San Mateo County Health Coverage Unit/Children’s Health Initiative Overview Claudia Lopez April 4, 2014

What is the Health Coverage Unit/Children Health Initiative? The San Mateo County Health Cover Unit (HCU) or also known as the Children’s Health Initiative (CHI) was established to address community- wide concern for the 17,000 county children who lacked access to comprehensive health insurance coverage. We now serve both children and indigent adults who do not qualify for Medi-Cal we have change our unit name to Health Coverage Unit.

How is CHI/HCU helping? We provide application assistance for both the adult indigents and families. – ACE – Healthy Kids – Medi-Cal – Cover California We conduct outreach, enrollment and education on the process or eligibility and enrollment.

Who is eligible? HCU/CHI is available to assist all San Mateo County residence regardless of immigration status. For children: Potentially eligible for Medi- cal/ Healthy Families/Healthy Kid, who are: Under Age 19, except for Medi-cal (21); Residents of San Mateo County; Not Insured through employer sponsored insurance coverage; Incomes below 400% of the FPL. For Adults: Potentially Medi-Cal, ACE, DHC, and Self pay Medically Indigent Adult who are: Age 19-64; Residents of San Mateo County; Not Insured through employer sponsored insurance coverage; Income below 400% of FPL

Eligibility Criteria Medi-Cal for Children and Families MAGI Medi-CalHealthy KidsCovered California Resident of San Mateo County No-It is a state programNo-It is a state ProgramYesNo- it’s a state program Legal Immigrant/ US Citizenship Legal Permanent Resident or US Citizen No Legal Permanent Resident, or US Citizen, lawful immigrants AgeUp to 19 th birthday0-64Up to their 19 th birthday0 – 64 Income Limit – Federal Poverty Limit (FPL) Up to 250%0 – 138% FPL139% – 200% FPL139%-200% FPL Monthly Premium 0-150% None 150% - 250% will be subject to monthly premium of $13 None under 133% None % $12 151%-200% $39 201%-300% $63 301%-400% $150 Depending on income and family size Retroactive coverage? Yes Once application is approved, coverage begins first day of month application was created. Retro coverage available up to three month back Yes Once application is approved, coverage begins first day of month application was created. Retro coverage available up to three month back No retroactive coverage available. Coverage begins 10 days from date application is approved. Coverage begins the following month if application is completed by 15. If after the 15 coverage begins two month later. Example Application completed December 12 th - Coverage begins January 1 Application completed December 20 th - Coverage begins February 1.

Family Size Children Birth thru Age 1 Children Ages1-18 Program Monthly Premium MinMaxMinMax 1 $0$2,433$0$1,460Medi-CalNo Premium $1,461$2,433Medi-Cal (TLICP) $13 per child up to $39 max for family of three or more $3,892Healthy KidsPlease see chart 2 $0$3,278$0$1,967Medi-CalNo premuim $1,968$3,278Medi-Cal (TLICP) $13 per child up to $39 max for family of three or more $5,244Healthy KidsPlease see chart $2,585 - $3,879 AIM (Pregnant Women Program) 3 $0$4,123$0$2,474Medi-CalNo premium $2,475$4,123Medi-Cal (TLICP) $13 per child up to $39 max for family of three or more $6,596Healthy KidsPlease see chart $3,255 - $4,884 AIM (Pregnant Women Program) 4 $0$4,908$0$2,944Medi-CalNo premium $2,945$4,970Medi-Cal (TLICP) $13 per child up to $39 max for family of three or more $7,952Healthy KidsPlease see chart $3,925- $5,889 AIM (Pregnant Women Program) 5 $0$5,745$0$3,489Medi-CalNo premium $3,490$5,815Medi-Cal (TLICP) $13 per child up to $39 max for family of three or more $9,304Healthy KidsPlease see chart $4,595 - $6,894 AIM (Pregnant Women Program) 6 $0$6,583$0$3,949Medi-CalNo premium $3,950$6,660Medi-Cal (TLICP) $13 per child up to $39 max for family of three or more $10,656Healthy KidsPlease see chart $5,265- $7,899 AIM (Pregnant Womem Program) Add for each additional family member: $839$507Medi-CalNo premium $508$845Medi-Cal (TLICP) $13 per child up to $39 max for family of three or more $1,352Healthy KidsPlease see chart $670- $1,006 AIM (Pregnant Women Program)

