94 Adult Systems of Care

95 General Healthcare for Adults There are fewer healthcare programs for adults than for children Most are for adults with disabilities or Pregnant women

96 Medicaid (Medi-Cal) California’s Medicaid program Health insurance for some low- income individuals

97 Fee for Service Medi-Cal Go to any doctor who accepts Medi-Cal Don’t need a referral to see a specialist

98 Eligibility for Fee for Service Medi-Cal People who receive SSI Most adults aren’t eligible for this

99 Medi-Cal Managed Care Most common kind of Medi-Cal For most adults this is your only choice Primary care provider gatekeeper need referral to see a specialist

100 Medi-Cal Managed Care Different Plans Los Angeles LA Care HealthNet Orange County Cal Optima All Medi-Cal programs are managed care

101 Automatically Qualify for Medi-Cal if … You receive cash benefits from Supplemental Security Income / State Supplementary Program (SSI/SSP). California Work Opportunity and Responsibility to Kids Program (CalWORKs). Refugee Cash Assistance (RCA). In-Home Supportive Services (IHSS).

102 You may also be eligible if you are 65 years of age or older. Blind or disabled, even if you are working receiving care in a skilled or intermediate care facility. Pregnant have certain chronic conditions such as tuberculosis or kidney dialysis. And other exceptions

103 Share of Cost Medi-Cal For people with disabilities who make too much money for regular Medi-Cal  pay a certain amount (share of cost) each month that you receive medical care before Medi-Cal begins to pay

104 Eligibility for Medi-Cal Income Few resources United States Citizen or documented resident

105 Important Points about Medi-Cal There are many ways to qualify for Medi-Cal An adult with a disability may qualify even if the rest of the family doesn’t It can be very confusing to figure out if you qualify.

106 Important Points about Medi-Cal You can get help with things like finding out if you are eligible, filling out applications or problems at places like the Consumer Health Center of Los Angeles

107 Denti-Cal Program for dental care. Provides regular cleaning and check-ups needed dental work Full dentures

108 Eligibility for Denti-Cal Eligible for Medi- Cal

109 Important points about Denti-Cal California provides Denti-Cal services for adults You can receive a list of dentists who accept Denti-Cal from CHDP

110 Medicare A federal health insurance program for: Seniors over age 65 People under age 65 who Are disabled and eligible for Social Security Disability Income (SSDI)

111 Medicare Not a comprehensive program Doesn’t pay for routine physicals, hearing aids, eyeglasses, prescription drugs (limited payment), or long-term care at home or in a nursing home

112 Medicare Medicare is not free You get Part A (Hospital Insurance) when you enroll But you must pay extra to get Part B (Medical Insurance)

113 Eligibility United States Citizen or documented resident and Seniors over age 65, or Has worked at least 10 years at a job that pays into Medicare

114 Eligibility People under age 65 who Are disabled eligible for Social Security Disability Income (SSDI)

115 Adult Programs for Special Populations

116 Aged, Blind & Disabled (ABD) Program Only for people who are Seniors - Over 65 or Blind or Disabled And make too much money to qualify for SSI

% Working Disabled Medi-Cal Program Special Medi-Cal program for adults with disabilities who are working but still need health coverage Monthly premium

118 Medi-Cal and Medicare (dual eligibility) Can qualify for both Medi- Cal and Medicare Medi-Cal may pay Medicare HMO fees May have a share of cost before Medi-Cal pays +

119 Genetic Health Prevention Program? (GHPP) State program for people 21 and older some genetic diseases medical case management and pays the medical and dental costs Some people under age 21

120 County Department of Mental Health (DMH) care for adults with Serious Mental Illness (SMI). Examples of these are severe depression or bi-polar disorder. not for people with developmental disabilities or substance abuse unless they also have a SMI.

121 Mental Health Programs Care can include therapy, medication, hospitalization and other services

122 Mental Health Programs Mental Health services who don’t have a SMI Medi-Cal, Private pay

123 Access for Infants and Mothers (AIM) Program AIM provides low-cost health coverage for pregnant women and their newborns (ages 0-2). Woman – to 60 days after the pregnancy has ended. The newborn- up to second birthday.

124 Other Related Programs

125 IHSS An alternative to out-of-home care, nursing homes or board and care facilities Two Types Residual program Personal Care Services Program (PCSP)

126 IHSS An alternative to out-of-home care, nursing homes or board and care facilities Services can be provided by a spouse or someone who isn’t related to you

127 Residual Program An alternative to out-of-home care, nursing homes or board and care facilities For people with disabilities (including blindness) Who don’t need personal care or paramedical services Must meet SSI/SSP disability criteria

128 Personal Care Services Program (PCSP) An alternative to out-of-home care, nursing homes or board and care facilities Covers similar services Provides personal care and/or Paramedical services Doesn’t fund protective services Must receive SSI to qualify

129 IHSS Services can be provided by A hired care provider A parent or spouse

130 IHSS Services include housecleaning, preparing meals, laundry, grocery shopping, personal care services taking people to medical appointments, and protective supervision for people with cognitive disabilities

131 Eligibility for IHSS United States citizens or qualified aliens; and California residents. Live at home Current recipients of SSI/SSP (PCSP) or Current recipients of SSI/SSP (Residual) Are eligible for SSI/SSP but their family income is too high May have share of cost are eligible for SSI/SSP, including income, but don’t get SSI Get Medi-Cal and meet SSI/SSP disability criteria. Limited resources

132 Important Points About IHSS You can qualify for both Residual and PSCP If service is covered by both programs, it will be funded by PSCP

133 Supplemental Security Income (SSI) not a healthcare system provider federal program that gives a monthly payment automatically eligible for fee for service Medi-Cal

134 SSI Adult programs List of eligible diagnoses. If not on the list, you may not be eligible.

135 Important Points about SSI Diagnosis on the list Different requirements for children and adults Financial eligibility Provides a cash payment you eligible for fee for service Medi- Cal

136 The Health Insurance Premium Payment Program (HIPP) may pay premiums for private health insurance for people who are on Medi-Cal a high-cost medical condition covered by private health insurance

137 Regional Center & Health Care Services Serves people with developmental disabilities Not a healthcare provider Can help their clients get some of the healthcare services they need.

138 Important Points about Regional Center & Health Care Services May fund healthcare services related to the developmental disability They are the payer of last resort