases over the course of the year. 6. What do I need to do for my child? Answer: You will receive information from the State about when the move to MEDI-CAL will happen for your child and what you may need to do. HEALTHY FAMILIES PROGRAM TRANSITION to MEDI-CAL FAQs Page 1 of 22. November 27, 2012. 7. Does my child need to reapply for HFP under MEDI-CAL for coverage? Answer: No, your child does not need to reapply, if he/she is already enrolled in HFP. 8. What if I do not want to move my child from HFP to MEDI-CAL ? Answer: Due to a change in state law, all children enrolled in HFP must move to MEDI-CAL to continue to receive medical, dental, mental health, alcohol and drug use treatment, and vision care benefits.
4 9. What happens if I move after my child transitions to MEDI-CAL ? Answer: If you move, you need to tell your county eligibility worker within ten days so your child's case information can be updated. If you are moving to another county, your child may be enrolled into a MEDI-CAL managed care health plan . To report changes online, register at 10. Will I have to pay co-payments for my child in MEDI-CAL ? Answer: No, children in MEDI-CAL do not pay co-payments for any service covered under MEDI-CAL . 11. Who do I talk to about my child's treatment plan and medications? Answer: After your child's move to MEDI-CAL , you can continue to consult your child's doctor for any treatment plans and medications. You can also contact your health plan 's member services at the number on your health insurance card for further assistance. 12. Will my child receive the same benefits under MEDI-CAL as he/she did under HFP?
5 Answers: You can find a comparison table that shows benefits covered by HFP and MEDI-CAL at the end of this document or on the DHCS HFP TRANSITION to MEDI-CAL webpage at the following link: Cal%20 Benefit% 13. What are Early and Periodic Screening, Diagnosis and Treatment PROGRAM (EPSDT) benefits? Answers: EPSDT allows for periodic screenings to determine health care needs for individuals under the age of 21 in MEDI-CAL . MEDI-CAL will cover the provision of EPSDT services based upon the identified health care needs of the child. In addition to the regular MEDI-CAL benefits, an individual may receive additional medically necessary services called EPSDT Supplemental Services. Examples of EPSDT. supplemental services include private duty nursing services from a registered nurse (RN) or licensed vocational nurse (LVN), case management, pediatric day health care , and nutritional and mental health evaluations and services.
6 HEALTHY FAMILIES PROGRAM TRANSITION to MEDI-CAL FAQs Page 2 of 22. November 27, 2012. 14. What is MEDI-CAL Fee-For-Service (FFS)? Answers: Some services, which are not provided through a MEDI-CAL managed health or dental plan , are contracted directly with health care providers to deliver all covered MEDI-CAL services. In these cases, you may choose a doctor, dentist, or other provider, who accepts MEDI-CAL payments for each service he/she provides at the MEDI-CAL payment rate. The provider bills MEDI-CAL for services through an entity known as the fiscal intermediary, which is under contract with DHCS to process medi - Cal claims and issue reimbursement. All children, except those living in Sacramento and Los Angeles Counties, will receive their dental care through the MEDI-CAL FFS dental PROGRAM known as Denti-Cal. In Denti-Cal, your child can go to any dentist that accepts Denti-Cal. To find a dentist in Denti-Cal that can care for your child, you can go to the Denti-Cal Provider Referral list online at or by calling this toll-free number 1-800-322-6384.
7 (available 8AM-5PM) and ask for the names of dentists in your area who accept Denti- Cal referrals. Children living in Los Angeles County will receive their dental care through a dental managed care plan or Denti-Cal. Children living in Sacramento County receive their dental care only through a dental managed care plan . HEALTHY FAMILIES PROGRAM TRANSITION to MEDI-CAL FAQs Page 3 of 22. November 27, 2012. ELIGIBILITY. 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, alcohol and drug use treatment, 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.
8 There is an online HFP Application called Heath-e-App that you can use to submit changes. You can also use it to submit your Annual Eligibility Review, PROGRAM reviews, and continued enrollment requests. The Health-e-App website is 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 income changes, you need to report it to your county eligibility worker within 10 days. To report changes online, register at 4. What will happen to my premium? Answer: If you now make a premium payment to HFP, under MEDI-CAL your premium may stay the same, decrease, or go away after your child moves to MEDI-CAL . You must keep paying your premiums for now.
9 Watch your mail for more information on your premiums. 5. 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. 6. 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) ($2,386/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. ($3,977/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. 7. What happens if I do not pay my premiums each month?
10 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 HEALTHY FAMILIES PROGRAM TRANSITION to MEDI-CAL FAQs Page 4 of 22. November 27, 2012. 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. 8. Will my child's annual review date change after HFP moves 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 them back by a specific date. 9. 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. What has changed to now allow my child to be in MEDI-CAL without a share-of-cost?