[1] [1] DHC charges will not exceed the highest amount that SMMC receives for medical services from Medicare, Medi-Cal, Healthy Families or other government-sponsored programs 2 Deposit required before receiving non-emergency services. 50% discount if bill is paid within 30 days; must pay 100% after 30 days. 3 The County Charity Care program is available only for emergency room visits, and inpatient and surgery visits transferred from SMMC’s emergency room. 4 Repayment plan interest-free based on ability to pay Eligibility CriteriaACE-County FWMAGI Medi-CalACE-CountyTemporary ACE ACE County Excess Income with Chronic Disease DHCSelf-PayCharity Care Resident of San Mateo County Yes No Legal Immigrant/ US Citizenship No Legal Permanent Resident or US Citizen No Legal Permanent Resident, or US Citizen No Age19 and above19 – 6419 and above19 – 6419 and aboveNo limit Income Limit – Federal Poverty Limit (FPL) % FPL0 – 138% FPL139% – 200% FPL139%-200% FPL201% – 225% FPL0 – 400% FPLNo limit % FPL Asset LimitNo Asset Limit $10,500 Annual FeeNone $360 None Payment for Outpatient Visits None $10 65% discount Varies Varies 2 patients have 30 days from the bill date to receive a 50% discount Not Covered 3 Payment for Inpatient Stays and Same Day Surgeries None $300 co-pay + 35% of charges 65% discount Varies 1 Varies 2 patients have 30 days from the bill date to receive a 50% discount None 3 PrescriptionsNone $7 65% discount50% discountNone Repayment Plan 4 Available? Not applicable Yes Not applicable Retroactive coverage? Yes Once application is approved, coverage begins first day of month application was created. SMMC may waive bills in the three months prior to coverage effective date Yes Once application is approved, coverage begins first day of month application was created. Retro coverage available up to three month back Yes Once application is approved, coverage begins first day of month application was created. SMMC may waive bills in the three months prior to coverage effective date *Only available after 4/1/2014 and through 12/31/2014 for those that did not apply for coverage with Covered California. Yes Once application is approved, coverage begins first day of month application was created. SMMC may waive bills in the three months prior to coverage effective date Yes (No time limit if after January 1, 2007) Not applicable Yes (Limited to 150 days from 1st bill date) Other requirementsNone Must not be eligible for Medi-Cal with or without a share of cost. Must be experiencing a hardship and have a chronic condition None Forms RequiredNone SSApp or CalHEERS MC 13 (LPR or Prucol) NoneDRA Excess Income/Chronic Disease Application None Charity Care Application

Family Size MAGI MC/ACE Fee Waiver ACE Excess Income Chronic Disease w/a Financial Hardship DHC 0%138%139%200%201%225%400% 1$0$1,343$1,344$1,946$1,947$2,189$3,892 2$0$1,809$1,810$2,622$2,623$2,950$5,244 3$0$2,276$2,277$3,298$3,299$3,710$6,596 4$0$2,743$2,744$3,976$3,977$4,473$7,952 5$0$3,210$3,211$4,652$4,653$5,234$9,304 6$0$3,676$3,677$5,328$5,329$5,994$10,656 7$0$4,144$4,145$6,006$6,007$6,757$12,012 8$0$4,611$4,612$6,682$6,683$7,517$13,364 9$0$5,077$5,078$7,358$7,359$8,278$14,716 10$0$5,545$5,546$8,036$8,037$9,041$16,072 Additional Family Member$0$466$467$676$677$761$1,352

For our local program we use the One-e-App web base application system. All Healthy and ACE application are processed through One-e-App One-e-App

How does One-e-App Work? Information is collected and entered in One-e-App by the Application Assistor. A preliminary eligibility is established based on the information provided by client. Depending on the program that client is found eligible for, the information is routed to that entity.

Question Claudia Lopez Trainer/Supervisor San Mateo County Health Coverage Unit