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• Under Title XXI, California will expand Medi-Cal eligibility to implement a resource disregard for children whose countable family income is at or below the appropriate FPL in the Medi-Cal program. Thus, eligibility for both programs will depend only on a family’s income. Eligibility workers, CHDP providers, and other organizations assisting families will be able to use an income chart to refer children to the appropriate program. • Healthy Families will compare its participant list against Medi-Cal’s enrollment files to ensure that children do not already have creditable coverage through Medi-Cal. • To provide families moving from Medi-Cal to Healthy Families with time to enroll in Healthy Families, the Department of Health Services will implement one month of “continued eligibility” for Medi-Cal covered children whose family income is at or below the appropriate FPL who lose eligibility for no cost Medi-Cal due to increased family income or increased age of a child. • The Healthy Families to Medi-Cal Presumptive Eligibility (PE) Program provides children who meet certain criteria with temporary no cost Medi-Cal coverage, until the County Welfare Department (CWD) makes a final eligibility determination. At HFP Annual Eligibility Review (AER), when children are determined to have family incomes below HFP Guidelines, they are provided PE while their application is forwarded to their local CWD for a full Medi-Cal eligibility determination. PE Medi-Cal is funded under Title XIX. • At initial application, when a child’s income is determined below Healthy Families Program (HFP) guidelines, they are granted temporary Accelerated Enrollment (AE) into Medi-Cal while the application is forwarded to the local County Welfare Department (CWD) for a full Medi-Cal eligibility determination. AE Medi-Cal is funded under Title XIX, during the AE period. Coordination with employer-sponsored coverage. The insurance program has been designed to ensure coordination with existing private coverage to reach only targeted low income children: • The program has a coverage “firewall” -- a prohibition against covering children who have had employer sponsored coverage within 3 months prior to applying for the Program. MRMIB is authorized to increase the length of the period to 6 months if it finds it is covering substantial numbers of children who were previously covered under employer-sponsored plans. • The program’s enabling statute prohibits insurance agents and insurers from referring dependents to the program where dependents are already covered through employer sponsored coverage. Effective Date: Approval Date: November 1, 2009 HFP Family Contribution Increase November 1, 2009 HFP Co-Payment Increase November 1, 2009 HFP Limited Dental Plan Choice for New Subscribers

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