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claim Title XXI funding for Healthy Families benefits already approved in California’s state plan. For individuals who declare on the joint application that they are United States Citizens/Nationals or Lawfully Residing children are granted two (2) months of presumptive eligibility at the time of application to provide documentation of status for continued enrollment into the HFP. If their documentation is provided within two (2) months of enrollment into the HFP, the eligibility period continues for the full twelve (12) months. If the documentation is invalid, these children will be disenrolled from the HFP at the end of their two (2) months of presumptive eligibility enrollment. Funding for these children during this presumptive eligibility period is funded by Title XXI. Prior to granting presumptive eligibility, California will screen applications against the Medi-Cal Eligibility Database System (MEDS) to assure that ineligible children are not granted presumptive eligibility. Children ineligible for presumptive eligibility are those already enrolled in Medi-Cal and Healthy Families, and children known to MEDS to have a confirmed ineligible immigration status. Insurance Program MRMIB will contract with a private company to conduct eligibility determinations, premium collection, payment of the application assistance fee and other enrollment functions. This is the same process that it uses for MRMIB’s two existing programs. Families will fill out a simple application and mail it with accompanying supporting documents to MRMIB’s enroller. The application/enrollment brochure will be published in English, Spanish, Arabic, Armenian, Chinese, Farsi, Hmong, Khmer/Cambodian, Korean, Russian, Tagalog, Vietnamese and any other languages designated by the Department of Health Care Services. Families with questions about the form will be able to call the administrative vendor through a toll free number. Families will be able to speak to the administrative vendor’s staff in English or Spanish, and may communicate via other languages through a telephone translation service. MRMIB is authorized to pay certain agencies and individuals such as insurance agents and parent-teacher organizations an application assistance fee for assisting a family with a successful application. The supporting documents that families send to the enroller will include documentation of income, ensuring that applying children are income eligible for the HFP. The HFP uses a s thorough process to verify income and citizenship/residency, including requiring copies of the past 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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